Early Patterns of Care for Occupational Back Pain

Pierre DC Côté, PhD; Marjorie L. Baldwin PhD; William G. Johnson; PhD


Spine. 2005;30(5):581-587. 

In This Article

Abstract and Introduction

Study Design: Cross-sectional analysis.

Objectives: To describe the early health care utilization for occupational back pain. To identify factors associated with health care seeking and provider choice among persons with occupational back pain.

Summary of Background Data: Back pain is the most prevalent work-related injury, yet little is known about patterns of care for occupational back pain.

Materials and Methods: The sample includes 1104 workers with incident episodes of low back pain. Outcomes measures include whether or not workers received care and the types of providers seen. Predictors of outcomes include demographics, injury severity, history of back pain, occupation, and employer.

Results: Eight percent of workers did not receive care in the first 4 to 16 weeks after filing a workers' compensation claim. Injury severity, gender, occupation, and employer were significant predictors of the decision to seek care. Almost 90% of workers who received care were treated by medical physicians, often in combination with physical therapists or chiropractors. Age, occupation, injury severity, and whether the employer or worker chose the initial health care provider were associated with the choice of provider. Employers selected providers for 78% of injured workers who received care. Medical physicians were the providers most often chosen by both employers and workers, but workers were more likely than employers to select chiropractors.

Conclusions: A small but significant number of injured workers do not seek care for their back pain. Medical physicians treat all but a small fraction of the workers who receive care. The decision to seek care and the choice of providers is associated with injury severity, occupation, and employer actions.

It is estimated that low back pain is responsible for the loss of 149 million workdays annually, with 102 million workdays lost because of occupational back pain.[1] Estimated health care costs for lost-time back injuries average over $3000 per claim.[2] Despite the significant disability and economic burdens associated with occupational back pain, little is known about the health care provided to injured workers.

Research on back pain in the general population provides some information on the determinants of health seeking behavior. The decision to seek health care for back pain is related to the severity of the condition and general health status.[3,4] Individuals who seek care are more likely to have longer episodes of back pain, higher pain severity, sciatica and other associated health disorders, poorer self-perceived health status, and more activity limitations than those who do not seek care.[3,4,5]

In the general population, individuals who seek care for back pain are most likely to be treated by either a medical physician or a chiropractor. Overall, medical patients are more likely to be female, to suffer from more comorbid health conditions, and to have more severe pain and disability than chiropractic patients.[3,6,7,8] Chiropractic patients are more likely to be high-school graduates, single, and employed.[6,7,8]

Research on back pain in the general population can inform the analysis of care-seeking behavior among injured workers, but separate studies of work-related back pain are needed because there are important differences between workers' compensation health care coverage and group health insurance coverage. Workers' compensation claimants, for example, are 100% covered for health care for work-related injuries, so the cost-sharing mechanisms used by health insurers to limit utilization do not apply. Choice of provider may be more or less restrictive in workers' compensation than in group health, depending on the state. Some states give employers the right to choose providers for the treatment of work-related injuries, whereas other states give workers the right to choose.

This article analyzes health care seeking behavior and provider choice among workers with occupational back pain, using data from the Arizona State University (ASU) Healthy Back Study . The data are restricted to the first 4 to 16 weeks after onset because we are interested in the process whereby employers and workers select initial treatment providers. The choices are important because the health care received early after onset is an important predictor of long-term outcomes.[9,10] The article seeks, first, to describe the early health care utilization for occupational back pain; second, to identify characteristics that distinguish workers who receive care from those who do not; and finally, to identify characteristics associated with the choice of the providers among those workers who receive care.


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