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

Cifuentes, Manuel MD, PhD; Willetts, Joanna MS; Wasiak, Radoslaw PhD, MA, MSc

Journal of Occupational and Environmental Medicine: April 2011 - Volume 53 - Issue 4 - p 396–404
doi: 10.1097/JOM.0b013e31820f3863
Original Articles

Objectives: To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

Method: A total of 894 cases followed 1 year using workers’ compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

Results: Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

Conclusions: In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.

From the Center for Disability Research at the Liberty Mutual Research Institute for Safety (Dr Cifuentes and Ms Willetts) and University of Massachusetts Lowell (Dr Cifuentes), Hopkinton, Mass; and Center for Health Economics & Science Policy at United BioSource Corporation, London, United Kingdom (Dr Wasiak).

Address correspondence to: Manuel Cifuentes, 71 Frankland Rd, Hopkinton, MA 01748; E-mail:;

Study funded by Liberty Mutual Research Institute for Safety.

©2011The American College of Occupational and Environmental Medicine