THE ASSOCIATION OF FIRST PROVIDER SEEN WITH TIME LOSS FROM WORK AMONG WORKERS WITH BACK INJURY

The Association of First Provider Seen With Time Loss
From Work Among Workers With Back Injury:
A Cohort Study
This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org

FROM: Am J Ind Med 2026 (May 26) [EPUB] ~ FULL TEXT

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Brian Chin PhC, MSPH • Sean D. Rundell PT, DPT, PhD • Jeanne M. Sears PhD, RN • Deborah Fulton-Kehoe PhD, MPH • June T. Spector MD, MPH • Gary M. Franklin MD, MPH

Washington State Department of Labor and Industries,
Tumwater, Washington, USA.

FROM: Weeks ~ JMPT 2016 (Feb) Hurwitz ~ JMPT 2016 (May)
Background: Prior evidence suggests that seeking initial care from a chiropractor for back pain, compared to seeing a primary care provider first, is associated with better clinical outcomes. However, prior studies have not comprehensively adjusted for potential confounders and few studies have focused on work-related outcomes.

Methods: This population-based prospective cohort study analyzed data from workers' compensation claimants with a work-related back injury who initiated care with either a chiropractor or a primary care physician. We evaluated the association of seeing a chiropractor first, compared to seeing a primary care physician first, with receipt of wage replacement benefits for temporary total disability (time loss) at 1 year after claim initiation. Association was estimated using logistic regression adjusting for potential confounders including patient sociodemographic characteristics, employment details, self-reported pain and physical function, injury severity, healthcare factors, and psychological factors. The E-value was used to assess unmeasured confounding.

Results: Of 1,219 participants (mean age = 39, 67.5% male, 72.1% non-Hispanic White), 541 (44.4%) initiated care with a chiropractor. Participants who saw a chiropractor first, compared to a primary care physician first, were less likely to be on time-loss at 1 year as estimated by adjusted multivariate logistic regression (4.8% vs. 11.8%; adjusted odds ratio [OR]: 0.45, 95% CI: 0.24-0.86; E-value: 3.8).

Conclusions: Patients with work-related back injury who initiated care with a chiropractor were less likely to be receiving time loss compensation at 1 year compared to those who saw a primary care physician. Comprehensive adjustment for patient characteristics did not account for the differential outcome by provider type.

Keywords: back pain; chiropractic; health care utilization; work disability; workers' compensation.

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The Association of First Provider Seen With Time Loss From Work Among Workers With Back Injury: A Cohort Study

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The Association of First Provider Seen With Time Loss
From Work Among Workers With Back Injury:
A Cohort Study