Clinical Guidelines Improve Low Back Pain Outcomes

  • Published
  • 18 June 2021
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  • News

Employees with work-related low back pain missed 11.5 fewer workdays in the year following injury onset when they received interventions recommended in peer-reviewed medical guidelines, according to findings published June 17 in PLOS ONE.

In a collaborative study, researchers with the University of Utah Health and MDGuidelines reviewed California workers’ compensation claims that were filed between 2009 and 2018 by employees with uncomplicated, acute low back pain or strain, a common complaint. Researchers tracked whether treatments prescribed in clinic visits within the first week after injury were categorized as recommended or non-recommended in the American College of Occupational and Environmental Medicine (ACOEM)’s Low Back Disorders Practice Guideline. They assumed that similar treatment patterns would continue in subsequent clinic visits to reach their conclusions.

MDGuidelines include ACOEM guidelines and recovery timeframe estimates. WorkCare’s occupational medicine physicians follow ACOEM guidelines. In most cases, employees who are directed by their employer to use Incident Intervention, WorkCare’s 24/7 telehealth triage program, are able to resolve low back pain with guided self-care at the workplace without a clinic referral or missing work.

When a WorkCare clinician refers an injured worker to a local provider for follow-up or the employee requests a referral, a WorkCare physician contacts the treating provider for a peer-to-peer consultation about care recommendations and return-to-work pathways in accordance with guidelines. This delivery model is designed to improve health outcomes while reducing medical costs, unnecessary prescription medications, claims and recordable injury rates by ensuring delivery of the right care, at the right time, in the right setting – not less care.

“The closer people’s care follows evidence-based guidelines, the faster their back pain resolves, by quite a bit,” said Kurt Hegmann, M.D., director of the University of Utah Rocky Mountain Center for Occupational and Environmental Health and lead author of the study, Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system.

About 65 percent of claimants in the study received at least some non-recommended treatments. Among the nearly 60,000 people whose medical claims were analyzed, 14 percent received only non-recommended treatments, 14 percent received only recommended treatments, 51 percent received a mix of non-recommended and recommended treatments and 21 percent did not receive any medical intervention.

The most common non-recommended treatments were prescriptions for opioids, which can be demotivating and addictive, and X-rays. The most common recommended treatments were nonsteroidal anti-inflammatory medications and muscle relaxants.