Regional Variation in Management Strategies for Occupational Low Back Pain in Australia

Area of Science:

• Occupational Health
• Health Services Research
• Pain Management

Background:

• Limited understanding of treatment pathways for lower back pain (LBP) in workers' compensation (WC) claims.
• Investigating transitions between physical therapy and pharmaceutical pain management is crucial for optimizing care.
• Geographic variations in treatment access and utilization warrant examination within WC systems.

Purpose of the Study:

• To analyze treatment transitions for physical therapy and pain medications in Australian workers' compensation (WC) lower back pain (LBP) claims.
• To identify potential geographic disparities in treatment pathways within Victoria's WC system.
• To inform targeted interventions and resource allocation for LBP management.

Main Methods:

• Markov transition matrices were used to analyze treatment pathways.
• Data from 32,132 accepted LBP claims in the Victorian WC scheme (2010-2017) were examined.
• Transitions were assessed at 1, 3, 6, 12, and 24 months post-claim, considering geographic location (major city/inner regional vs. outer regional/remote).

Main Results:

• Physical therapy was initiated earliest (median 77 days), followed by opioids (median 162 days) and other medications (median 157 days).
• Workers in outer regional/remote areas received 11.8% less physical therapy compared to those in major cities/inner regions, a disparity consistent over time.
• Those in outer regional/remote areas had higher probabilities of receiving only pharmaceutical treatment, especially in sub-acute and persistent pain phases.

Conclusions:

• Significant geographic disparities exist in recommended treatment guidelines for LBP within the WC system.
• Opioid use was more prevalent as a first-line treatment in outer regional/remote areas, contrasting with a preference for physical therapy in major cities/inner regions.
• Further research into accessibility is recommended to address these disparities and inform targeted interventions and resource distribution.