Prevalence, Predictors and Wage Replacement Duration Associated with Diagnostic Imaging in Australian Workers with Accepted Claims for Low Back Pain: A Retrospective Cohort Study

The Association of Physiotherapy Continuity of Care with Duration of Time Loss Among Compensated Australian Workers with Low Back Pain

PURPOSE

The aims of this study are to determine how continuous the care provided by physiotherapists to compensated workers with low back pain is, what factors are associated with physiotherapy continuity of care (CoC; treatment by the same provider), and what the association between physiotherapy CoC and duration of working time loss is.

METHODS

Workers' compensation claims and payments data from Victoria and South Australia were analysed. Continuity of care was measured with the usual provider continuity metric. Binary logistic regression examined factors associated with CoC. Cox regression models examined the association between working time loss and CoC.

RESULTS

Thirty-six percent of workers experienced complete CoC, 25.8% high CoC, 26.1% moderate CoC, and 11.7% low CoC. Odds of complete CoC decreased with increased service volume. With decreasing CoC, there was significantly longer duration of compensated time loss.

CONCLUSION

Higher CoC with a physiotherapist is associated with shorter compensated working time loss duration for Australian workers with low back pain.

Relationship between the timing of physical therapy commencement and the duration of work disability: a retrospective cohort analysis of work-related low back pain claims

BACKGROUND

Early physical therapy for workers reporting low back pain (LBP) may reduce disability and improve return to work. This study aimed to explore the relationship between the timing of physical therapy commencement and the duration of work disability after the onset of compensable LBP.

METHODS

We conducted a retrospective cohort analysis of workers with workers' compensation claims for LBP in two Australian states. We investigated the association between the timing of physical therapy commencement and work disability duration using an accelerated failure time model. Median duration of work disability in paid calendar weeks was the principal outcome.

RESULTS

We examined 9160 accepted workers' compensation claims for LBP. Patients who had not seen a physical therapist had the shortest duration of disability (median, 4.1 weeks). In those who had seen a physical therapist, the median duration of work disability was associated with the timing of commencement of physical therapy, from 8.0 weeks for care within 7 days of the injury to 34.7 weeks when care was commenced greater than 30 days after the onset of injury. Our adjusted model demonstrated that, compared to physical therapy within 7 days of injury onset, commencement of physical therapy between 8 and 14 days, 15 and 30 days, and greater than 30 days was associated with a 37.0% (Time ratios (TR) 1.37; 95% CI (1.23, 1.52)), 119% (TR 2.19; 95% CI (1.96, 2.44)) and 315% (TR 4.51; 95% CI (4.06, 5.02)) increased likelihood of longer disability duration, respectively.

CONCLUSIONS

In workers with work-related LBP undertaking physical therapy, early commencement of physical therapy was associated with a significantly shorter duration of disability. Although we cannot establish causality, our findings highlight the potential benefits of initiatives that promote timely initiation of treatment in reducing extended work disability for injured workers undergoing physical therapy for LBP.

Is low-value care for persistent musculoskeletal pain more common in rural than urban areas? A scoping review

BACKGROUND

Low-value care refers to the provision of health services that confer little or no benefit to patients, or have the potential to incur unwarranted harms. A breadth of literature exists investigating geographical variations in rates of potential low-value interventions for musculoskeletal pain. This scoping review aimed to examine the provision of low-value care for osteoarthritis and lower back pain by degree of rurality (e.g., urban, rural and remote areas).

METHODS

This scoping review followed the Joanna Briggs Institute (JBI) methodology. Electronic searches were performed on five literature databases with no time frame, language or terminology restrictions. Two independent reviewers screened titles and abstracts, reviewed full papers and extracted data from selected studies using a COVIDENCE-developed data extraction tool.

RESULTS

After screening, 21 papers were selected. Two of the papers explicitly referenced low-value care while 19 investigated the provision of potential low-value interventions. Hip and knee arthroplasty, knee arthroscopy, inappropriate pharmacotherapy and complementary and alternative medicine, were more common in rural compared to urban areas. Hip and knee arthroplasty (in women), lumbar spinal fusion, spinal imaging and glucosamine use, were less common in remote compared to regional and urban areas.

CONCLUSIONS

There is a higher report of multiple low-value interventions for osteoarthritis and lower back pain in rural compared to urban areas and lower reporting in remote areas. The lack of healthcare services in rural areas may promote low-value care, while geographical isolation in remote areas may limit utilization of both low- and high-value interventions.

Factors Associated with the Timing of Initial Visit to Healthcare Providers for Injured Workers with Low Back Pain Claims: A Multijurisdiction Retrospective Cohort

PURPOSE

Evidence shows that patient outcomes following musculoskeletal injury have been associated with the timing of care. Despite the increasing number of injured workers presenting with low back pain (LBP) in primary care, little is known about the factors that are associated with the timing of initial healthcare provider visits. This study investigated factors that are associated with the timing of initial workers' compensation (WC)-funded care provider visits for LBP claims.

METHODS

We used a retrospective cohort design. A standardised multi-jurisdiction database of LBP claims with injury dates from July 2011 to June 2015 was analysed. Determinants of the time to initial general practitioner (GPs) and or musculoskeletal (MSK) therapists were investigated using an accelerated failure time model, with a time ratio (TR) > 1 indicating a longer time to initial healthcare provider visit.

RESULTS

9088 LBP claims were included. The median time to first healthcare provider visit was 3 days (interquartile range (IQR) 1-9). Compared to General practitioners (GPs) (median 3 days, IQR 1-8), the timing of initial consultation was longer if the first healthcare providers were MSK therapists (median 5 days, IQR 2-14) (p < 0.001). Female workers had a shorter time to first healthcare provider visit [TR = 0.87; 95% CI (0.78, 0.97)] compared to males. It took twice as long to see MSK therapists first as it did to see GPs for injured workers [TR = 2.12; 95% CI (1.88, 2.40)]. Professional workers and those from remote areas also experienced delayed initial healthcare provider visits.

CONCLUSIONS

The time to initial healthcare provider visit for compensable LBP varied significantly by certain occupational and contextual factors. Further research is needed to investigate the impact of the timing of initial visits to healthcare providers on claim outcomes.

Patterns of physiotherapy attendance in compensated Australian workers with low back pain: a retrospective cohort study

ABSTRACT

Workers with low back pain (LBP) frequently seek care from physiotherapists. We sought to identify patterns of physiotherapy attendance and factors associated with these patterns in Australian workers with accepted compensation claims for LBP. We included workers with accepted workers' compensation claims for LBP from 4 Australian states between 2011 and 2015. We used trajectory modelling to identify distinct groups of workers based on the number (ie, volume) of monthly physiotherapy attendances over a 2-year period from claim acceptance. Descriptive statistics and logistic regression models were used to compare the characteristics of the groups. A small but significant proportion attend numerous times over a long period. 79.0% of the sample (N = 22,767) attended physiotherapy at least once in the 2 years after claim acceptance. Among these, trajectory modelling identified 4 distinct patterns of attendance. Most (N = 11,808, 51.9%) recorded a short-term low-volume pattern, 26.8% (n = 6089) recorded a short-term high-volume pattern, 14.3% (n = 3255) recorded a long-term low-volume pattern, and 7.1% (n = 1615) recorded a long-term high-volume pattern. Workers from Victoria (OR 0.34, 99% CI 0.31, 0.37), South Australia (OR 0.69, 99% CI 0.60, 0.80), and Western Australia (OR 0.79, 99% CI 0.69, 0.88) were significantly less likely to attend physiotherapy than workers from Queensland. Victorian workers were significantly more likely to be in one of the 2 long-term trajectory groups (OR 8.17, 99% CI 6.86, 9.73; OR 18.68, 99% CI 13.57, 25.70). In conclusion, most compensated Australian workers with LBP attend physiotherapy. Significant interjurisdictional differences between attendance patterns suggests that policy may play an important role in healthcare delivery.

The Association of Physiotherapy and Opioid Use With Duration of Compensated Time Loss for Workers With Low Back Pain

OBJECTIVE

To determine patterns of physiotherapy and opioid use among compensated workers with low back pain (LBP), factors associated with these, and their association with time loss.

METHODS

Accepted Victorian and South Australian workers' compensation claims, services, and medicines data for LBP claims lodged June 30, 2010-July 1, 2015. Descriptive statistics, multinomial logistic, and Cox regression were used to determine usage groups, their predictors, and effect of these on time loss.

RESULTS

Of 15,728 claims, 24.4% received no services, 3.6% received opioids only, 43.3% received physiotherapy only, and 28.8% received both opioids and physiotherapy. Sex, age, occupation, remoteness, jurisdiction, and socioeconomic status were significantly associated with usage groups. Using opioids and physiotherapy had the longest time loss.

CONCLUSIONS

Any services/medicine usage was associated with increased time loss and was longest for combined physiotherapy and opioids.

The Prevalence of Mental Health Service Use in Australian Workers with Accepted Workers' Compensation Claims for Low Back Pain: A Retrospective Cohort Study

PURPOSE

Low back pain (LBP) is a leading cause of disability globally and interferes with work performance and quality of life. For work-related LBP, Australian workers can receive workers' compensation and access funded healthcare to promote recovery, including mental health services, as there are strong links between chronic LBP and mental health. The objective of this study was to determine the prevalence of funded mental health services for workers with compensated LBP.

METHODS

Claims and services data from four Australian workers' compensation jurisdictions were analysed. Prevalence of accessing at least one mental health service was reported as a percentage of all claims overall and by duration of time loss, age group, sex, financial year of claim lodgement, jurisdiction, socioeconomic status and remoteness. Odds of accessing at least one service was determined using logistic regression.

RESULTS

Almost 10% of LBP claims accessed at least one mental health service (9.7%) with prevalence increasing with time loss. Prevalence was highest in Victoria however a higher percentage of workers with LBP accessed mental health services earlier in Queensland. Odds of accessing services was highest with longest time loss duration, among females and in Queensland. Lower odds were observed in regional areas and among those aged over 56 years.

CONCLUSION

Findings suggest opportunities for workers' compensation regulators and insurers to provide greater access to appropriate mental health services alongside physical treatment as standard practice, such as those in more remote locations or earlier in a claim, to improve recovery outcomes for workers with LBP.

Development and initial application of a harmonised multi-jurisdiction work injury compensation database

Objectives

Workers' compensation schemes provide funding for wage replacement and healthcare for injured and ill workers. In Australia, workers' compensation schemes operate independently in different jurisdictions, making comparisons of health service use challenging. We sought to develop and deploy a new database of health service and income support data, harmonising data from multiple Australian workers' compensation jurisdictions.

Methods

We worked with workers' compensation authorities from six Australian jurisdictions to combine claims, healthcare, medicines and wage replacement data for a sample of compensated workers with claims for musculoskeletal conditions. We designed a structured relational database and developed a bespoke health services coding scheme to harmonise data across jurisdictions.

Results

The Multi-Jurisdiction Workers' Compensation Database contains four data sets: claims, services, medicines and wage replacement. The claims data set contains 158,946 claims for low back pain (49.6%), limb fracture (23.8%) and non-specific limb conditions (26.7%). The services data set contains a total of 4.2 million cleaned and harmonised services including doctors (29.9%), physical therapists (56.3%), psychological therapists (2.8%), diagnostic procedures (5.5%) and examinations and assessments (5.6%). The medicines data set contains 524,380 medicine dispenses, with 208,504 (39.8%) dispenses for opioid analgesics.

Conclusions

The development of this database presents potential opportunities to gain a greater understanding of health service use in the Australian workers' compensation sector, to measure the impact of policy change on health services and to provide a method for further data harmonisation. Future efforts could seek to conduct linkage with other data sources.

Framing the Care of Injured Workers: An Empirical Four-Jurisdictional Comparison of Workers' Compensation Boards' Healthcare Policies

PURPOSE

The objective of this study was to explore how workers' compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers' compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers?

METHODS

We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis.

RESULTS

We identified two main themes: (1) Shaping HCPs' clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP's behaviours with workers; (2) Controlling workers' trajectories of care. This theme presents how WC policies achieve control of the workers' trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs.

CONCLUSIONS

This policy analysis shed light on the different ways in which WC policies shape HCP's day-to-day practices and workers' trajectories. A better understanding and a nuanced portrait of these policies' impacts can help support reflections on future policy changes and inform policy development in other jurisdictions.

Variation in General Practice Services Provided to Australian Workers with Low Back Pain: A Cross-Jurisdictional Comparative Study

PURPOSE

To compare the frequency of General Practitioner (GP) services and the time between first and last GP services (service duration) provided to workers with low back pain (LBP) between four Australian workers' compensation jurisdictions.

METHODS

Retrospective cohort study using service level data collated from the Australian states of Western Australia, South Australia, Victoria and Queensland. Negative binomial regression was used to compare GP service volume between jurisdictions in workers with accepted LBP compensation claims. Quantile regression was used to compare GP service duration. Models were adjusted for sociodemographic factors and occupation. Analyses were repeated in four cohorts with progressively more restrictive cohort definitions to account for the influence of jurisdictional policy variation in employer excess, service delivery and maximum time-loss benefit duration.

RESULTS

The study sample included 47,185 time-loss claims accepted between July 2010 and June 2015, that were linked with 452,391 GP services. Workers with LBP in Queensland recorded significantly fewer GP services funded and recorded significantly shorter average service duration than in other states. This pattern of jurisdictional variation was evident in all four cohorts, but was attenuated when cohorts excluded short- and long duration claims. In the final, most restricted cohort statistically significant adjusted incidence rate ratios of 1.47-1.60 were observed in Victoria, South Australia and Western Australia, while these states recorded additional service duration of 4.3-20.7 weeks at the median.

CONCLUSION

There is significant variation in provision of GP services to injured workers with LBP between four Australian workers' compensation jurisdictions. Administrative requirements for time-based provision of work capacity certificates by medical practitioners may be contributing to service variation.