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As an increasing number of workers with injuries are receiving physical therapy, a new study from the Workers Compensation Research Institute finds that for workers with low back pain only injuries, early initiation of PT is associated with lower utilization and costs of medical services and shorter duration of temporary disability.

“This is a comprehensive study that shows a strong association between PT timing and outcomes for workers with low back pain,” said WCRI President and CEO John Ruser. “While the study cannot conclude that early PT causes better outcomes, it does suggest that the potential benefits of early PT should be considered when planning care for these injuries.”

The study ─The Timing of Physical Therapy for Low Back Pain: Does It Matter in Workers’ Compensation? ─ focuses on claims with LBP-only injuries, recognizing that PT is often used as first-line treatment for LBP and other musculoskeletal injuries before considering opioid prescriptions and invasive procedures. Controlling for a rich set of factors that might influence both PT timing and outcomes, the study finds the following:

Later timing of PT initiation is associated with longer TD duration. On average, the number of TD weeks per claim was 58 percent longer for those with PT initiated more than 30 days post injury and 24 percent longer for those with PT starting 15 to 30 days post injury, compared with claims with PT within 3 days post injury.
Workers whose PT treatment started more than 30 days post injury were 46 and 47 percent more likely to receive opioid prescriptions and MRI, respectively, compared with those who had PT treatment initiated within 3 days of injury. The differences between PT after 30 days post injury and PT within 3 days post injury were 29 percent for pain management injections and 89 percent for low back surgeries.
— The average payment for all medical services received during the first year of treatment was lower for workers with early PT compared with those with late PT. For example, the average medical cost per claim for workers who had PT more than 30 days post injury was 24 percent higher than for those who had PT within 3 days post injury.
— Among claims with PT treatment starting more than 30 days post injury, the percentage with attorney involvement was considerably higher (27 percent compared with 13 – 15 percent among those in the early PT groups) and workers received initial medical care much later (on average 18 days compared with 2 – 3 days in the early PT groups).

This study is based on nearly 26,000 LBP-only claims with more than seven days of lost time from 27 states, with injuries from October 1, 2015, through March 31, 2017, and detailed medical transactions up through March 31, 2018. 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.

The study was authored by Dongchun Wang, Kathryn Mueller, and Randy Lea.