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

Little is known about transitions in physical therapy and pharmaceutical pain management among workers' compensation (WC) claims with lower back pain (LBP). This study examined these transitions within Victoria's WC system-one of 11 in Australia-to better understand treatment pathways and potential geographic variation.

Treatment transitions were analysed using Markov transition matrixes based on 32,132 accepted LBP claims with two years of medicine and service data from the Victorian WC scheme (01/01/2010-31/12/2017; data censored 31/12/2019). Transitions were assessed within 1, 3, 6, 12, and 24 months post claim. Geographic location was coded as major city/inner regional vs. outer regional/remote.

Physical therapy was initiated earliest (median: 77 days post claim; interquartile range [IQR]: 19-217). Opioids and other medications followed, with median initiation at 162 (IQR: 36-412) and 157 (IQR: 77-407) days, respectively. During the acute period, an 11.8% lower proportion of workers from outer regional/remote areas received physical therapies compared to those from major cities/inner regional areas, this gap remained consistent throughout the entire follow-up period. They also showed slightly higher probabilities of receiving only pharmaceutical treatment, particularly during the sub-acute and persistent periods.

The findings reveal geographic disparities in recommended treatment guidelines. Opioids were more likely used as first-line treatments for WC claims in outer regional/remote areas, while physical therapy was favoured in major cities/inner regional areas. Further research should explore whether accessibility contributes to these disparities. Understanding such disparities is essential for informing targeted interventions, clinician education, and resource distribution.