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Early Patterns of Care for Occupational Back Pain

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

doi: 10.1097/01.brs.0000154613.17511.dd
Occupational Health/Ergonomics

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.

We investigated health care utilization following the onset of occupational back pain. Eight percent of workers do not receive care. Medical physicians, often in combination with physical therapists or chiropractors, treat almost 90% of workers who receive care. Receiving care and the type of care received are associated with demographic characteristics, severity of injury, occupation, and employer.

From the *Institute for Work & Health and Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada, †School of Health Management and Policy, W. P. Carey School of Business, Arizona State University, Tempe, AZ, and ‡School of Health Administration and Policy and Department of Economics, W. P. Carey School of Business, Arizona State University, Tempe, AZ.

Supported by a grant, with full freedom to publish, from the National Chiropractic Mutual Insurance Company, a national insurer of doctors of chiropractic. Dr. Côté is supported by the Canadian Institute of Health Research through a New Investigator Award and by the Institute for Work & Health by the Workplace Safety and Insurance Board of Ontario. Additional support was provided by the Office of the Vice President for Research and Economic Affairs, Arizona State University.

Acknowledgment date: August 26, 2003. First revision date: November 20, 2003. Acceptance date: April 6, 2004.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Corporate/Industry and Institutional funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence to Pierre Côté, DC, PhD, Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario, Canada, M5G 2E9; E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.