Shawn Thistle 2016-05-28 01:19:58
Study Title: Health maintenance care in work-related low back pain and its association with disability recurrence
Authors: Cifuentes M, Willetts J & Wasiak R Center for Disability Research at the Liberty Mutual Research Institute for Safety; University of Massachusetts Lowell; Center for Health Economics & Science Policy at United BioSource Corporation, London, U.K.
Publication Information: Journal of Occupational & Environmental Medicine 2011; 53(4): 396-404.
Low back pain (LBP) is one of society’s costliest afflictions. Aside from lost work time and treatment costs associated with a new case of LBP, a potentially significant financial burden lies in the recurrence of this condition.
As manual medicine providers, we focus more on return to work than perhaps any other health-care providers. In the context of the current literature, demonstrating an association between specific type(s) of treatment or provider( s) and significant recurrence of a condition (measured as recurrent work disability) could imply an important advancement in the treatment of work-related back injuries.
The study aimed at comparing occurrence of repeated disability episodes across types of health-care providers (chiropractors, physical therapists and physicians) who treat claimants with new episodes of work-related LBP. The authors hypothesized that since chiropractors generally are strong proponents of health maintenance care, their patients would experience a lower risk of recurrent disability.
Data was analyzed from the administrative records of a large insurance company representing approximately 10 per cent of the United States workers’ compensation with coverage in many states, industries, and company sizes. Claims filed in seven states (Illinois, Massachusetts, Maryland, New Hampshire, New York, Texas, and Wisconsin) between January 1st and December 31st, 2006 were reviewed.
The final study cohort was comprised of 894 cases – median age was 41, 32 per cent were women. The most frequent jobs held by claimants were transportation and material moving (29.1 per cent), production (12.8 per cent), office and administrative support (9.6 per cent), and building and ground cleaning (6 per cent).
During the ‘disability episode’, the largest group sought only or mostly physical therapy care (48 per cent), followed by only or mostly chiropractic (27 per cent).
During the health maintenance care period, the largest group was only or mostly visits to a physician (31 per cent), followed by only or mostly visits to physical therapist (24 per cent) and only or mostly visits to chiropractor (21 per cent). Sixteen per cent received no medical care during the health maintenance care period.
After controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95 per cent confidence interval [CI] = 1.0 to 3. 9) or physicians (HR = 1.6; 95 per cent CI = 0.9 to 6.2) was higher than that of chiropractors (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1. 2; 95% CI = 0.4 to 3.8).
In general, those seen by chiropractors utilized fewer opioids, had less surgery, lower medical costs and shorter periods of initial disability than those who consulted other providers.
About 11 per cent of the cases experienced recurrence. Provider type during the health maintenance care period was significantly associated with recurrent disability with the only or mostly physical therapy group having the highest proportion of recurrent disability (16. 9 per cent), and the only or mostly chiropractor and the “no health maintenance care” groups having the lowest proportion of recurrent disability (6.5 per cent and 5.5 per cent, respectively).
Application, conclusions
After the authors controlled for demographics and severity indicators, the likelihood of recurrent disability due to LBP for recipients of services during the health maintenance care period by all other provider groups was consistently worse when compared with recipients of health maintenance care by chiropractors. Receiving chiropractic care during both disability (“curative”) and health maintenance care periods (main exposure variable, “preventive”), and the combination of both (curative and preventive) was associated with lower disability recurrence.
This study is one of the first of its kind offering data that our profession can utilize to support our continued inclusion in the care of occupational LBP. Further research is required to confirm and expand on these results, as well as extend our investigation of other common occupational injuries.
DR. SHAWN THISTLE is the founder and CEO of RRS Education (rrseducation.com), which helps busy clinicians integrate current research evidence rationally into practice. He also maintains a practice in Toronto, lectures at CMCC and provides chiropractic medicolegal consulting services. Reach him at: [email protected]
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