Background: Acute low back pain (LBP) represents the leading cause of disability in the United States and affects up to 80% of adults. Within the US Military Health System (MHS), guidelines advise against certain modalities for the diagnosis and treatment of LBP due to inefficient or detrimental results. This study examines LBP low-value care treatments among providers within the MHS during the COVID-19 pandemic.

Methods: We conducted an open retrospective study using electronic medical records from the MHS Data Repository between the fiscal years 2018-2022, divided into pre-pandemic and pandemic. We identified the first instance of LBP treatment by provider type and personnel category. Targeted low-value care treatments were computed tomography, magnetic resonance imaging, X-Ray, and opioid prescriptions. Binomial logistic regression was used to calculate odds ratios by provider type.

Results: A total of 785,795 LBP patients were identified, with 142,167 (18%) having imaging within 4 weeks of diagnosis. Since the pandemic, a significant proportion of physicians (48%) and physician assistants (34%) utilized imaging compared to nurse practitioners (18%). Active duty providers (48%) used imaging the most. Pandemic proportions display similarity to pre-pandemic physician (51%) and active duty (50%) proportions. Opioid prescription data and overall odds ratios will be available prior to the conference.

Conclusion: Physicians and active duty providers displayed higher usage of imaging within 4 weeks of diagnosis of LBP. Regression analysis will be conducted to assess further differences pre and post-pandemic. Further training for these provider groups may reduce low-value care treatments within the MHS.