In May, the Workers Compensation Research Institute (WCRI) announced the release of a new study on chiropractic care for low back pain. The study reveals substantial variation in the use of chiropractic care across 28 states and offers insights into the patterns and outcomes of chiropractic care.
“This study will be helpful for policymakers and stakeholders who are interested in re-evaluating the role of chiropractors, especially those who have been adopting evidence-based practices and contributing to cost-effective care,”said John Ruser, WCRI’s president and CEO.
In Michigan, WCRI found that the percentage of low-back pain claims that received chiriopractic care (in the first 18 months of treatment after the injury) was only 2.1 percent. In contrast were Minnesota (34 percent), Wisconsin (28 percent), California (25 percent), and New York (20 percent). Overall, 16 of the 28 states studies were between 5 and 34 percent. Ten states had a lower percentage than Michigan, including 1 percent in South Carolina, Georgia, Arkansas, New Jersey, and North Carolina. Of the 28 states studied, the vast majority of states with a low percentage of injured workers who saw a chiropractor were in states in which the employer controls the treatment received.
“Chiropractors often participate in the delivery of physical medicine services for low back pain, but few workers received chiropractic care in states where employers or insurers control the selection of providers,” Ruser said.
In Michigan, under the “28-Day Rule,” the employer controls the injured worker’s medical treatment for the first 28 days of treatment [MCL §418.315(1)]. After the initial 28 days, the employee can choose his or her own provider, but has to notify their employer/insurance company in writing.
The study, Chiropractic Care for Workers with Low Back Pain, describes the prevalence of chiropractic care and provider patterns of physical medicine treatment for workers with low back pain. It provides some evidence as to how different provider patterns of physical medicine treatment are associated with variations in overall medical and indemnity costs, and the duration of temporary disability. The study also looks at the utilization of medical services, including magnetic imaging studies, opioid prescriptions, and pain management injections.
Key findings of the study include:
The study found that:
In terms of temporary disability, for low-back pain claims with chiropractic-only physical medicine and E&M services, the number of weeks of temporarty disability was 86 percent lower for claimants who received chiropractic-only physical medicine and E/M services, compared to claims with non-chiropractic-only physical medicine and E/M services (0.7 to 4.9).
Additionally, in compdaring a subset of claims with similar characteristics, the study also showed that:
The data used in this study are from the WCRI Detailed Benchmark/Evaluation database, which includes more than 2 million open and closed claims from 28 states, including Michigan. Injuries were sustained over a two-year peiod (October 1, 2015 – September 30, 2017). Medical transactions were tracked thrpough March 31, 2019. Researchers compared costs and claim duration for workers treated exclusively by chiropractors, workers who received no chiropractic care, and workers who received services from chiropractors and other provider types. Claims for serious conditions needing immediate care (tumors, fractures, etc.) were excluded from the data.
The Workers Compensation Research Institute is an independent, not-for-profit research organization based in Massachuisetts. Organized in 1983, WCRI does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the United States, Canada, Australia, and New Zealand.
WCRI Press Release, “Chiropractic Care for Workers with Injuries Varied Greatly across 28 States, Finds New WCRI Study,” May 17, 2022
Chiropractic Care for Workers with Low Back Pain. Dongchun Wang, Kathryn L. Mueller, Donald R. Murphy, and Randall D. Lea. May 2022. WC-22-17