| Care seeking | Carey et al23 (1995) | Mean no. of visits associated with initiation of care significantly higher with DCs than with medical providers (mean visits in rural/urban areas = 10.1/15 for DCs vs 4.6/4.4 for PCPs; P = .001) |
| Sundararajan et al33 (1998) | Patients who saw HMO providers least likely to see multiple providers during an episode of care for LBP (9% [95% CI = 5% to 14%]), whereas patients who initiated care with orthopedic surgeons most likely to do so (30% [95% CI = 23% to 37%]); of those who initiated care with DCs and PCPs, 19% (95% CI = 16% to 23%) and 14% (95% CI = 11% to 17%), respectively, sought care from other health care providers |
| Fritz et al25 (2016) | Duration of episode of care with initial visit in DC setting longer than that with initial visit in primary care setting (standardized ß = 0.51 [95% CI = 0.27 to 0.76]; P < .001) |
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| Medication use/prescription | Carey et al23 (1995) | Average no. of prescriptions or over-the-counter medications lower among patients initiating care with DCs than among those initiating care with medical practitioners (2.3 vs 3.5 medications, respectively; P < .001) |
| Fritz et al24 (2015) | Odds of receiving opioid medication early significantly lower for patients entering via physical therapy (OR = 0.5 [95% CI = 0.28 to 0.89]; P = .02) than for those entering via primary care (combined PCP, ED, and physiatry) |
| Frogner et al30 (2018) | Patients who had physical therapy first had an 89.4% (SE = 0.053; P < .001) reduced probability of receiving an opioid prescription than those who had no physical therapy or physical therapy later |
| Azad et al31 (2019) | Compared with patients who initiated care with PCP, those who initiated care with nonmedical provider less likely to receive an early opioid prescription (HR = 0.5 [95% CI = 0.49 to 0.5]; P < .0001) and less likely to receive a third opioid prescription (HR = 0.45 [95% CI = 0.43 to 0.46]; P < .0001) |
| Kazis et al27 (2019) | Compared with patients who initiated care with PCP, patients who initiated care with DC (OR = 0.1 [95% CI = 0.09 to 0.1]; P < .01), acupuncturist (OR = 0.09 [95% CI = 0.07 to 0.12]; P < .01), or physical therapist (OR = 0.15 [95% CI = 0.13 to 0.17]; P < .01) had significantly lower odds of early opioid use; this result also seen with long-term opioid use (for DC: OR = 0.22 [95% CI = 0.15 to 0.48] [P < .01]; for acupuncturist: OR = 0.07 [95% CI = 0.01 to 0.48] [P < .01]; for physical therapist: OR = 0.27 [95% CI = 0.15 to 0.48] [P < .01]) |
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| Imaging | Carey et al23 (1995) | No. of radiographs higher per episode of care for patients initiating care with DCs and orthopedic surgeons (67%–72% of patients) than for those initiating care with PCPs (26%–32% of patients) (P = .001); use of advanced imaging lower for patients seeing DCs (7%–8%) and going to HMO (6%) than for patients seeing an orthopedist (17%) (P = .004) |
| Fritz et al24 (2015) | Relative to primary care, physical therapy as entry setting associated with lower odds of radiography (OR = 0.32 [95% CI = 0.15 to 0.65]; P < .001); no statistical difference seen in advanced imaging rates |
| Fritz et al25 (2016) | Relative to primary care, physical therapy as entry setting associated with decreased risk of radiography (OR = 0.39 [95% CI = 0.18–0.84]), but no statistical difference in advanced imaging rates; chiropractic as entry setting associated with decreased risk of advanced imaging rates (OR = 0.21 [95% CI = 0.08 to 0.50]), but no statistical difference in radiography |
| Frogner et al30 (2018) | Patients who had physical therapy as first point of care had 29.7% (SE = 0.045; P < .001) reduced probability of having advanced imaging and 16.6% (SE = 0.056; P < .001) reduced probability of having radiography than those who had no physical therapy or physical therapy later |
| O’Reilly-Jacob et al32 (2019) | No significant difference in rates of low-value back images between primary care medical doctors (24.5% [IQR = 11%–38%]) and primary care nurse practitioners (26.5% [IQR = 7%–40%]) after initial consultation |
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| Cost of care | Carey et al23 (1995) | Care initiated by urban chiropractors (adjusted mean = $783 [95% CI = $698 to $868]) and orthopedists (adjusted mean = $746 [95% CI = $633 to $858]) had highest costs per episode of LBP compared with care initiated via urban primary care providers (adjusted mean = $508 [95% CI = $418 to $598]) |
| Liliedahl et al29 (2010) | Mean cost per episode significantly lower for care initiated with chiropractor ($532.54 [SE = $9.56]) than initiated with medical doctor ($661.10 [SE = $29.16]) |
| Fritz et al24 (2015) | Physical therapy as entry point of care associated with significantly lower health care costs over 12 mo ($335 [95% CI = $241 to $429]) than primary care ($533 [95% CI = $470 to $598]) |
| Fritz et al25 (2016) | Care initiated via physical therapy (standardized ß = −0.21 [95% CI = −0.63 to 0.2]; P = .34) and chiropractic (standardized ß = −0.28 [95% CI = −0.058 to 0.021]; P = .07) not associated with statistically significant differences in cost compared with care initiated via primary care |
| Frogner et al30 (2018) | Care initiated via physical therapy associated with higher provider costs but lower pharmacy, outpatient, and out-of-pocket costs than care not initiated via physical therapy; total costs did not differ between patients who did and patients who did not initiate care via physical therapy |
| Garrity et al26 (2020) | The 90-d cost ratio higher for care initiated via physical therapy in both provisional access states (1.28 [95% CI = 1.20 to 1.36]) and unrestricted states (1.14 [95% CI = 1.05 to 1.23]) than for care initiated via primary care |