The Association of First Provider Seen with Time Loss from Work Among Workers with Back Injury: A Cohort Study

Details

• Journal Article:
  American Journal of Industrial Medicine
• Personal Author:
  Young, Morgan ; Elmore, Andrea ; Roseen, Eric J. ; Fulton-Kehoe, Deborah ; Franklin, Gary
• Description:
  Background: Prior evidence suggests that seeking initial care from a chiropractor for back pain, compared to seeing a primary care provider first, is associated with better clinical outcomes. However, prior studies have not comprehensively adjusted for potential confounders and few studies have focused on work-related outcomes. Methods: This population-based prospective cohort study analyzed data from workers' compensation claimants with a work-related back injury who initiated care with either a chiropractor or a primary care physician. We evaluated the association of seeing a chiropractor first, compared to seeing a primary care physician first, with receipt of wage replacement benefits for temporary total disability (time loss) at 1 year after claim initiation. Association was estimated using logistic regression adjusting for potential confounders including patient sociodemographic characteristics, employment details, self-reported pain and physical function, injury severity, healthcare factors, and psychological factors. The E-value was used to assess unmeasured confounding. Results: Of 1219 participants (mean age = 39, 67.5% male, 72.1% non-Hispanic White), 541 (44.4%) initiated care with a chiropractor. Participants who saw a chiropractor first, compared to a primary care physician first, were less likely to be on time-loss at 1 year as estimated by adjusted multivariate logistic regression (4.8% vs. 11.8%; adjusted odds ratio OR: 0.45, 95% CI: 0.24-0.86; E-value: 3.8). Conclusions: Patients with work-related back injury who initiated care with a chiropractor were less likely to be receiving time loss compensation at 1 year compared to those who saw a primary care physician. Comprehensive adjustment for patient characteristics did not account for the differential outcome by provider type. Description provided by NIOSH
• Subjects:
  • Back Injuries
  • Occupational Health
  • Safety
  • Workers' Compensation
• Keywords:
  • Workers Compensation; Lost work days; Back injuries; Cohort studies; Population based studies; Medical care;
  • Author Keywords: back pain; chiropractic; health care utilization; work disability; workers' compensation
• Source:
  Am J Ind Med 2026 May; :Epub ahead of print
• ISSN:
  0271-3586
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  San Francisco Region OSHA ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  12 pdf pages
• Volume:
  2026
• NIOSHTIC Number:
  nn:20071687
• Contact Point Address:
  Morgan Young, Washington State Department of Labor and Industries, Tumwater, Washington, USA
• Email:
  yomo235@lni.wa.gov
• Federal Fiscal Year:
  2026
• Performing Organization:
  University of Washington
• Peer Reviewed:
  True
• Start Date:
  20010930
• End Date:
  20070929
• Download URL:
  https://stacks.cdc.gov/view/cdc/259458/cdc_259458_DS1.pdf
• File Type:
  [PDF - 934.75 KB]
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:77e69251f0e4c118f024e242cdf8e072e57817225eab7181375f80a597116d3c2469e5a14f2e5786c6d6226824246049e19aaea4cc918b9ab6b7b256f7fe72f8