{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T04:32:08Z","timestamp":1790483528090,"version":"4.1.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"7-8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,22]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Spine pain is one of the largest and costliest burdens to our healthcare systems. While evidence-based guidelines for spine pain have been established, and continue to evolve, the actual management of this condition continues to burden the healthcare system. This has led to increased costs due to inefficient entry to healthcare, utilization of treatments unsupported by clinical guidelines, and patient navigation through our healthcare systems. The purpose of this study was to assess the healthcare utilization and related outcomes for Active Duty Service Members (ADSM) receiving healthcare services in a novel acute spine pain clinic (ASPC) during the first 5\u2009years of operation at a large Military Treatment Facility.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>In 2014 the Physical Medicine and Rehabilitation and Physical Therapy (PT) services designed a novel acute spine clinic intended to directly receive ADSM with acute spine symptoms for an initial evaluation by a Physical Therapist. The inclusion criteria into the ASPC were: ADSM, pain less than or equal to 7\u2009days, no more than three prior episodes of acute spine pain in the past 3\u2009years, and not currently receiving care from Chiropractic, Pain Management, or PT services. The exclusion criteria were: significant and\/or progressive neurological deficits, bowel or bladder dysfunction, unstable vital signs or fever, hematuria or extensive trauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 1,215 patients presented to the ASPC for evaluation between 2014 and 2019. The most common chief complaint was acute pain in the lumbar spine (73%), followed by cervical spine pain (15%), and thoracic spine pain (12%) represented the fewest. The average number of PT visits per patient was 3.5 (range 1-13) with 61.1% utilizing three or fewer visits. Over 95% of cases returned to work the same day as their initial evaluation. Sixty-six percent returned to work without restriction the same day as their initial evaluation. Light duty recommendations were provided to 412 (33.9%) patients ranging from one to 30\u2009days, with greater than 85% of the light duty being less than 14\u2009days. Recommendations to not return to work (sick-in-quarters) were issued to 56 (4.6%) patients. The sick-in-quarters recommendations were for a 24-hour period in 48 cases, 48\u2009hours for seven cases, and 72\u2009hours for one case. All encounters in which the patient first sought care at the ASPC for low back pain met the Healthcare Effectiveness Data Set standard for low back pain care of having no imaging within 28\u2009days of the first encounter for nonspecific low back pain. A medical record review of 100 randomly selected patients within 12\u2009months of the initial evaluation demonstrated decreased utilization of medication, imaging, and referral to surgical services.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This innovative approach demonstrates the potential benefits of rapid access to treatment and education for patients with acute spine pain by a Physical Therapist. Modeling this approach at Military Treatment Facilities may lead to decreased utilization of medications, radiology services, specialty care referrals, and reduced cost of care provided to individuals with acute spine pain.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usac064","type":"journal-article","created":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T06:53:10Z","timestamp":1647240790000},"page":"e2340-e2346","source":"Crossref","is-referenced-by-count":11,"title":["Improving Access and Decreasing Healthcare Utilization for Patients With Acute Spine Pain: Five-Year Results of a Direct Access Clinic"],"prefix":"10.1093","volume":"188","author":[{"given":"Josh","family":"Halfpap","sequence":"first","affiliation":[{"name":"Bowling Green State University, College of Health and Human Services, Doctor of Physical Therapy Program , Bowling Green, OH, USA"},{"name":"Department of Physical and Occupational Therapy, Naval Medical Center San Diego , San Diego, CA 92134, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Riebel","sequence":"additional","affiliation":[{"name":"Sports Medicine and Rehabilitation Team, Naval Medical Readiness and Training Command Great Lakes , North Chicago, IL 60064, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Tognoni","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Scripps Mercy Hospital San Diego , San Diego, CA 92103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Coller","sequence":"additional","affiliation":[{"name":"Bowling Green State University, College of Health and Human Services, Doctor of Physical Therapy Program , Bowling Green, OH, USA"},{"name":"Department of Physical and Occupational Therapy, Naval Medical Center San Diego , San Diego, CA 92134, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G","family":"Sheu","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Naval Medical Center San Diego , San Diego, CA 92134, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy Program, College of Allied Health Professions, University of Nebraska Medical Center , Omaha, NE 68198, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,12]]},"reference":[{"issue":"10053","key":"2023072301093175100_R1","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/S0140-6736(16)31678-6","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","author":"GBD 2015 Disease and Injury Incidence 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