Real-World Effect of a Digitally Delivered Conservative Musculoskeletal Care Program on Spinal Diagnostic Imaging Utilization in a Commercially Insured Population with Chronic Back Pain

TL;DR

A digital conservative care program for back pain reduced spinal imaging use in insured patients, especially those who had prior imaging.

Contribution

This study provides real-world evidence that digital conservative care reduces spinal diagnostic imaging utilization.

Findings

Digital program participants had 14.2% spinal imaging visits vs 18.2% in usual care (P = .0003).

Participants with prior imaging had a stronger reduction in imaging use (−4.8%, P = .007).

Abstract

Conservative, noninvasive musculoskeletal treatment delivered digitally has demonstrated similar or better effectiveness in managing and reducing chronic back pain, compared to in-person care. However, there is limited evidence whether digital care reduces future spinal diagnostic imaging visits.

The primary goal was to examine the associations between participating in a digital conservative musculoskeletal care program for back pain and subsequent spinal diagnostic imaging use.

Using medical claims data from a US commercial health plan database, this retrospective, secondary data analysis compared spinal diagnostic imaging visits among a group of digital program participants who had over 12 weeks of back pain to matched patients who only had usual care to treat their back pain. To mitigate selection bias, a propensity score matching model was developed to match study participants based on demographic, comorbidity, baseline medical care use and cost. The study outcomes were any spinal diagnostic imaging visit and number of spinal diagnostic imaging visits per 1000 participants up to 1 year after participating in the digital program.

The study included 2165 digital participants and 2165 matched comparison group patients. We found that digital participants had fewer spinal diagnostic imaging visits in the year after participating in the digital program compared with comparison group patients (14.2% vs 18.2%, P = .0003). The association between the digital program participation and spinal diagnostic imaging visit is stronger in the group who had imaging in the 12 months before, compared to those who had not (−4.8%, P = .007 vs −3.4%, P = .0163).

Consistent with previous studies demonstrating that early conservative management is associated with lower odds of imaging, findings from this study offer an encouraging direction for effective alternatives for managing back pain, improving performance outcomes and reducing premature utilization of healthcare services.

The study provides evidence that participating in a digital musculoskeletal program that delivers conservative care is associated with fewer imaging use, especially among participants who had received imaging previously.