Injured workers with low back pain whose injuries are covered by workers' compensation reported the lowest improvement in function following physical therapy compared to patients covered by all other payment systems, according to study released Tuesday by the Workers Compensation Research Institute.

The data used in the study was collected at admission and discharge from low back pain patients who received outpatient physical therapy or occupational therapy in the United States from 2017 to 2021 and included 1.3 million patients covered under workers’ compensation, private insurance, Medicare, Medicaid, auto insurance, other insurance or self-paid.

Of them, workers' comp patients reported the least improvement in function.

WCRI noted in its analysis that features unique to the comp system, such as no co-pays and instances where providers are called to determine maximum medical improvement status for workers, “could potentially explain the differences between workers’ comp and non-workers' comp patients.”

Another explanation, WCRI said, might be the presence of biopsychosocial factors “which may have disproportionate prevalence and impact on workers’ comp patients.”

The report said, “[W]ork-related low back pain disability tends to be substantially influenced by non-clinical factors such as poor recovery expectations after an injury, fear of pain due to movement, catastrophizing, perceived injustice, job dissatisfaction, pessimism, being fearful in general, having low levels of motivation” and a “lack of family or community support systems.”

More information about the WCRI report is here.

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