title: The association between physical medicine and rehabilitation service utilization and disability duration following work-related fracture.
abstract: BACKGROUND
  Rural residents with work-related fractures utilize healthcare differently and return to work (RTW) sooner than their similarly-injured urban peers.
  
  
  OBJECTIVE
  To elucidate the relationship between physical medicine and rehabilitation (PM&R) service usage and work-disability duration following work-related injury.
  
  
  METHODS
  Retrospective cohort study, employing a two-phase sequential analysis. The project involved a longitudinal analysis of PM&R utilization and work-disability duration of 2,216 people across the U.S. who fractured a bone, received PM&R services, and had at least seven days off work. In the first phase of the analysis each individual was assigned a PM&R utilization score based on how similar his or her usage was to that typical of rural residents. The second phase tested the relationship between assigned PM&R utilization scores and work-disability duration.
  
  
  RESULTS
  Differences in urban versus rural PM&R utilization included less total PM&R services and fewer passive services in the first 8 weeks for rural claimants. Among those off work for more than a month, rural residents used more active services just prior to RTW, with a gradual decreasing of services leading up to RTW. Controlling for covariates, aggregate PM&R utilization scores were found to relate to time to first RTW (Hazard Ratio=1.66, p<0.005).
  
  
  CONCLUSIONS
  Findings suggest that using services in a way that is more consistent with rural patterns is associated with decreased work-disability durations. Consistent with previous studies, results suggest that passive services, prolonged episodes of care, and failure to focus on transitioning to self-management are related to longer work-disability durations.
authors.affiliation: Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Young
authors.affiliation: Occupational Health Department, Kaiser Permanente, San Francisco, CA, USA.
authors.forename: Stasia
authors.initials: S
authors.lastname: Muhlner
authors.affiliation: Work Environment, University of Massachusetts, Lowell, MA, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Kurowski
authors.affiliation: Work Environment, University of Massachusetts, Lowell, MA, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cifuentes
mesh_terms: D000328:Adult; D005260:Female; D050723:Fractures, Bone / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D060051:Occupational Injuries / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D010810:Physical and Rehabilitation Medicine / Q000379:methods; D012189:Retrospective Studies; D062707:Return to Work; D012424:Rural Population / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*; D014942:Workers' Compensation; D055815:Young Adult
keywords: Occupational-injury; rehabilitation; return-to-work; rural-urban differences; workers' compensation