Health Maintenance Care in Work-Related
Low Back Pain and Its Association
With Disability Recurrence

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

Journal of Occupational and Environmental Medicine 2011 (Apr);   53 (4):   396–404 ~ FULL TEXT

Cifuentes M, Willetts J, Wasiak R.

From the Center for Disability Research at the Liberty Mutual Research Institute for Safety (Dr Cifuentes and Ms Willetts) and University of Massachusetts Lowell (Dr Cifuentes), Hopkinton, Mass; and Center for Health Economics & Science Policy at United BioSource Corporation, London, United Kingdom (Dr Wasiak).

This study is unique in that it was conducted by the Center for Disability Research at the Liberty Mutual Research Institute for Safety and the University of Massachusetts Lowell, Hopkinton, Mass; and the Center for Health Economics & Science Policy at United BioSource Corporation, London, United Kingdom. Their objective was to compare the occurrences of repeated disability episodes between types of health care providers, who treat claimants with new episodes of work-related low back pain (LBP). They followed 894 patients over 1-year, using workers’ compensation claims data. By controlling for demographics and severity, they determined the hazard ratio (HR) for disability recurrence between 3 types of providers: Physical Therapists (PT), Physicians (MD), or Chiropractors (DC). The results are quite interesting: For PTs: HR = 2.0 For MDs: HR = 1.6 For DCs: HR = 1.0 Statistically, this means you are twice as likely to end up disabled if you got your care from a Physical Therapists (PT), rather than from a chiropractor. You’re also 60% more likely to be disabled if you choose a Physicians (MD) to manage your care, rather than a chiropractor. The authors concluded: “In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services.”

The Abstract:

OBJECTIVES:   To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

METHOD:   A total of 894 cases followed 1 year using workers' compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

RESULTS:   Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (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).

CONCLUSIONS:   In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.

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