The Association of First Provider Seen With Time Loss From Work Among Workers With Back Injury: A Cohort Study

The Chiro.Org Blog

SOURCE:   Am J Ind Med 2026 (May 26) [EPUB]
Brian Chin PhC, MSPH • Sean D. Rundell PT, DPT, PhD • Jeanne M. Sears PhD, RN • Deborah Fulton-Kehoe PhD, MPH • June T. Spector MD, MPH • Gary M. Franklin MD, MPH

Washington State Department of Labor and Industries,
Tumwater, Washington, USA.

FROM:   Weeks ~ JMPT 2016 (Feb)    Hurwitz ~ JMPT 2016 (May)

Background:   Prior evidence suggests that seeking initial care from a chiropractor for back pain, compared to seeing a primary care provider first, is associated with better clinical outcomes. However, prior studies have not comprehensively adjusted for potential confounders and few studies have focused on work-related outcomes.

Methods:   This population-based prospective cohort study analyzed data from workers’ compensation claimants with a work-related back injury who initiated care with either a chiropractor or a primary care physician. We evaluated the association of seeing a chiropractor first, compared to seeing a primary care physician first, with receipt of wage replacement benefits for temporary total disability (time loss) at 1 year after claim initiation. Association was estimated using logistic regression adjusting for potential confounders including patient sociodemographic characteristics, employment details, self-reported pain and physical function, injury severity, healthcare factors, and psychological factors. The E-value was used to assess unmeasured confounding.

Results:   Of 1,219 participants (mean age = 39, 67.5% male, 72.1% non-Hispanic White), 541 (44.4%) initiated care with a chiropractor. Participants who saw a chiropractor first, compared to a primary care physician first, were less likely to be on time-loss at 1 year as estimated by adjusted multivariate logistic regression (4.8% vs. 11.8%; adjusted odds ratio [OR]: 0.45, 95% CI: 0.24-0.86; E-value: 3.8).

There is more like this @ our

Return to WORKERS’ COMPENSATION Section and the

Return to INITIAL PROVIDER/FIRST CONTACT Section

Read the rest of this Full Text article now!

Conclusions:   Patients with work-related back injury who initiated care with a chiropractor were less likely to be receiving time loss compensation at 1 year compared to those who saw a primary care physician. Comprehensive adjustment for patient characteristics did not account for the differential outcome by provider type.

Keywords:   back pain; chiropractic; health care utilization; work disability; workers’ compensation.