CHIROPRACTIC AND WORKERS' COMPENSATION
 
   

Chiropractic and Workers' Compensation

This section was compiled by Frank M. Painter, D.C.
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Maintenance Care, Wellness and Chiropractic
A Chiro.Org article collection

Review a recent (2011) single blinded placebo controlled study, conducted by the Mansoura Faculty of Medicine, that conclusively demonstrates that maintenance care provides significant benefits for those with chronic low back pain.

Managing Sickness Absence of Patients with Musculoskeletal Pain -
A Cross-sectional Survey of Scandinavian Chiropractors

Chiropractic & Manual Therapies 2019 (Jan 11);   27:   1 ~ FULL TEXT

Whilst not always engaged in sickness absence management with regards to musculoskeletal pain, chiropractors favour a 'return-to-work' rather than a 'stay-at-home' approach. Several practice behaviours and perceptions and beliefs are associated with these outcomes; however, system or organisational barriers are linked to clinician non-engagement.

A Prospective Cohort Study of the Impact of Return-to-Work Coordinators
in Getting Injured Workers Back on the Job

Journal of Occupational Rehabilitation 2018 (Jun);   28 (2):   298–306 ~ FULL TEXT

Expectations of recovery and return-to-work, pain and disability levels, depression, workplace factors, and access to multidisciplinary resources are important modifiable factors in progressing return-to-work across health and injury conditions. Employers, healthcare providers and other stakeholders can use this information to facilitate return-to-work for injured/ill workers regardless of the specific injury or illness. Future studies should investigate novel interventions, and other factors that may be common across health conditions.

Can Chiropractors Contribute to Work Disability Prevention Through Sickness
Absence Management for Musculoskeletal Disorders? - A Comparative Qualitative
Case Study in the Scandinavian Context

Chiropractic & Manual Therapies 2018 (Apr 26);   26:   15 ~ FULL TEXT

Allied healthcare providers (AHPs), in this instance chiropractors, with patient management expertise can fulfil a key role in SAM and by extension work disability prevention when these practices are legislatively supported. In cases where these practices occur informally, however, practitioners face systemic-related issues and professional self-image challenges that tend to hamper them in fulfilling a more integrated role as providers of WDP practices.

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

Journal of Occupational Rehabilitation 2017 (Sep);   27 (3):   382–392 ~ FULL TEXT

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.

This On-site Chiropractic Clinic Is Saving a Minnesota Manufacturer Big Money
The Star Tribune ~ Jan 1, 2017 ~ FULL TEXT

A year into the project, workers report that they are feeling better and like having health care services at their job. Statistics show that they are incurring injuries at much lower rates. They are also recovering quicker when they do get hurt.   And when it comes to the bottom line, the results have been better than Friendship Homes and Northwestern expected.   For every $1 that the company has invested in the program, it is saving $8 by avoiding more-costly and less-effective treatments, spending less on insurance payments and keeping more workers on the job in the first place, which generates savings through less lost tine for workers and less overtime to compensate for absences.

Factors Affecting Return To Work After Injury Or Illness:
Best Evidence Synthesis of Systematic Reviews

Chiropractic & Manual Therapies 2016 (Sep 8);   24 (1):   32 ~ FULL TEXT

Expectations of recovery and return-to-work, pain and disability levels, depression, workplace factors, and access to multidisciplinary resources are important modifiable factors in progressing return-to-work across health and injury conditions. Employers, healthcare providers and other stakeholders can use this information to facilitate return-to-work for injured/ill workers regardless of the specific injury or illness. Future studies should investigate novel interventions, and other factors that may be common across health conditions.

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. 2016 (Apr);   22 (2):   247–252 ~ FULL TEXT

The RESULTS portion of this Abstract only partially discusses the findings, comparing 3 different professions' treatment, costs, and outcomes for low back pain.   In it they only mention the costs associated with medical management, while in reviewing chiropractic care vs. physical thereapy portions, they choose to emphasize:

  • Entry in chiropractic was associated with an increased episode of care duration
  • Entry in physical therapy no patient entering in physical therapy had surgery.

That *seems* to suggest that physical therapy *may* entail less expense, or shorter durations of care, or that chiropractic patients are more likely to end up with surgery.   None of that is true.   Their own Table 2 plainly reveals that chiropractic care was the least expensive form of care provided to the 3 groups.

Workers' Compensation, Return to Work, and Lumbar Fusion for Spondylolisthesis
Orthopedics. 2016 (Jan);   39 (1):   e1-8 ~ FULL TEXT

In this study, researchers reviewed the files of 686 workers who underwent fusion surgery for spondylolisthesis between 1993 and 2013, revealing that only 29.9% of them ever returned to work (for at least 6 months). The failure rate (meaning return-to-work) was 70.1%.

A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions
for Spine Pain in the United States

BMC Health Serv Res. 2015 (Oct 19);   15:   474 ~ FULL TEXT

The search uncovered 1,276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care.

Association of Worker Characteristics and Early Reimbursement for Physical Therapy,
Chiropractic and Opioid Prescriptions With Workers' Compensation Claim Duration,
For Cases of Acute Low Back Pain: An Observational Cohort Study

BMJ Open. 2015 (Aug 26);   5 (8):   e007836 ~ FULL TEXT

Our analysis found that early Workplace Safety and Insurance Board (WSIB) reimbursement for physiotherapy or chiropractic care, in claimants fully off work for more than 4 weeks, was not associated with claim duration, and that early reimbursement for opioids predicted prolonged claim duration. Well-designed randomised controlled trials are needed to verify our findings and establish causality between these variables and claim duration.

Tracking Low Back Problems in a Major Self-Insured Workforce:
Toward Improvement in the Patient's Journey

J Occup Environ Med. 2014 (Jun);   56 (6):   604-620 ~ FULL TEXT

This comprehensive new study from the Journal of Occupational and Environmental Medicine reveals that chiropractic care costs significantly less than other forms of low back care, and appears to comply with guideline recommendations more closely than than any of the other 4 comparison groups.   The authors came to these conclusions after an exhaustive analysis of an integrated database belonging to a giant, self-insured Fortune 500 manufacturer covering nine years of claims They evaluated the direct and indirect costs of LBP for all employees, looking in-depth at personnel characteristics, and medical, behavioral health, pharmaceutical, Workers Comp costs, disability, absenteeism, and lost productivity during the 2001 to 2009 period.

Health Maintenance Care in Work-Related Low Back Pain
and Its Association With Disability Recurrence

J Occupat Enviro Med 2011 (Apr);   53 (4):   396–404 ~ FULL TEXT

This study is unique in that it was conducted by the Center for Disability Research at the Liberty Mutual Research Institute for Safety AND the University of Massachusetts Lowell, Hopkinton, Mass. They found that statistically you are twice as likely to end up disabled if you got your care from a Physical Therapists (PT), rather than from a chiropractor. You’re also 60% more likely to be disabled if you choose a Physicians (MD) to manage your care, rather than a chiropractor.

Functional Scores and Subjective Responses of Injured Workers With Back or Neck Pain
Treated With Chiropractic Care in an Integrative Program:
A Retrospective Analysis of 100 Cases

J Manipulative Physiol Ther. 2009 (Nov);   32 (9):   765–771 ~ FULL TEXT

This study identified positive effects of chiropractic management included in integrative care when treating work-related neck or back pain. Improvement in both functional scores and subjective response was noted in all 3 time-based phases of patient status (acute, subacute, and chronic).

Course and Prognostic Factors for Neck Pain in Workers:
Results of the Bone and Joint Decade 2000–2010 Task Force
on Neck Pain and Its Associated Disorders

J Manipulative Physiol Ther. 2009 (Feb);   32 (2 Sup):  S108–116 ~ FULL TEXT

We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 14 of these studies related to course and prognostic factors in working populations. Between 60% and 80% of workers with neck pain reported neck pain 1 year later. Few workplace or physical job demands were identified as being linked to recovery from neck pain. However, workers with little influence on their own work situation had a slightly poorer prognosis, and white-collar workers had a better prognosis than blue-collar workers. General exercise was associated with better prognosis; prior neck pain and prior sick leave were associated with poorer prognosis.

Colorado Workers' Compensation: Medical vs Chiropractic Costs
for the Treatment of Lowback Pain

J Manipulative Physiol Ther. 2009 (Feb);   32 (2 Sup):  S108–116 ~ FULL TEXT

This study adds to the understanding of differences associated with costs and services provided by DCs and MDs when treating simple and nonspecific LBP. It does not bring about an understanding of patient satisfaction for each provider or explain all potential benefits that might have been achieved by treatment. Results from our study appear to demonstrate that chiropractic care is more expensive than medical care when treating relatively simple forms of LBP. Because costs can greatly increase because of repeated treatments, the difference in expenses is mainly due to more services and longer treatment periods. Further research is needed to evaluate quality of life and patient satisfaction related to different treatment approaches, as well as follow-up of patient's functional status and stability upon return to work, resumption of activities of daily livings, and impacts of relapses. Future evaluations should also examine effectiveness when treating more complex disorders causing spine and LBP. Cost-effectiveness has become very important when choosing a heath care provider for most third-party payers. However, because patients respond differently to different forms of treatment, it would be in the best interest of both the insurance company and the patient for the patient to be provided preferred treatment options for his/her condition and to take an active role in his/her overall treatment plan.

The Burden and Determinants of Neck Pain in Workers:
Results of the Bone and Joint Decade 2000–2010 Task Force
on Neck Pain and Its Associated Disorders

J Manipulative Physiol Ther. 2009 (Feb);   32 (2):   S70-86 ~ FULL TEXT

One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible. The annual prevalence of neck pain varied from 27.1% in Norway to 47.8% in Québec, Canada. Each year, between 11% and 14.1% of workers were limited in their activities because of neck pain. Risk factors associated with neck pain in workers include age, previous musculoskeletal pain, high quantitative job demands, low social support at work, job insecurity, low physical capacity, poor computer workstation design and work posture, sedentary work position, repetitive work and precision work. We found preliminary evidence that gender, occupation, headaches, emotional problems, smoking, poor job satisfaction, awkward work postures, poor physical work environment, and workers' ethnicity may be associated with neck pain. There is evidence that interventions aimed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers.

Satisfaction as a Predictor of Clinical Outcomes Among Chiropractic and Medical Patients
Enrolled in the UCLA Low Back Pain Study

Spine (Phila Pa 1976). 2005 (Oct 1);   30 (19):   2121–2128 ~ FULL TEXT

Greater satisfaction increased the odds of remission from clinically meaningful pain and disability at 6 weeks (adjusted odds ratio [OR] for 10-point increase in satisfaction = 1.61, 95% confidence interval [CI] = 0.99, 2.68), but not at 6, 12, or 18 months (6 months: adjusted OR = 1.05, 95% CI = 0.73, 1.52; 12 months: adjusted OR = 0.94, 95% CI = 0.67, 1.32; 18 months: adjusted OR = 1.07; 95% CI = 0.76, 1.50). Perception of improvement was greater among highly satisfied than less satisfied patients throughout the 18-month follow-up period.

An Evaluation of Medical and Chiropractic Provider Utilization and Costs:
Treating Injured Workers in North Carolina

J Manipulative Physiol Ther 2004 (Sep);   27 (7):   442–448 ~ FULL TEXT

These data, with the acknowledged limitations of an insurance database, indicate lower treatment costs, less workdays lost, lower compensation payments, and lower utilization of ancillary medical services for patients treated by DCs. Despite the lower cost of chiropractic management, the use of chiropractic services in North Carolina appears very low.

A Randomized Clinical Trial Comparing Chiropractic Adjustments to Muscle Relaxants
for Subacute Low Back Pain

J Manipulative Physiol Ther 2004 (Jul);   27 (6):   388-398 ~ FULL TEXT

Researchers compared the relative efficacy of chiropractic adjustments with muscle relaxants and placebo/sham for sub-acute low back pain (two- to six-weeks duration). They found chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing the global impression of severity scale (GIS).

The Use of Muscle Relaxant Medications in Acute Low Back Pain
Spine (Phila Pa 1976) 2004 (Jun 15);   29 (12):   1346–1351 ~ FULL TEXT

Muscle relaxants were used by 49% of patients; among those who sought care from doctors, 64% used muscle relaxants. Muscle relaxant users were more impaired at baseline. Over time, among patients with greater functional status impairment (Roland disability score > 12) at baseline, muscle relaxant users had somewhat slower recovery from the episode of back pain. This finding persisted after controlling for baseline functional status, age, worker's compensation status, and use of nonsteroidal inflammatory agents.

Chiropractic Treatment of Workers' Compensation Claimants in the State of Texas
MGT of America, Austin, Texas ~ February 2003 ~ FULL TEXT

This retrospective study of workers’ compensation claims from 1996 to 2001 was conducted to determine the use and efficacy of chiropractic care in Texas. The researchers reviewed 900,000 claims during that time period to determine if chiropractic was cost-effective compared to medical treatment. They found that chiropractic treatment costs were the lowest of all providers. The study data demonstrated that increased utilization of chiropractic care could lead to declining costs relative to lower back injuries.

Economic Case for the Integration of Chiropractic Services into the Health Care System
J Manipulative Physiol Ther 2000 (Feb);   23 (2):   118–122 ~ FULL TEXT

In this study the author explores the effects of the integration of chiropractic care into the health care system. The author indicates that greater use of chiropractic care would lead to reduced costs and improved outcomes. As support, the author points to studies which demonstrate that chiropractic is effective for neuromusculoskeletal disorders and the evidence that patients often prefer chiropractic care over a medical approach.

Cost Comparison of Chiropractic and Medical Treatment of Common
Musculoskeletal Disorders: A Review of the Literature After 1980

Topics in Clinical Chiropractic 1999;   6 (2):   57–68 ~ FULL TEXT

The majority of retrospective studies in general report results in favor of chiropractic treatment. Three of the five prospective studies are in favor of medical treatment. None of the identified studies included all direct costs of care. Well designed prospective randomized studies that include complete economic analysis are needed.

The Outcomes and Costs of Care for Acute Low Back Pain Among Patients Seen by
Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons
The North Carolina Back Pain Project

New England J Medicine 1995 (Oct 5);   333 (14):   913–917 ~ FULL TEXT

This study sought to compare patients’ recovery and satisfaction for those with acute low back pain receiving care from the following six groups:

  • Urban Primary Care Physicians;
  • Rural Primary Care Physicians;
  • Urban Doctors of Chiropractic (DCs);
  • Rural DCs;
  • Orthopedic Surgeons; and
  • Primary Care Providers at a Group Model HMO.

After six months, functional recoveries, return to work and complete back pain recoveries were similar for all groups. Satisfaction with care was highest for those visiting DCs.

Preliminary Findings of Analysis of Chiropractic Utilization and Cost in the Workers'
Compensation System of New South Wales, Australia

J Manipulative Physiol Ther 1995 (Oct);   18 (8):   503–511

The total utilization rate for chiropractic intervention in spinal injuries for workers' compensation claimants was 12%. Payments for physiotherapy and chiropractic treatment totalled over $25.2 million and represented 2.4% of total payments for all cases. Average chiropractic treatment cost for a sample of 20 randomly selected cases was $299.65; average medical treatment cost per case was $647.20. Further analysis of the 20 selected cases seemed to show an average cost per claim that was significantly different from WCA database figures.

A Comparison of Health Care Costs for Chiropractic and Medical Patients
J Manipulative Physiol Ther 1993 (Jun);   16 (5):   291–299

Nearly one-fourth of patients were treated by chiropractors.   Patients receiving chiropractic care experienced significantly lower health care costs as represented by third party payments in the fee-for-service sector. Total cost differences on the order of $1,000 over the 2-yr period were found in the total sample of patients as well as in subsamples of patients with specific disorders. The lower costs are attributable mainly to lower inpatient utilization. The cost differences remain statistically significant after controlling for patient demographics and insurance plan characteristics.

Cost Per Case Comparison of Back Injury Claims of Chiropractic Versus Medical Management
for Conditions With Identical Diagnostic Codes

J Occup Med 1991 (Aug);   33 (8):   847–852

This study indicated that costs were significantly higher for medical claims than for chiropractic claims; in addition, the number of work days lost was nearly ten times higher for those who received medical care instead of chiropractic care.

Disabling Low Back Oregon Workers' Compensation Claims Part II: Time Loss
J Manipulative Physiol Ther 1991 (May);   14 (4):   231–239

Chiropractic claimants had a higher frequency of return to work with 1 wk or less of time loss. No difference was seen in time loss days for MD or DC claimants with no documented history of low back pain. However, for claimants with a history of chronic low back problems, the median time loss days for MD cases was 34.5 days, compared to 9 days for DC cases. It is suggested that chiropractors are better able to manage injured workers with a history of chronic low back problems and to return them more quickly to productive employment.

Patient Evaluations of Low Back Pain Care From Family Physicians and Chiropractors
West J Med 1989 (Mar);   150 (3):   351–355 ~ FULL TEXT

Patients of chiropractors were three times as likely as patients of family physicians to report that they were very satisfied with the care they received for low back pain (66% versus 22%, respectively). Compared with patients of family physicians, patients of chiropractors were three times more likely to have been satisfied with the amount of information they were given, to have perceived that their provider was concerned about them, and to have felt that their provider was comfortable and confident dealing with their problem.

An Analysis of Florida Workers' Compensation Medical Claims for Back-related Injuries
J American Chiro Association 1988;   25 (7):   50–59

This study is an analysis of worker's compensation claims in Florida from June through December of 1987. All of the claims analyzed were related to back injuries. The greater purpose of this study was to compare the cost of osteopathic, medical and chiropractic doctors. The cost of drugs were not included in the analysis. The results of the study lead to the finding that individuals who had compensable injuries and were treated by chiropractors often times were not forced to be hospitalized. It was also revealed that chiropractic care is a "relatively cost-effective approach to the management of work-related injuries."



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