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


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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Fig. 1
Fig. 2



Acute low back pain injury program of care


Analysis of variance


Confidence interval


Doctor of chiropractic


Hazard ratio


Institut de Recherche en Santé Sécurité au Travail


Institute for Work and Health


Medical doctor


National occupational code


Odds ratio




Receiver operating characteristics


Readiness to return to work


Standard deviation


Standard international classification 1980


Workplace Safety and Insurance Board


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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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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).

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  • Chiropractic
  • Medicine
  • Physiotherapy
  • Back pain
  • Occupational
  • Healthcare provider
  • Compensation duration