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The Relationship of the Amount of Physical Therapy to Time Lost From Work and Costs in the Workers’ Compensation System

Leung, Nina PhD, MPH; Tao, Xuguang Grant MD, PhD; Bernacki, Edward J. MD, MPH

Journal of Occupational and Environmental Medicine: August 2019 - Volume 61 - Issue 8 - p 635–640
doi: 10.1097/JOM.0000000000001630

Physical therapy (PT) is perceived as a cost driver in the US workers’ compensation system. We conducted a 5-year (2013 to 2017) retrospective analysis utilizing 192,197 claims from a large Texas based workers’ compensation insurance company to describe the relationship between the amount of physical therapy delivered and workers’ compensation costs and lost-time. Closed, indemnity claims with 15 or more PT visits were six times more likely (95% confidence interval [CI]: 5.50, 86.58) to result in high medical costs (>$7000, excluding PT costs) and were four times more likely (95% CI: 3.77, 4.42) to result in more than or equal to 6 months of lost-time, when controlling for confounders. When the number of PT visits more than or equal to 15 visits for a lost time claim, this level of PT exceeds all other predictors (opioid use, comorbidities, legal involvement, surgery, etc) of medical cost and extended time out from work.

Department of Population Health, Dell Medical School – The University of Texas at Austin, Austin, Texas; and Division of Occupational and Environmental Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Leung, Dr Tao, Dr. Bernacki).

Address correspondence to: Nina Leung, PhD, MPH, Assistant Professor, Department of Population Health, Dell Medical School – The University of Texas at Austin, 1601 Trinity Street, Stop Z0200, Austin, TX (

Clinical Significance: PT is an accepted treatment option to assist in the recovery of work related musculoskeletal or repetitive trauma disorders. When the number of PT visits equals or exceeds 15 visits for a lost time claim, this amount of PT exceeds all other cost and disability drivers (opioid use, comorbidities, legal involvement, etc) as a predictor of high-cost claims (costs in or above the 90th percentile) or where less than 50% of claimants will return to work.

Leung, Tao, and Bernacki have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

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Copyright © 2019 by the American College of Occupational and Environmental Medicine