Influence of Advanced Orthopaedic Certification on Clinical Outcomes of Patients with Low Back Pain

PURPOSE: To determine differences in outcomes of care for patients treated by clinicians with or without advanced orthopaedic certification. Levels of certification studied included orthopaedic clinical specialist certification (OCS), graduation from residency programs approved by the American Academy of Orthopaedic Manual Therapy (AAOMPT) and miscellaneous manual therapy certifications (MTC). SUBJECTS: Retrospective study was performed using Focus On Therapeutic Outcomes, Inc. (Knoxville, TN) data, which was obtained from 930 therapists (28 OCS, 7 AAOMPT, 7 MTC, 2 OCS/AAOMPT) from 39 states who treated 24,276 patients with lumbar impairments in 1999 and 2000. METHODS: Patients completed health status surveys at intake and discharge. Three health status measures were calculated: overall health status (OHS), SF-12 Physical Component Summary scale (PCS), and SF-36 physical functioning scale (PF-10). Change in health status over the episode of rehabilitation was risk adjusted by developing linear mixed models and analyzed across certification processes. RESULTS: Patients treated by therapists with MTC reported higher OHS, PCS, and PF-10 discharge scores than patients treated by therapists without MTC (P