title: Workers' characteristics associated with the type of healthcare provider first seen for occupational back pain.
abstract: Few studies have compared the factors that drive patients' decision to choose a chiropractor, physician or physiotherapist as their first healthcare provider for occupational back pain. The purpose of this study is to identify characteristics associated with the choice of first healthcare provider seen for acute uncomplicated occupational back pain.
  
  
  
  We analyzed data collected by the Workplace Safety and Insurance Board from a cohort of workers with compensated back pain in 2005 in Ontario (Canada). Multivariable logistic regression models were created to identify factors associated with the type of first healthcare provider seen (chiropractor, physician, or physiotherapist). Adjustments to the final models were evaluated using the area under the receiver-operating characteristics curve (ROC).
  
  
  
  According to the 5520 analyzed claims, 85.3 % of the patients saw a physician, 11.4 % saw a chiropractor, and 3.2 % saw a physiotherapist. Longer job tenure (odds ratio (OR) = 1.02, P = 0.004), higher gross personal income (OR = 1.06, P = 0.018), mixed-manual job (OR = 1.35, P = 0.004) and previous similar injury (OR = 1.60, P < 0.001) increased the odds of seeing a chiropractor rather than a physician, while the size of the community (>500,000 inhabitants) and the availability of an early return to work program in the workplace (OR = 0.77, P = 0.035) decreased it. The odds of seeing a physiotherapist rather than a physician increased with increasing age (OR = 1.19, P = 0.019), previous similar injury (OR = 1.71, P < 0.001) and severity of injury (OR = 2.03, P = 0.010). Increased age (OR = 1.28, P = 0.008) and size of community (>1,500,000 inhabitants; OR = 2.58, P = 0.002) increased the odds of seeing a physiotherapist rather than a chiropractor, while holding a mixed-manual job significantly decreased those odds (OR = 0.63, P = 0.044). The area under the ROC curve of our multivariable models varied from 0.62 to 0.64.
  
  
  
  The type of first healthcare provider sought for occupational back pain is influenced by injury-and work-related factors and by the worker's age, income and community size. Contrary to previous studies, the workers who first sought a physician did not have higher odds of having a severe injury.
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.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: D000328:Adult; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data; D008875:Middle Aged; D060051:Occupational Injuries / Q000628:therapy*; D016017:Odds Ratio; D009864:Ontario; D057240:Patient Preference / Q000706:statistics & numerical data*; D059825:Physical Therapists / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D012372:ROC Curve
keywords: Back pain; Chiropractic; Determinants; Healthcare provider; Medical doctor; Occupational health; Physiotherapy; Primary care