Conclusion: “Patients with Work-Related Back Injury Who Initiated Care with A Chiropractor Less Likely to Be Receiving Time Loss Compensation At 1 Year”
A population-based prospective cohort study published in the American Journal of Industrial Medicine shows that patients with work-related back injury who initiated care with a chiropractor were less likely to be receiving time loss compensation at one year, compared to those who first saw a primary care physician. The objective of the study was to determine if the first provider seen for a work-related back injury affects the likelihood of long-term (1-year) temporary total disability.
The study authors:
- Analyzed data from workers’ compensation claimants with a work-related back injury who initiated care with either a chiropractor or a primary care physician
- 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 one year after claim initiation
- Used 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
Of 1,219 participants, 541 (44.4%) initiated care with a chiropractor. Those who initiated care with a chiropractor were less likely to be on time-loss at one year, as estimated by adjusted multivariate logistic regression (4.8% vs. 11.8%).
The study authors note: “Understanding predictors of long‐term disability is an important part of improving clinical outcomes for workers who experience back pain. Prior studies have observed an association between the type of healthcare provider first seen following the onset of back pain and health care utilization and outcomes.” For example, the authors write, seeing a chiropractor first, compared to a physician or primary care provider, has been associated with:
- Less disability
- Lower overall healthcare utilization, fewer opioid prescriptions
- Lower overall health care costs
Conclusion
The authors conclude: “Patients with work-related back injury who initiated care with a chiropractor were less likely to be receiving time loss compensation at one year compared to those who saw a primary care physician. Chiropractic patients differed from primary care physician patients for some sociodemographic, employment, and health‐related characteristics, but importantly these factors did not account for the differential outcome by provider type. Future studies should explore downstream costs and interventions based on the initial provider type seen. Given these findings, it may be beneficial for health care delivery systems to consider improving early access to chiropractic services for back pain patients in their care pathways, and for insurers to review policies that may create barriers to early access.”
Source: M. Young, A. Elmore, E. J. Roseen, D. Fulton-Kehoe, and G. Franklin, “The Association of First Provider Seen With Time Loss From Work Among Workers With Back Injury: A Cohort Study,” American Journal of Industrial Medicine 69 (2026): 645-656, https://doi.org/10.1002/ajim.70097.
