Workers with low back pain (LBP) who received manual therapy (MT) early within two weeks of their physical therapy care (PT) had lower medical costs and fewer days away from work than those who received it later, according to a new study from the Workers Compensation Research Institute (WCRI). MT is hands-on therapy that improves range of motion and reduces pain.

“This is a unique study that addresses an unfamiliar but important health care issue in workers’ compensation,” said John Ruser, president and CEO of WCRI. “Although the findings only provide evidence of association between the use and early use of MT and outcomes, it helps fill information gaps in medical and health care policy research regarding this therapy.”

The study, Outcomes Associated with Manual Therapy for Workers with Non-Chronic Low Back Pain, focuses on LBP claims in 28 states. It compares costs and outcomes between claims with early and late MT and between claims with and without MT. The following are among the study’s findings:

– – Among workers with LBP who received MT, early MT (within 2 weeks of PT care) was associated with lower costs and shorter temporary disability (TD) duration as compared with late MT (after 2 weeks of PT care). Early MT was also associated with a lower likelihood of receiving magnetic resonance imaging (MRI), pain management injections, and opioids, as compared with late MT.
– – Among workers with LBP, those who received MT had higher costs and slightly longer TD durations than those who did not receive MT but received other PT services. These differences may partly reflect dissimilarities in injury severity or underlying health conditions that cannot be measured in the data. Also, longer periods of observation (more than 18 months) may be important to consider when addressing the cost effectiveness of MT treatment.
– – Large interstate variations in the utilization of MT services were seen across the 28 study states, which could be explained, to some extent, by differences in state policies influencing provider practices and billing.

The findings are based on statistical analysis that controls for various factors affecting treatment choice and outcomes. Data used for the analysis capture medical services and benefit payments at 18 months postinjury for workers with LBP who did not have surgery but received MT and other medical services provided by non-chiropractic providers.

The 28 study states are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.