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Less coordination of care was found to be a factor in injured workers who relied on “extended” physical rehabilitation post-injury, according to a study released Wednesday by the Workers Compensation Research Institute.
According to WCRI, physical medicine services are commonly used in treating workers with lower back pain and other musculoskeletal injuries, and in recent years, there has been an increase in the frequency of claims receiving physical medicine services. After adjusting for the differences in severity and other factors, WCRI found that claims with extended physical medicine use had higher overall medical costs, higher indemnity payments and a longer duration of temporary disability.
Most treatment guidelines for low back pain address initial physical medicine care, leaving subsequent care ordered by providers over a longer period of time at the discretion of the employers or payers, according to the study, which pegged several factors as increasing the likelihood of extended services.
The most important factors are related to the involvement of multiple providers in care, suggesting that better coordination between providers could result in less visits, according to WCRI.
Severity indicators also predict extended physical medicine use. For example, claims with nerve involvement were 2.4 times more likely to have extended physical medicine use relative to similar cases without neuropathic conditions. Workers with at least one comorbidity were also 1.8 times more likely to have extended physical medicine visits, according to WCRI.
Practice patterns also made a difference in predicting the likelihood of having extended physical medicine use, as WCRI found that if a claim already had 15 or more visits during the initial six weeks of physical medicine care, the claim was twice as likely to have extended physical medicine use compared to a claim with fewer than 15 visits within six weeks.
WCRI also found that a worker’s characteristics had a “small influence” on the likelihood of having extended physical medicine use. For example, younger male workers were less likely to have extended physical medicine use while workers aged 55 or older had an increased likelihood of having extended physical medicine use.