title: Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain.
abstract: Objective To compare the duration of financial compensation and the occurrence of a second episode of compensation of workers with occupational back pain who first sought three types of healthcare providers. Methods We analyzed data from a cohort of 5511 workers who received compensation from the Workplace Safety and Insurance Board for back pain in 2005. Multivariable Cox models controlling for relevant covariables were performed to compare the duration of financial compensation for the patients of each of the three types of first healthcare providers. Logistic regression was used to compare the occurrence of a second episode of compensation over the 2-year follow-up period. Results Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100 % wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10-1.31], P value < 0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100 % compensation (adjusted HR = 0.84 [0.71-0.98], P value = 0.028) during the first 149 days of compensation. The odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist (OR = 1.49 [1.02-2.19], P value = 0.040) rather than a physician (reference). Conclusion The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest. These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker's compensation system. Further investigation is required to understand the between-provider differences.
authors.affiliation: Public Health PhD Program, School of Public Health, University of Montreal, Montreal, QC, Canada. marc-andre.blanchette@umontreal.ca.
authors.forename: Marc-André
authors.identifier: 0000-0001-7172-7344
authors.initials: MA
authors.lastname: Blanchette
authors.affiliation: Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.|Public Health Research Institute, University of Montreal, Montreal, QC, Canada.
authors.forename: Michèle
authors.initials: M
authors.lastname: Rivard
authors.affiliation: Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, QC, Canada.|Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec (CHUQ), Québec City, QC, Canada.
authors.forename: Clermont E
authors.initials: CE
authors.lastname: Dionne
authors.affiliation: Institute for Work & Health, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Sheilah
authors.initials: S
authors.lastname: Hogg-Johnson
authors.affiliation: Institute for Work & Health, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Ivan
authors.initials: I
authors.lastname: Steenstra
mesh_terms: D001416:Back Pain / Q000191:economics / Q000628:therapy*; D002684:Chiropractic / Q000706:statistics & numerical data; D015331:Cohort Studies; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D060051:Occupational Injuries / Q000191:economics / Q000628:therapy*; D059825:Physical Therapists / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012008:Recurrence; D013997:Time Factors; D014942:Workers' Compensation / Q000191:economics / Q000706:statistics & numerical data*
keywords: Back pain; Chiropractic; Compensation duration; Healthcare provider; Medicine; Occupational; Physiotherapy