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Workers with low back pain (LBP) frequently seek care from physiotherapists. We sought to identify patterns of physiotherapy attendance and factors associated with these patterns in Australian workers with accepted compensation claims for LBP. We included workers with accepted workers' compensation claims for LBP from 4 Australian states between 2011 and 2015. We used trajectory modelling to identify distinct groups of workers based on the number (ie, volume) of monthly physiotherapy attendances over a 2-year period from claim acceptance. Descriptive statistics and logistic regression models were used to compare the characteristics of the groups. A small but significant proportion attend numerous times over a long period. 79.0% of the sample (N5 22,767) attended physiotherapy at least once in the 2 years after claim acceptance. Among these, trajectory modelling identified 4 distinct patterns of attendance. Most (N = 11,808, 51.9%) recorded a short-term low-volume pattern, 26.8% (n = 6089) recorded a short-term high-volume pattern, 14.3% (n = 3255) recorded a long-term low-volume pattern, and 7.1% (n = 1615) recorded a long-term high-volume pattern. Workers from Victoria (OR 0.34, 99% CI 0.31, 0.37), South Australia (OR 0.69, 99% CI 0.60, 0.80), and Western Australia (OR 0.79, 99% CI 0.69, 0.88) were significantly less likely to attend physiotherapy than workers from Queensland. Victorian workers were significantly more likely to be in one of the 2 long-term trajectory groups (OR 8.17, 99% CI 6.86, 9.73; OR 18.68, 99% CI 13.57, 25.70). In conclusion, most compensated Australian workers with LBP attend physiotherapy. Significant interjurisdictional differences between attendance patterns suggests that policy may play an important role in healthcare delivery. [ABSTRACT FROM AUTHOR]

This study shows that more continuous care with a primary care physician is associated with less working time loss in workers with low back pain. This relationship is strongest in workers with more than 2 months off work. Policies and practices that support continuity of care may help prevent chronicity and reduce time away from work. Objectives: The aims of the study are to determine the continuity of care (CoC) provided by primary care physicians among workers with low back pain, to identify factors associated with CoC, and to investigate whether CoC is associated with working time loss. Methods: Continuity of care was measured with the usual provider continuity metric. Ordinal logistic regression models examined factors associated with CoC. Quantile regression models examined the association between working time loss and CoC. Results: Complete CoC was observed in 33.8% of workers, high CoC among 37.7%, moderate CoC in 22.1%, and low CoC in 6.4%. In workers with more than 2-months time loss, those with complete CoC had less time off work. Conclusions: Higher CoC with a primary care physician is associated with less working time loss and this relationship is strongest in the subacute phase of low back pain. [ABSTRACT FROM AUTHOR]

The Disability Support Pension (DSP) is the major Australian government financial benefit program for people of working age with medical conditions and disabilities that restrict work capacity. Between 2012 and 2018 a series of policy reforms sought to restrict the growth in DSP payments and encourage more people with some work capacity to seek employment. We characterise changes in three markers of access to disability financial support over the reform period (1) DSP recipient rates (2) DSP grant (approval) rates and (3) the rate of unemployment benefit receipt in people with impaired work capacity. Results demonstrate a significant reduction in DSP receipt and grant rates, and significant increase in the rate of unemployment benefit receipt in working-age Australians with work disabling medical conditions and disability. These changes were not distributed uniformly. People whose primary medical condition was a musculoskeletal or circulatory system disorder demonstrated greater declines in DSP receipt and grant rates, while there was a more rapid increase in unemployment benefit receipt among people with primary mental health conditions. Some trend changes occur in periods during which new disability assessment and pension eligibility policies were introduced, though our ability to attribute changes to specific policy changes is limited. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the Plan of Action for a Case (PACE) tool improved identification of workers at risk of delayed return to work. Design: Prospective cohort of workers with accepted workers' compensation claims in the state of New South Wales, Australia. Interventions: The 41-item PACE tool was completed by the case manager within the first two weeks of a claim. The tool gathered information from the worker, employer and treating practitioner. Multivariate logistic regression models predicted work time loss of at least one and three months. Results: There were 524 claimants with complete PACE information. A total of 195 (37.2%) had work time loss of at least one month and 83 (15.8%) had time loss of at least three months. Being male, injury location, an Orebro Musculoskeletal Pain Screening Questionnaire–Short Form score >50, having a small employer, suitable duties not being available, being certified unfit, and the worker having low one-month recovery expectations predicted time loss of over one month. For three months, injury location, a Short Form Orebro score >50, no return-to-work coordinator, and being certified unfit were significant predictors. The model incorporating PACE information provided a significantly better prediction of both one- and three-month outcomes than baseline information (area-under-the-curve statistics—one month: 0.85 and 0.68, respectively; three months: 0.85 and 0.69, respectively; both P < 0.001) Conclusion: The PACE tool improved the ability to identify workers at risk of ongoing work disability and identified modifiable factors suited to case manager–led intervention. [ABSTRACT FROM AUTHOR]