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Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain

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Abstract

Objective To compare the duration of financial compensation and the occurrence of a second episode of compensation of workers with occupational back pain who first sought three types of healthcare providers. Methods We analyzed data from a cohort of 5511 workers who received compensation from the Workplace Safety and Insurance Board for back pain in 2005. Multivariable Cox models controlling for relevant covariables were performed to compare the duration of financial compensation for the patients of each of the three types of first healthcare providers. Logistic regression was used to compare the occurrence of a second episode of compensation over the 2-year follow-up period. Results Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100 % wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10–1.31], P value < 0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100 % compensation (adjusted HR = 0.84 [0.71–0.98], P value = 0.028) during the first 149 days of compensation. The odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist (OR = 1.49 [1.02–2.19], P value = 0.040) rather than a physician (reference). Conclusion The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest. These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker’s compensation system. Further investigation is required to understand the between-provider differences.

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Abbreviations

ALBI:

Acute low back pain injury program of care

ANOVA:

Analysis of variance

CI:

Confidence interval

DC:

Doctor of chiropractic

HR:

Hazard ratio

IRSST:

Institut de Recherche en Santé Sécurité au Travail

IWH:

Institute for Work and Health

MD:

Medical doctor

NOC:

National occupational code

OR:

Odds ratio

PT:

Physiotherapist

ROC:

Receiver operating characteristics

R-RTW:

Readiness to return to work

SD:

Standard deviation

SIC-80:

Standard international classification 1980

WSIB:

Workplace Safety and Insurance Board

References

  1. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74. doi:10.1136/annrheumdis-2013-204428.

    Article  PubMed  Google Scholar 

  2. Schmidt CO, Raspe H, Pfingsten M, Hasenbring M, Basler HD, Eich W, et al. Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine. 2007;32(18):2005–11. doi:10.1097/BRS.0b013e318133fad8 (Phila Pa 1976).

    Article  PubMed  Google Scholar 

  3. Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey: the prevalence of low back pain and related disability in Saskatchewan adults. Spine. 1998;23(17):1860–6.

    Article  CAS  PubMed  Google Scholar 

  4. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine. 2006;31(23):2724–7. doi:10.1097/01.brs.0000244618.06877.cd (Phila Pa 1976).

    Article  PubMed  Google Scholar 

  5. Leroux I, Dionne CE, Bourbonnais R, Brisson C. Prevalence of musculoskeletal pain and associated factors in the Quebec working population. Int Arch Occup Environ Health. 2005;78(5):379–86. doi:10.1007/s00420-004-0578-2.

    Article  PubMed  Google Scholar 

  6. WSIB. By the numbers: 2013 WSIB statistical report. Toronto, ON: Workplace Safety and Insurance Board. http://www.wsibstatistics.ca. Accessed 3 Aug 2014.

  7. Lamarche D, Veilleux F, Provencher J, Boucher P. Statistiques sur les affections vertébrales 2005–2008. Québec; QC: Commission de la santé et de la sécurité du travail du Québec2009 Contract No.: ISBN: 978-2-550-56793-6.

  8. Loi sur les accidents du travail et les maladies professionnelles (LATMP). L.R.Q., c. A-3.001 (1985).

  9. WSIB. Un plus grand choix de professionels de la santé pour les travailleurs blessés ou malades. Bull Polit. 2004;17(1):3.

    Google Scholar 

  10. McIntosh G, Frank J, Hogg-Johnson S, Bombardier C, Hall H. Prognostic factors for time receiving workers’ compensation benefits in a cohort of patients with low back pain. Spine. 2000;25(2):147–57 (Phila Pa 1976).

    Article  CAS  PubMed  Google Scholar 

  11. Ojha HA, Snyder RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: a systematic review. Phys Ther. 2014;94(1):14–30. doi:10.2522/ptj.20130096.

    Article  PubMed  Google Scholar 

  12. Gregory AW, Pentland W. Program of care for acute low back injuries: one-year evaluation report. Maitland Consulting Inc.; 2004.

  13. Sears JM, Wickizer TM, Franklin GM, Cheadle AD, Berkowitz B. Nurse practitioners as attending providers for injured workers: evaluating the effect of role expansion on disability and costs. Med Care. 2007;45(12):1154–61. doi:10.1097/MLR.0b013e3181468e8c.

    Article  PubMed  Google Scholar 

  14. Turner JA, Franklin G, Fulton-Kehoe D, Sheppard L, Stover B, Wu R, et al. ISSLS prize winner: early predictors of chronic work disability: a prospective, population-based study of workers with back injuries. Spine. 2008;33(25):2809–18. doi:10.1097/BRS.0b013e31817df7a7 (Phila Pa 1976).

    Article  PubMed  Google Scholar 

  15. Steenstra IA, Busse JW, Tolusso D, Davilmar A, Lee H, Furlan AD, et al. Predicting time on prolonged benefits for injured workers with acute back pain. J Occup Rehabil. 2015;25(2):267–78. doi:10.1007/s10926-014-9534-5.

    Article  PubMed  Google Scholar 

  16. Steenstra IA, Franche RL, Furlan AD, Amick B 3rd, Hogg-Johnson S. The added value of collecting information on pain experience when predicting time on benefits for injured workers with back pain. J Occup Rehabil. 2015;. doi:10.1007/s10926-015-9592-3.

    PubMed  PubMed Central  Google Scholar 

  17. Bultmann U, Franche RL, Hogg-Johnson S, Cote P, Lee H, Severin C, et al. Health status, work limitations, and return-to-work trajectories in injured workers with musculoskeletal disorders. Qual Life Res. 2007;16(7):1167–78. doi:10.1007/s11136-007-9229-x.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Blanchette M-A. Première ligne de soins pour les travailleurs atteints de rachialgie occupationnelle: étude du délai de consultation et du premier fournisseur de services de santé [Ph.D. thesis by articles]: Université de Montréal. 2016.

  19. Wilkins R. PCCF+ version 4G user’s guide: automated geographic coding based on the statistics Canada postal code conversion files. Health Analysis and Measurement Group. Statistics Canada, 64 pp. 2006.

  20. Statistics Canada. Standard industrial classification—establishments (SIC-E) 1980. Statistics Canada. 2014. http://www23.statcan.gc.ca/imdb/p3VD.pl?Function=getVD&TVD=53446. Accessed 12 Aug 2015.

  21. WSIB. Operational policy: responsibilities of the workplace parties in work reintegration. 2011.

  22. Hébert F, Duguay P, Massicotte P, Levy M. Révision des catégories professionnelles utilisées dans les études de l’IRSST portant sur les indicateurs quinquennaux de lésions professionnelles. Montréal: IRSST1996 Contract No.: Études et recherches/Guide technique R-137.

  23. Duguay P, Boucher A, Busque M, Prud’homme P, Vergara D. Lésions professionnelles indemnisées au Québec en 2005–2007: profil statistique par industrie-catégorie professionnelle. Études et recherches/Rapport R-749 Montréal: IRSST. 2012;202.

  24. Dasinger LK, Krause N, Deegan LJ, Brand RJ, Rudolph L. Physical workplace factors and return to work after compensated low back injury: a disability phase-specific analysis. J Occup Environ Med. 2000;42(3):323–33.

    Article  CAS  PubMed  Google Scholar 

  25. Sinnott P. Administrative delays and chronic disability in patients with acute occupational low back injury. J Occup Environ Med. 2009;51(6):690–9. doi:10.1097/JOM.0b013e3181a033b5.

    Article  PubMed  Google Scholar 

  26. Rubin DB. Multiple imputation for nonresponse in surveys. Wiley; 2004.

  27. Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE. Predictor selection. Regression methods in biostatistics. Berlin: Springer; 2012. p. 395–429.

    Google Scholar 

  28. Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998;339(15):1021–9. doi:10.1056/nejm199810083391502.

    Article  CAS  PubMed  Google Scholar 

  29. Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Belin TR, Yu F, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine. 2002;27(20):2193–204. doi:10.1097/01.brs.0000029253.40547.84 (Phila Pa 1976).

    Article  PubMed  Google Scholar 

  30. Hurwitz EL, Morgenstern H, Kominski GF, Yu F, Chiang LM. A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study. Spine. 2006;31(6):611–21. doi:10.1097/01.brs.0000202559.41193.b2 (Phila Pa 1976; discussion 22).

    Article  PubMed  Google Scholar 

  31. Meade TW, Dyer S, Browne W, Frank AO. Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. BMJ. 1995;311(7001):349–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ. 1990;300(6737):1431–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier G, Jacobsen S. The McKenzie method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization: a randomized controlled trial. Spine. 2011;36(24):1999–2010. doi:10.1097/BRS.0b013e318201ee8e (Phila Pa 1976).

    Article  PubMed  Google Scholar 

  34. Skargren EI, Carlsson PG, Oberg BE. One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization. Spine. 1998;23(17):1875–83 (Phila Pa 1976; discussion 84).

    Article  CAS  PubMed  Google Scholar 

  35. Skargren EI, Oberg BE, Carlsson PG, Gade M. Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain. Six-month follow-up. Spine. 1997;22(18):2167–77 (Phila Pa 1976).

    CAS  PubMed  Google Scholar 

  36. Baldwin ML, Cote P, Frank JW, Johnson WG. Cost-effectiveness studies of medical and chiropractic care for occupational low back pain. A critical review of the literature. Spine J. 2001;1(2):138–47. doi:10.1016/S1529-9430(01)00016-X.

    Article  CAS  PubMed  Google Scholar 

  37. Brown A, Angus D, Chen S, Tang Z, Milne S, Pfaff J et al. Costs and outcomes of chiropractic treatment for low back pain (structured abstract). Health Technology Assessment Database 2005.

  38. Butler RJ, Johnson WG. Adjusting rehabilitation costs and benefits for health capital: the case of low back occupational injuries. J Occup Rehabil. 2010;20(1):90–103. doi:10.1007/s10926-009-9206-z.

    Article  PubMed  Google Scholar 

  39. Cote P, Cassidy JD, Carroll L. The treatment of neck and low back pain: who seeks care? who goes where? Med Care. 2001;39(9):956–67.

    Article  CAS  PubMed  Google Scholar 

  40. Wasiak R, Pransky GS, Atlas SJ. Who’s in charge? Challenges in evaluating quality of primary care treatment for low back pain. J Eval Clin Pract. 2008;14(6):961–8. doi:10.1111/j.1365-2753.2007.00890.x.

    Article  PubMed  Google Scholar 

  41. Hurwitz EL, Chiang LM. A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002–03. BMC Health Serv Res. 2006;6:49. doi:10.1186/1472-6963-6-49.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Cote P, Baldwin ML, Johnson WG. Early patterns of care for occupational back pain. Spine. 2005;30(5):581–7. doi:10.1097/01.brs.0000154613.17511.dd (Phila Pa 1976).

    Article  PubMed  Google Scholar 

  43. Richardson B, Shepstone L, Poland F, Mugford M, Finlayson B, Clemence N. Randomised controlled trial and cost consequences study comparing initial physiotherapy assessment and management with routine practice for selected patients in an accident and emergency department of an acute hospital. Emerg Med J EMJ. 2005;22(2):87–92. doi:10.1136/emj.2003.012294.

    Article  CAS  PubMed  Google Scholar 

  44. Fritz JM, Kim J, Dorius J. Importance of the type of provider seen to begin health care for a new episode low back pain: associations with future utilization and costs. J Eval Clin Pract. 2015. doi:10.1111/jep.12464.

    Google Scholar 

  45. Allen H, Wright M, Craig T, Mardekian J, Cheung R, Sanchez R, et al. Tracking low back problems in a major self-insured workforce: toward improvement in the patient’s journey. J Occup Environ Med. 2014;56(6):604–20. doi:10.1097/jom.0000000000000210.

    Article  PubMed  Google Scholar 

  46. Amorin-Woods LG, Beck RW, Parkin-Smith GF, Lougheed J, Bremner AP. Adherence to clinical practice guidelines among three primary contact professions: a best evidence synthesis of the literature for the management of acute and subacute low back pain. J Can Chiropr Assoc. 2014;58(3):220–37.

    PubMed  PubMed Central  Google Scholar 

  47. Lim KL, Jacobs P, Klarenbach S. A population-based analysis of healthcare utilization of persons with back disorders: results from the Canadian Community Health Survey 2000–2001. Spine. 2006;31(2):212–8 (Phila Pa 1976).

    Article  PubMed  Google Scholar 

  48. Plenet A, Gourmelen J, Chastang JF, Ozguler A, Lanoe JL, Leclerc A. Seeking care for lower back pain in the French population aged from 30 to 69: the results of the 2002–2003 Decennale Sante survey. Ann Phys Rehabil Med. 2010;53(4):224–31. doi:10.1016/j.rehab.2010.03.006 (31–8).

    Article  CAS  PubMed  Google Scholar 

  49. Nyiendo J, Haas M, Goldberg B, Sexton G. Patient characteristics and physicians’ practice activities for patients with chronic low back pain: a practice-based study of primary care and chiropractic physicians. J Manipulative Physiol Ther. 2001;24(2):92–100. doi:10.1067/mmt.2001.112565.

    Article  CAS  PubMed  Google Scholar 

  50. Sharma R, Haas M, Stano M. Patient attitudes, insurance, and other determinants of self-referral to medical and chiropractic physicians. Am J Public Health. 2003;93(12):2111–7.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Cote P, Hogg-Johnson S, Cassidy JD, Carroll L, Frank JW, Bombardier C. Initial patterns of clinical care and recovery from whiplash injuries: a population-based cohort study. Arch Intern Med. 2005;165(19):2257–63. doi:10.1001/archinte.165.19.2257.

    Article  PubMed  Google Scholar 

  52. Hurwitz EL, Morgenstern H. The effects of comorbidity and other factors on medical versus chiropractic care for back problems. Spine. 1997;22(19):2254–63 (Phila Pa 1976; discussion 63–4).

    Article  CAS  PubMed  Google Scholar 

  53. Hestbaek L, Munck A, Hartvigsen L, Jarbol DE, Sondergaard J, Kongsted A. Low back pain in primary care: a description of 1250 patients with low back pain in danish general and chiropractic practice. Int J Fam Med. 2014;2014:106102. doi:10.1155/2014/106102.

    Google Scholar 

  54. Kosny A, Maceachen E, Ferrier S, Chambers L. The role of health care providers in long term and complicated workers’ compensation claims. J Occup Rehabil. 2011;21(4):582–90. doi:10.1007/s10926-011-9307-3.

    Article  PubMed  Google Scholar 

  55. Cote P, Hogg-Johnson S, Cassidy JD, Carroll L, Frank JW, Bombardier C. Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result? Arthritis Rheum. 2007;57(5):861–8. doi:10.1002/art.22775.

    Article  PubMed  Google Scholar 

  56. Cote P, Soklaridis S. Does early management of whiplash-associated disorders assist or impede recovery? Spine. 2011;36(25 Suppl):S275–9. doi:10.1097/BRS.0b013e3182388d32 (Phila Pa 1976).

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Ashleigh Burnet and many others from the WSIB for facilitating access to data. M. A. Blanchette is currently supported by a Ph.D. fellowship from the Canadian Institutes for Health Research (CIHR) and previously received Ph.D. Grants from both the Quebec Chiropractic Foundation and the CIHR strategic training program in transdisciplinary research on public health intervention (4P). The data extraction was funded through a grant from the WSIB Research Advisory Committee. Dr. Hogg-Johnson reports grants from Workplace Safety & Insurance Board Research Advisory Council, during the conduct of the study; grants from Ontario Ministry of Labour, outside the submitted work.

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Authors and Affiliations

  1. Public Health PhD Program, School of Public Health, University of Montreal, Montreal, QC, Canada

    Marc-André Blanchette

  2. Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada

    Michèle Rivard

  3. Public Health Research Institute, University of Montreal, Montreal, QC, Canada

    Michèle Rivard

  4. Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, QC, Canada

    Clermont E. Dionne

  5. Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec (CHUQ), Québec City, QC, Canada

    Clermont E. Dionne

  6. Institute for Work & Health, Toronto, ON, Canada

    Sheilah Hogg-Johnson & Ivan Steenstra

  7. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Sheilah Hogg-Johnson & Ivan Steenstra

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  1. Marc-André Blanchette
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  2. Michèle Rivard
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  3. Clermont E. Dionne
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  4. Sheilah Hogg-Johnson
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  5. Ivan Steenstra
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Correspondence to Marc-André Blanchette.

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Blanchette, MA., Rivard, M., Dionne, C.E. et al. Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain. J Occup Rehabil 27, 382–392 (2017). https://doi.org/10.1007/s10926-016-9667-9

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