A recent WCRI study found that starting physical therapy within the first two weeks after injury was associated with lower medical utilization and costs, as well as a shorter duration of temporary disability.
For workers, back pain is a common worker injury. This can occur in industrial workers who lift heavy workers and office workers who may not have the ergonomic resources they need.
A recent study by WCRI found that early physical therapy can help reduce the cost of these injuries.
In a recent webinarWhen to start physiotherapy for lower back pain: does it matter for employee compensation? “WCRI went through their results This found that starting physiotherapy within the first two weeks after injury was associated with lower medical utilization and costs, as well as a shorter duration of temporary disability.
Speakers included for the webinar Dongchun Wang, economist at WCRI, Dr. Randy Lea, Senior Research Fellow at WCRI, orthopedic surgeon and chief physician at the Columbus, Ohio hospital, and Dr. Kathryn Mueller, professor at the Colorado School of Public Health and the School of Medicine, former Medical Director of the Department of Compensation for Workers in Colorado.
Wang emphasized that the study focuses on physical therapy as defined by “workers with three or more visits for PT services, and by PT services we broadly mean physical modalities, manual therapy, and therapeutic exercises.”
WCRI excluded workers with only one or two visits as this is likely just an assessment and home exercise instruction. Chiropractic was excluded as well as claims with red flags like nerve involvement.
The study at a glance
To analyze the impact of when physiotherapy was given, WCRI divided the data into five “buckets” based on the injury date: within three days, 4-7 days, 8-14 days, 15-30 days, and after 30 days. In the 27 study states, 68 percent of patients with lower back pain (LBP) received only one PT treatment, and nearly half of them received seven or more visits.
Additionally, there were big differences between states: only 44 percent of LBP-only claims in Louisiana received PT to 80 percent in Delaware. Back to the date, 48 percent of claims in the 27 study states started late, that is, after two weeks. The difference in the services associated with the late PT is amazing.
“Workers with late PT were more likely to receive medical benefits after 30 days, particularly 46 percent more likely to have opioid prescriptions, 47 percent more likely to have MRIs, and 29 percent more likely to have pain management injections.” Explained Wang.
“For lower back surgery, the surgery rate for this particular group of claims is low, but if you compare the early group and the late group, the likelihood that workers in the late PT group would be low after 30 days was 89 percent lower back surgery. ”
Overall, workers in the late PT group had 24 percent higher medical costs and 58 percent longer duration of temporary disability. “This study isn't looking at the optimal time for PT initiation, but we're examining patterns in the results and seeing evidence that leads us to conclude that 14 days is a pretty good marker for late PT,” Wang continued away.
Early PT correlates with better outcomes
While the study shows correlation and not causation, Lea and Müller have set out some clear implications for providers and employers.
“For employers, providing early access and measures to reduce costs and take-up has been an important topic in discussions about work-related injuries and illnesses for more than 20 years,” said Lea.
“Our results are consistent with this concept. Early PT intervention is beneficial from a cost and clinical perspective. “Lea also stressed that the payers can Do yourself a favor by adding a 14 day clock to your typical predictive analytics program.
Lea also noted some elements of the study that patients should consider. “For various reasons, patients can sometimes avoid or even refuse care. let us For some reason, say you don't trust the care offered. Here I think it is important to make a concerted effort to include joint decisions in the care plan. Special to let them know that research suggests late care results are less favorable, ”he explained.
Lea also commented on the fact that treatment guidelines are sometimes not detailed enough at the time of PT, but that the study can help refine those guidelines.
State Legislation Attorney
For her part, as a longtime state regulator, Mueller sees a strong call to action in the data for states to implement guidelines that encourage early PT.
“From states that had 60 percent Of all the PT cases that happen after 30 days, there are five such conditions if I were one of them conditions I would look at that because the prediction is not very good, ”she said.
“From a government regulation perspective, I'm going to look at this and say, ‘Where am I and when I have so many late cases, is there anything in my system that somehow adds to that? Are there too many prior approvals, don't they see a provider soon enough after the breach? ‘”
Mueller also encouraged government agencies and individual regulatory agencies to focus on the supplemental charts that target patients with 3-6 PT visits as opposed to patients with seven or more.
About a third of these patients received opioids and about a third received an MRI. “That doesn't go well with what most guidelines say should happen to patients who only have lower back pain and none of the red flag factors,” said Mueller.
Lea said this study suggests numerous other avenues for research, including an assessment that examines the difference between a cohort not receiving PT and the way certain patterns are set. He also suggested a future study that will identify and examine PT care patterns, and then determine their impact on usage, cost, and duration of TD.
This study is based on nearly 26,000 LBP-only claims with more than seven days of downtime from 27 states, injuries from October 1, 2015 through March 31, 2017, and detailed medical transactions through March 31, 2018.
The data was statistically checked for factors such as employee and injury characteristics, country-specific factors, attorney involvement and time of first aid.
The 27 states are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, North Carolina, Pennsylvania , South Carolina, Tennessee, Texas, Virginia and Wisconsin. &
Nina Luckman is a New Orleans-based business writer with a primary focus on the employee compensation industry. For the past few years, Nina has been the editor of the Louisiana Comp Blog, a news site she started in 2014 under the auspices of a group's auto insurance fund. She can be reached at [email protected]