Skip to main content

Advertisement

SpringerLink
Log in

Prevalence, Predictors and Wage Replacement Duration Associated with Diagnostic Imaging in Australian Workers with Accepted Claims for Low Back Pain: A Retrospective Cohort Study

  • Published:
Journal of Occupational Rehabilitation Aims and scope Submit manuscript

Abstract

Objectives To determine in Australian workers with an accepted workers’ compensation claim for low back pain (LBP) (1) the prevalence of diagnostic imaging of the spine and factors associated with its use, and (2) the association between spinal diagnostic imaging events and wage replacement duration. Methods Workers with accepted workers’ compensation claims for LBP longer than 2 weeks were grouped by whether workers’ compensation funded no, single, or multiple diagnostic spinal imaging in the 2 years since reported LBP onset. Ordinal logistic regression was used to define the demographic, occupational and social factors associated with each group. Time-to-event analysis was used to determine the association between spinal imaging and wage replacement duration. Results In the sample of 30,530 workers, 9267 (30.4%) received single spinal imaging and 6202 (20.3%) received multiple spinal imaging. Male workers and workers from the state of Victoria had significantly higher odds of multiple imaging. Socioeconomically advantaged workers and workers from remote Australia had significantly lower odds of multiple imaging. Magnetic Resonance Imaging was the most common imaging modality. Workers with single spinal imaging (median duration 17.0 weeks; HR 2.0, 95% CI 1.9, 2.1) and multiple spinal imaging (median duration 49.0 weeks; HR 4.0, 95% CI 3.9, 4.1) had significantly longer wage replacement duration than those with no imaging (median duration 6.1 weeks). Conclusions Over half of Australian workers with an accepted workers’ compensation claim for LBP longer than 2 weeks received diagnostic spinal imaging. Receipt of diagnostic imaging, particularly multiple imaging, was associated with longer wage replacement duration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

Data used in this paper are not available for distribution by the authors. The R analysis code used to analyse the data is available in the supplementary materials.

References

  1. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356–2367.

    Article  Google Scholar 

  2. Koes BW, van Tulder MW, Ostelo R, Kim Burton A, Waddell G. Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine. 2001;26(22):2504–2513 (discussion 2513-2504).

    Article  CAS  Google Scholar 

  3. National Institute for Health and Care Excellence (NICE): Low back pain and sciatica in over 16s: assessment and management. In. London, UK: NICE; 2016.

  4. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811–816.

    Article  CAS  Google Scholar 

  5. Kim J-H, van Rijn RM, van Tulder MW, Koes BW, de Boer MR, Ginai AZ, Ostelo RWGJ, van der Windt DAMW, Verhagen AP. Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic review. Chiropractic Manual Ther. 2018;26(1):37.

    Article  Google Scholar 

  6. Graves JM, Fulton-Kehoe D, Jarvik JG, Franklin GM. Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain. Health Serv Res. 2014;49(2):645–665.

    Article  Google Scholar 

  7. Webster BS, Choi Y, Bauer AZ, Cifuentes M, Pransky G. The cascade of medical services and associated longitudinal costs due to nonadherent magnetic resonance imaging for low back pain. Spine. 2014;39(17):1433–1440.

    Article  Google Scholar 

  8. Lemmers GPG, van Lankveld W, Westert GP, van der Wees PJ, Staal JB. Imaging versus no imaging for low back pain: a systematic review, measuring costs, healthcare utilization and absence from work. Eur spine J . 2019;28(5):937–950.

    Article  CAS  Google Scholar 

  9. Downie A, Hancock M, Jenkins H, Buchbinder R, Harris I, Underwood M, Goergen S, Maher CG. How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years. Br J Sports Med. 2019;54(11):642–651.

    Article  Google Scholar 

  10. Froud R, Patterson S, Eldridge S, Seale C, Pincus T, Rajendran D, Fossum C, Underwood M. A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskelet Disord. 2014;15(1):50.

    Article  Google Scholar 

  11. Collie A, Di Donato M, Iles R. Work disability in Australia: an overview of prevalence, expenditure, support systems and services. J Occup Rehabil. 2019;29(3):526–539.

    Article  Google Scholar 

  12. International Labour Organization (ILO): World Social Protection Report 2017–19 - Universal social protection to achieve the Sustainable Development Goals. In. Geneva, Switzerland: ILO; 2017.

  13. Lippel K, Lötters F. Public insurance systems: a comparison of cause-based and disability-based income support systems. In: Loisel P, Anema JR, editors. Handbook of Work disability: prevention and management. New York: Springer; 2013. p. 183–202.

    Chapter  Google Scholar 

  14. Safe Work Australia (SWA): Comparison of Workers' Compensation Arrangements in Australia and New Zealand 2015. In: Canberra, Australia: SWA; 2015.

  15. Victorian WorkCover Authority: Guidelines for the management of employees with compensable low back pain. In: Melbourne; 1996.

  16. Graves JM, Fulton-Kehoe D, Martin DP, Jarvik JG, Franklin GM. Factors associated with early magnetic resonance imaging utilization for acute occupational low back pain: a population-based study from Washington State workers’ compensation. Spine. 2012;37(19):1708–1718.

    Article  Google Scholar 

  17. Shraim M, Cifuentes M, Willetts JL, Marucci-Wellman HR, Pransky G. Why does the adverse effect of inappropriate MRI for LBP vary by geographic location? An exploratory analysis. BMC Musculoskelet Disord. 2019;20(1):574.

    Article  Google Scholar 

  18. Webster BS, Bauer AZ, Choi Y, Cifuentes M, Pransky GS. Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine. 2013;38(22):1939–1946.

    Article  Google Scholar 

  19. Webster BS, Cifuentes M. Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes. J Occup Environ Med. 2010;52(9):900–907.

    Article  Google Scholar 

  20. Graves JM, Fulton-Kehoe D, Jarvik JG, Franklin GM. Impact of an advanced imaging utilization review program on downstream health care utilization and costs for low back pain. Med Care. 2018;56(6):520–528.

    Article  Google Scholar 

  21. Collie A, Lane TJ, Hassani-Mahmooei B, Thompson J, McLeod C. Does time off work after injury vary by jurisdiction? A comparative study of eight Australian workers’ compensation systems. BMJ Open. 2016;6(5):e010910.

    Article  Google Scholar 

  22. Di Donato M, Iles R, Lane T, Buchbinder R, Collie A. The impact of income support systems on healthcare quality and functional capacity in workers with low back pain: a realist review. Pain 2020.

  23. Australian Government Department of Health: Medicare Benefits Schedule Book - Operating from 1 November 2019. In. Edited by Department of Health. Canberra: Australian Government; 2019.

  24. Di Donato M, Buchbinder R, Iles R, Gray S, Collie A. Comparison of compensated low back pain claims experience in australia with limb fracture and non-specific limb condition claims: a retrospective cohort study. J Occup Rehabil 2020.

  25. Australian Safety and Compensation Council (ASCC): Type of Occurrence Classification System (Third edition, revision one). In: Canberra, Australia: ASCC; 2008.

  26. Australian Bureau of Statistics (ABS): Australian and New Zealand standard classification of occupations, 2013, Version 1.2. In: Canberra: Australian Bureau of Statistics; 2013.

  27. Australian Bureau of Statistics (ABS): 2006 RA from 2006 POA Correspondence. Australian Standard Geographical Classification (ASGC) Remoteness Area Correspondences. In: Canberra: Australian Bureau of Statistics; 2011.

  28. Australian Bureau of Statistics (ABS): Postal Area, Indexes, SEIFA 2011. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011. In. Canberra: Australian Bureau of Statistics; 2013.

  29. Department of Health and Aged Care: Measuring Remoteness: Accessibility/Remoteness Index of Australia (ARIA) Revised Edition. Occasional Papers: New Series Number 14. In: Canberra: Department of Health and Aged Care; 2001.

  30. Microsoft Corporation: Microsoft Visual Studio 2017. In: Redmond, Washington: Microsoft Corporation; 2018.

  31. R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2017.

    Google Scholar 

  32. Pransky G, Foley G, Cifuentes M, Webster BS. Geographic variation in early MRI for acute work-related low back pain and associated factors. Spine. 2015;40(21):1712–1718.

    Article  Google Scholar 

  33. Agency for Clinical Innovation (ACI): Management of people with acute low back pain. In. Chatswood, Australia: ACI; 2016.

  34. Stochkendahl M, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, Andersen MØ, Fournier G, Højgaard B, Jensen M, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Euro Spine J. 2017;27(1):60–75.

    Article  Google Scholar 

  35. Chou R, Qaseem A, Owens DK, Shekelle P. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011;154(3):181–189.

    Article  Google Scholar 

  36. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009;60(10):3072–3080.

    Article  Google Scholar 

  37. Buchbinder R, Underwood M, Hartvigsen J, Maher CG. The Lancet Series call to action to reduce low value care for low back pain: an update. Pain. 2020;161(1):S57.

    Article  Google Scholar 

  38. Hong AS, Ross-Degnan D, Zhang F, Wharam JF. Clinician-level predictors for ordering low-value imaging. JAMA Intern Med. 2017;177(11):1577–1585.

    Article  Google Scholar 

  39. Fine B, Schultz SE, White L, Henry D. Impact of restricting diagnostic imaging reimbursement for uncomplicated low back pain in Ontario: a population-based interrupted time series analysis. CMAJ Open. 2017;5(4):E760–E767.

    Article  Google Scholar 

  40. Bartys S, Frederiksen P, Bendix T, Burton K. System influences on work disability due to low back pain: an international evidence synthesis. Health Policy. 2017;121(8):903–912.

    Article  Google Scholar 

  41. Sharma S, Traeger AC, Reed B, Hamilton M, O’Connor DA, Hoffmann TC, Bonner C, Buchbinder R, Maher CG. Clinician and patient beliefs about diagnostic imaging for low back pain: a systematic qualitative evidence synthesis. BMJ Open. 2020;10(8):e037820.

    Article  Google Scholar 

  42. French SD, Nielsen M, Hall L, Nicolson PJA, van Tulder M, Bennell KL, Hinman RS, Maher CG, Jull G, Hodges PW. Essential key messages about diagnosis, imaging, and self-care for people with low back pain: a modified Delphi study of consumer and expert opinions. Pain. 2019;160(12):2787–2797.

    Article  Google Scholar 

  43. Suman A, Armijo-Olivo S, Deshpande S, Marietta-Vasquez J, Dennett L, Miciak M, Reneman M, Werner EL, Straube S, Buchbinder R et al. A systematic review of the effectiveness of mass media campaigns for the management of low back pain. Disability Rehabil 2020;1–29.

  44. Buchbinder R, Jolley D, Wyatt M. 2001 Volvo Award Winner in Clinical Studies: effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice. Spine. 2001;26(23):2535–2542.

    Article  CAS  Google Scholar 

  45. Machado GC, Richards B, Needs C, Buchbinder R, Harris IA, Howard K, McCaffery K, Billot L, Edwards J, Rogan E, et al. Implementation of an evidence-based model of care for low back pain in emergency departments: protocol for the Sydney Health Partners Emergency Department (SHaPED) trial. BMJ Open. 2018;8(4):e019052.

    Article  Google Scholar 

  46. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012. https://doi.org/10.1002/14651858.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This paper uses data supplied by WorkSafe Victoria, WorkCover Queensland, ReturnToWork South Australia, and WorkCover Western Australia. The views expressed are the responsibility of the authors and are not necessarily the views of WorkSafe Victoria, WorkCover Queensland, ReturnToWork South Australia, or WorkCover Western Australia. The authors would also like to acknowledge the invaluable assistance of Ms Dianne Beck in the cleaning and preparation of data for this paper.

Funding

Mr Di Donato receives a Research Training Program (RTP) Scholarship Stipend from the Australian Government. Professor Buchbinder is supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. Professor Collie is supported by an Australian Research Council (ARC) Discovery Project Grant (DP190102473) and Future Fellowship (FT190100218).

Author information

Authors and Affiliations

  1. Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia

    Michael Di Donato, Ross Iles, Ting Xia & Alex Collie

  2. Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale St, Malvern, VIC, 3144, Australia

    Rachelle Buchbinder

  3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 4 Drysdale St, Malvern, VIC, 3144, Australia

    Rachelle Buchbinder

Authors
  1. Michael Di Donato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ross Iles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rachelle Buchbinder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ting Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alex Collie
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the conceptualisation and design of the paper and the interpretation of the findings. MDD and RI cleaned the health services data and identified imaging services. MDD conducted the analysis with assistance from TX and AC. MDD drafted the manuscript. All authors provided feedback on and approved the final manuscript.

Corresponding author

Correspondence to Michael Di Donato.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethical Approval

This study received ethics approval from the Monash University Human Research Ethics Committee (MUHREC) (Project ID 17267, November 2018). Participant data were de-identified. Consent for use of data for research purposes is assumed when entering each of the workers’ compensation schemes.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 178 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Donato, M., Iles, R., Buchbinder, R. et al. Prevalence, Predictors and Wage Replacement Duration Associated with Diagnostic Imaging in Australian Workers with Accepted Claims for Low Back Pain: A Retrospective Cohort Study. J Occup Rehabil 32, 55–63 (2022). https://doi.org/10.1007/s10926-021-09981-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10926-021-09981-8

Keywords

Search

Navigation