Campus Access Only

All rights reserved. This publication is intended for use solely by faculty, students, and staff of University of the Pacific. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Date of Award


Document Type

Thesis - Pacific Access Restricted

Degree Name

Master of Science (M.S.)


Physical Therapy

First Advisor

Darcy A. Umphred

First Committee Member

Brad Stockert

Second Committee Member

Gayle Riley


In today's health care environment tremendous efforts are being made by Health Maintenance Organizations (HMOs) to deliver appropriate patient care while controlling utilization of services and costs. One area of concern over the past two years has been the apparent over-utilization of spinal surgeries within a local Senior HMO. This HMO has no specific plan or physician guidelines for the management of low back pain. Utilization of spinal surgeries is measured in incidence of admissions per thousand members of the Senior HMO. Over the past two years the incidence of spinal surgeries per thousand has grown from 2.4 in 1995, 4.1 in 1996 and 7.4 during the first quarter of 1997. This is compared to a suggested rate of 1.5 per thousand for similar HMO populations around the country.

The purpose of this study was to determine the effectiveness of the presentation of a treatment algorithm and physician guidelines for the management of low back pain (LBP). In order to determine the effectiveness of the presentation of the algorithm, the incidence of spinal surgeries per thousand for nine quarters prior to the presentation was compared to the incidence per thousand for the three quarters following the presentation.

Results of this comparison showed a slight drop, but statistically insignificant (P = .62), in the rate of surgeries compared to the previous year. When compared to the previous two years the rate was actually slightly higher, but statistically insignificant (P = .57) after the presentation. Although the comparisons were determined to be insignificant, trend analysis indicated a gradual rise in the incidence during the initial five quarters, a plateau during the next four quarters, and a slight decrease in the rate of surgeries during the last three quarters which followed the introduction of the treatment algorithm.

At this time it would be appropriate to continue the analysis of quarterly data and continue feedback and education to the primary care physicians in an attempt to promote proper utilization of spinal surgeries and overall management of LBP.



To access this thesis/dissertation you must have a valid email address and log-in to Scholarly Commons.

Find in PacificSearch



If you are the author and would like to grant permission to make your work openly accessible, please email


Rights Statement

Rights Statement

In Copyright. URI:
This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).