Chiropractic and Workers' Compensation

	Maintenance Care, Wellness and Chiropractic A Chiro.Org article collection Review a recent (2011) single blinded placebo controlled study, conducted by the Mansoura Faculty of Medicine, conclusively demonstrated that maintenance care provided significant benefits for those suffering from chronic low back pain.
	Integrated Health Care and Chiropractic A Chiro.Org article collection Review recent articles which suggest that adding chiropractic care to the Team helps lower costs and improves patient outcomes.
	Spinal Pain Management and Chiropractic A Chiro.Org article collection Although this page doesn not review management of Workers' Comp cases per se, these articles do support the efficasy of chiropractic (spinal manipulation) in recovery of function, patient satisfaction, and improvements of activities of daily living (ADLs).
	Effect of Chiropractic Care on Low Back Pain for Active-duty Military Members: Mediation Through Biopsychosocial Factors (NCT01692275) PLoS One 2024 (Oct 1); 19 (10): e0310642 ~ FULL TEXT This study evaluates biopsychosocial factors as mediators of the effect of chiropractic care on low back pain (LBP) intensity and interference for active-duty military members. Data from a multi-site, pragmatic clinical trial comparing six weeks of chiropractic care plus usual medical care to usual medical care alone for 750 US active-duty military members with LBP were analyzed using natural-effect, multiple-mediator modeling. In contrast with effects on pain interference, much of the effect of adding chiropractic care to usual medical care for US military members on pain intensity did not appear to occur through the PROMIS-29 biopsychosocial factors. Physical and social factors appear to be important intermediate measures for patients receiving chiropractic care for low back pain in military settings. Further study is needed to determine if the effect of chiropractic care on pain intensity for active-duty military occurs through other unmeasured factors, such as patient beliefs, or if the effect occurs directly.
	Chiropractic Care for Workers with Low Back Pain Workers Compensation Research Institute (May 17, 2022) This study describes the prevalence of chiropractic care and provider patterns of physical medicine treatment for workers with low back pain. It provides some evidence as to how different provider patterns of physical medicine treatment are associated with variations in overall medical and indemnity costs, and the duration of temporary disability. The study also looks at the utilization of medical services, including magnetic imaging studies, opioid prescriptions, and pain management injections. Claims with care provided exclusively by chiropractors were associated with lower costs and shorter duration of temporary disability than a set of claims with similar characteristics where care was exclusively provided by non-chiropractic providers.
	Guideline Adherence and Lost Workdays for Acute Low Back Pain in the California Workers' Compensation System PLoS One 2021 (Jun 17); 16 (6): e0253268 ~ FULL TEXT When workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers.
	Initial Return to Work and Long-term Employment Patterns: Associations with Work-related Permanent Impairment and with Participation in Workers' Compensation-based Return-to-work Programs Am J Ind Med 2021 (May); 64 (5): 323–337 ~ FULL TEXT State wage files provide an efficient approach to identifying RTW patterns. Workers with permanent impairment were at substantially higher risk of poor employment outcomes. WC-based RTW programs may promote better employment outcomes.
	Do Physical Therapists Follow Evidence-based Guidelines when Managing Musculoskeletal Conditions? Systematic Review BMJ Open. 2019 (Oct 7); 9 (10): e032329 ~ FULL TEXT CONCLUSIONS:   Many physical therapists seem not to follow evidence-based guidelines when managing musculoskeletal conditions. There is considerable scope to increase use of recommended treatments and reduce use of treatments that are not recommended.
	Relationship Between Early Prescription Dispensing Patterns and Work Disability in a Cohort of Low Back Pain Workers' Compensation Claimants: A Historical Cohort Study Occup Environ Med. 2019 (Aug); 76 (8): 573–581 ~ FULL TEXT Findings suggest provision of early opioids leads to prolonged work disability compared with NSAIDs and SMRs, though longer supplies of all drug classes are also associated with work disability. Residual confounding likely partially explains the findings. Research is needed that accounts for prescriber, system and workplace factors.
	Managing Sickness Absence of Patients with Musculoskeletal Pain - A Cross-sectional Survey of Scandinavian Chiropractors Chiropractic & Manual Therapies 2019 (Jan 11); 27: 1 ~ FULL TEXT Whilst not always engaged in sickness absence management with regards to musculoskeletal pain, chiropractors favour a 'return-to-work' rather than a 'stay-at-home' approach. Several practice behaviours and perceptions and beliefs are associated with these outcomes; however, system or organisational barriers are linked to clinician non-engagement.
	Effects of the New York State Workers Compensation Board Medical Treatment Guidelines on Return to Work J Occup Environ Med. 2018 (Jul); 60 (7): 617–621 Guidelines use positively influenced return-to-work after acute occupational low back injuries. Inconsistencies in following Guidelines were observed for diagnostic tests, having a potential paradoxical effect on lost time. Further studies are necessary to test for additional hypotheses.
	A Prospective Cohort Study of the Impact of Return-to-Work Coordinators in Getting Injured Workers Back on the Job J Occupational Rehabilitation 2018 (Jun); 28 (2): 298–306 ~ FULL TEXT Expectations of recovery and return-to-work, pain and disability levels, depression, workplace factors, and access to multidisciplinary resources are important modifiable factors in progressing return-to-work across health and injury conditions. Employers, healthcare providers and other stakeholders can use this information to facilitate return-to-work for injured/ill workers regardless of the specific injury or illness. Future studies should investigate novel interventions, and other factors that may be common across health conditions.
	Can Chiropractors Contribute to Work Disability Prevention Through Sickness Absence Management for Musculoskeletal Disorders? - A Comparative Qualitative Case Study in the Scandinavian Context Chiropractic & Manual Therapies 2018 (Apr 26); 26: 15 ~ FULL TEXT Allied healthcare providers (AHPs), in this instance chiropractors, with patient management expertise can fulfil a key role in SAM and by extension work disability prevention when these practices are legislatively supported. In cases where these practices occur informally, however, practitioners face systemic-related issues and professional self-image challenges that tend to hamper them in fulfilling a more integrated role as providers of WDP practices.
	Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain J Occupational Rehabilitation 2017 (Sep); 27 (3): 382–392 ~ FULL TEXT The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest. These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker's compensation system. Further investigation is required to understand the between-provider differences.
	This On-site Chiropractic Clinic Is Saving a Minnesota Manufacturer Big Money The Star Tribune ~ Jan 1, 2017 ~ FULL TEXT A year into the project, workers report that they are feeling better and like having health care services at their job. Statistics show that they are incurring injuries at much lower rates. They are also recovering quicker when they do get hurt.   And when it comes to the bottom line, the results have been better than Friendship Homes and Northwestern expected.   For every $1 that the company has invested in the program, it is saving $8 by avoiding more-costly and less-effective treatments, spending less on insurance payments and keeping more workers on the job in the first place, which generates savings through less lost tine for workers and less overtime to compensate for absences.
	Factors Affecting Return To Work After Injury Or Illness: Best Evidence Synthesis of Systematic Reviews Chiropractic & Manual Therapies 2016 (Sep 8); 24 (1): 32 ~ FULL TEXT Expectations of recovery and return-to-work, pain and disability levels, depression, workplace factors, and access to multidisciplinary resources are important modifiable factors in progressing return-to-work across health and injury conditions. Employers, healthcare providers and other stakeholders can use this information to facilitate return-to-work for injured/ill workers regardless of the specific injury or illness. Future studies should investigate novel interventions, and other factors that may be common across health conditions.
	Importance of the Type of Provider Seen to Begin Health Care for a New Episode Low Back Pain: Associations with Future Utilization and Costs J Eval Clin Pract. 2016 (Apr); 22 (2): 247–252 ~ FULL TEXT The RESULTS portion of this Abstract only partially discusses the findings, comparing 3 different professions' treatment, costs, and outcomes for low back pain.   In it they only mention the costs associated with medical management, while in reviewing chiropractic care vs. physical thereapy portions, they choose to emphasize: Entry in chiropractic was associated with an increased episode of care duration Entry in physical therapy no patient entering in physical therapy had surgery. That *seems* to suggest that physical therapy *may* entail less expense, or shorter durations of care, or that chiropractic patients are more likely to end up with surgery.   None of that is true.   Their own Table 2 plainly reveals that chiropractic care was the least expensive form of care provided to the 3 groups.
	Workers' Compensation, Return to Work, and Lumbar Fusion for Spondylolisthesis Orthopedics. 2016 (Jan); 39 (1): e1–8 ~ FULL TEXT In this study, researchers reviewed the files of 686 workers who underwent fusion surgery for spondylolisthesis between 1993 and 2013, revealing that only 29.9% of them ever returned to work (for at least 6 months). The failure rate (meaning return-to-work) was 70.1%.
	A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for Spine Pain in the United States BMC Health Serv Res. 2015 (Oct 19); 15: 474 ~ FULL TEXT The search uncovered 1,276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care.
	Chiropractors' Caracteristics Associated with Their Number of Workers' Compensation Patients J Can Chiropr Assoc 2015 (Sep); 59 (3): 202–215 ~ FULL TEXT Canadian DCs who reported a higher volume of workers' compensation patients had practices oriented towards the treatment of injured workers, collaborated with other health care providers, and facilitated workers' access to care.
	Association of Worker Characteristics and Early Reimbursement for Physical Therapy, Chiropractic and Opioid Prescriptions with Workers' Compensation Claim Duration, For Cases of Acute Low Back Pain: An Observational Cohort Study BMJ Open. 2015 (Aug 26); 5 (8): e007836 ~ FULL TEXT Our analysis found that early Workplace Safety and Insurance Board (WSIB) reimbursement for physiotherapy or chiropractic care, in claimants fully off work for more than 4 weeks, was not associated with claim duration, and that early reimbursement for opioids predicted prolonged claim duration. Well-designed randomised controlled trials are needed to verify our findings and establish causality between these variables and claim duration.
	Tracking Low Back Problems in a Major Self-Insured Workforce: Toward Improvement in the Patient's Journey J Occup Environ Med. 2014 (Jun); 56 (6): 604–620 ~ FULL TEXT This comprehensive new study from the Journal of Occupational and Environmental Medicine reveals that chiropractic care costs significantly less than other forms of low back care, and appears to comply with guideline recommendations more closely than than any of the other 4 comparison groups.   The authors came to these conclusions after an exhaustive analysis of an integrated database belonging to a giant, self-insured Fortune 500 manufacturer covering nine years of claims They evaluated the direct and indirect costs of LBP for all employees, looking in-depth at personnel characteristics, and medical, behavioral health, pharmaceutical, Workers Comp costs, disability, absenteeism, and lost productivity during the 2001 to 2009 period.
	Factors Associated with Early Magnetic Resonance Imaging Utilization for Acute Occupational Low Back Pain: A Population-based Study From Washington State Workers' Compensation Spine (Phila Pa 1976) 2012 (Sep 1); 37 (19): 1708–1718 ~ FULL TEXT Among respondents, 362 (19.8%) received an early MRI. Multivariable regression showed that male workers were 43% more likely to receive an early MRI than female workers (incident rate ratio [IRR]: 1.43, 95% confidence interval [CI]: 1.12-1.82). Initial visit type with a surgeon was associated with 78% greater likelihood of receiving an early MRI than that with a primary care physician (IRR: 1.78, 95% CI: 1.08-2.92). Having a chiropractor as the initial provider was associated with a reduced likelihood of early MRI (IRR: 0.53, 95% CI: 0.42-0.66). Workers with elevated work fear-avoidance, higher Roland scores, or increased injury severity were more likely to receive early MRI than counterparts with lower levels or scores.
	Predictors of Short-term Work-related Disability Among Active Duty US Navy Personnel: A Cohort Study in Patients with Acute and Subacute Low Back Pain Spine J. 2012 (Sep); 12 (9): 806–816 ~ FULL TEXT This study provides evidence for the utility of evaluating for maladaptive beliefs in the clinical setting for military personnel presenting with complaints of LBP. The doctorpatient interaction has been shown to have a strong impact on patient’s attitudes and behaviors related to LBP. Fearavoidance beliefs are modifiable psychological factors that respond to clinical intervention. Primary care physicians, aware of the findings of this study, may use these findings as a justification to modify their interactions with patients to emphasize a good prognosis and the importance of maintaining normal activity levels despite pain during the initial stages of a treatment for LBP. Doing so may interrupt a possible negative cycle of fear and disability as articulated by the fear-avoidance models and may enhance, in the long run, force readiness. Our results lend additional evidence to the importance of psychological factors in the progression and maintenance of disability across populations.
	Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence J Occupat Enviro Med 2011 (Apr); 53 (4): 396–404 ~ FULL TEXT This study is unique in that it was conducted by the Center for Disability Research at the Liberty Mutual Research Institute for Safety AND the University of Massachusetts Lowell, Hopkinton, Mass. They found that statistically you are twice as likely to end up disabled if you got your care from a Physical Therapists (PT), rather than from a chiropractor. You’re also 60% more likely to be disabled if you choose a Physicians (MD) to manage your care, rather than a chiropractor.
	Functional Scores and Subjective Responses of Injured Workers With Back or Neck Pain Treated With Chiropractic Care in an Integrative Program: A Retrospective Analysis of 100 Cases J Manipulative Physiol Ther. 2009 (Nov); 32 (9): 765–771 ~ FULL TEXT This study identified positive effects of chiropractic management included in integrative care when treating work-related neck or back pain. Improvement in both functional scores and subjective response was noted in all 3 time-based phases of patient status (acute, subacute, and chronic).
	Course and Prognostic Factors for Neck Pain in Workers: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Sup): S108–116 ~ FULL TEXT We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 14 of these studies related to course and prognostic factors in working populations. Between 60% and 80% of workers with neck pain reported neck pain 1 year later. Few workplace or physical job demands were identified as being linked to recovery from neck pain. However, workers with little influence on their own work situation had a slightly poorer prognosis, and white-collar workers had a better prognosis than blue-collar workers. General exercise was associated with better prognosis; prior neck pain and prior sick leave were associated with poorer prognosis.
	Colorado Workers' Compensation: Medical vs Chiropractic Costs for the Treatment of Lowback Pain J Chiropractic Medicine 2008 (Dec); 7 (4): 127–133~ FULL TEXT This study adds to the understanding of differences associated with costs and services provided by DCs and MDs when treating simple and nonspecific LBP. It does not bring about an understanding of patient satisfaction for each provider or explain all potential benefits that might have been achieved by treatment. Results from our study appear to demonstrate that chiropractic care is more expensive than medical care when treating relatively simple forms of LBP. Because costs can greatly increase because of repeated treatments, the difference in expenses is mainly due to more services and longer treatment periods. Further research is needed to evaluate quality of life and patient satisfaction related to different treatment approaches, as well as follow-up of patient's functional status and stability upon return to work, resumption of activities of daily livings, and impacts of relapses. Future evaluations should also examine effectiveness when treating more complex disorders causing spine and LBP. Cost-effectiveness has become very important when choosing a heath care provider for most third-party payers. However, because patients respond differently to different forms of treatment, it would be in the best interest of both the insurance company and the patient for the patient to be provided preferred treatment options for his/her condition and to take an active role in his/her overall treatment plan.
	The Burden and Determinants of Neck Pain in Workers: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders J Manipulative Physiol Ther. 2009 (Feb); 32 (2): S70–86 ~ FULL TEXT One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible. The annual prevalence of neck pain varied from 27.1% in Norway to 47.8% in Québec, Canada. Each year, between 11% and 14.1% of workers were limited in their activities because of neck pain. Risk factors associated with neck pain in workers include age, previous musculoskeletal pain, high quantitative job demands, low social support at work, job insecurity, low physical capacity, poor computer workstation design and work posture, sedentary work position, repetitive work and precision work. We found preliminary evidence that gender, occupation, headaches, emotional problems, smoking, poor job satisfaction, awkward work postures, poor physical work environment, and workers' ethnicity may be associated with neck pain. There is evidence that interventions aimed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers.
	Satisfaction as a Predictor of Clinical Outcomes Among Chiropractic and Medical Patients Enrolled in the UCLA Low Back Pain Study Spine (Phila Pa 1976). 2005 (Oct 1); 30 (19): 121–2128 ~ FULL TEXT Greater satisfaction increased the odds of remission from clinically meaningful pain and disability at 6 weeks (adjusted odds ratio [OR] for 10-point increase in satisfaction = 1.61, 95% confidence interval [CI] = 0.99, 2.68), but not at 6, 12, or 18 months (6 months: adjusted OR = 1.05, 95% CI = 0.73, 1.52; 12 months: adjusted OR = 0.94, 95% CI = 0.67, 1.32; 18 months: adjusted OR = 1.07; 95% CI = 0.76, 1.50). Perception of improvement was greater among highly satisfied than less satisfied patients throughout the 18-month follow-up period.
	An Evaluation of Medical and Chiropractic Provider Utilization and Costs: Treating Injured Workers in North Carolina J Manipulative Physiol Ther 2004 (Sep); 27 (7): 442–448 ~ FULL TEXT These data, with the acknowledged limitations of an insurance database, indicate lower treatment costs, less workdays lost, lower compensation payments, and lower utilization of ancillary medical services for patients treated by DCs. Despite the lower cost of chiropractic management, the use of chiropractic services in North Carolina appears very low.
	A Randomized Clinical Trial Comparing Chiropractic Adjustments to Muscle Relaxants for Subacute Low Back Pain J Manipulative Physiol Ther 2004 (Jul); 27 (6): 388–398 ~ FULL TEXT Researchers compared the relative efficacy of chiropractic adjustments with muscle relaxants and placebo/sham for sub-acute low back pain (two- to six-weeks duration). They found chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing the global impression of severity scale (GIS).
	The Use of Muscle Relaxant Medications in Acute Low Back Pain Spine (Phila Pa 1976) 2004 (Jun 15); 29 (12): 1346–1351 ~ FULL TEXT Muscle relaxants were used by 49% of patients; among those who sought care from doctors, 64% used muscle relaxants. Muscle relaxant users were more impaired at baseline. Over time, among patients with greater functional status impairment (Roland disability score > 12) at baseline, muscle relaxant users had somewhat slower recovery from the episode of back pain. This finding persisted after controlling for baseline functional status, age, worker's compensation status, and use of nonsteroidal inflammatory agents.
	Compliance with Clinical Practice Guidelines in Family Physicians Managing Worker's Compensation Board Patients with Acute Lower Back Pain Spine J 2003 (Nov); 3 (6): 442–450 ~ FULL TEXT Physicians demonstrated a high degree of compliance with the guideline-recommended history, examination procedures and medications, but low compliance with recommended imaging and many treatment recommendations. Recently published clinical practice guidelines regarding the management of patients with acute mechanical lower back pain have not been fully implemented into the patterns of practice of the family physicians.
	A Randomized Trial of Combined Manipulation, Stabilizing Exercises, and Physician Consultation Compared to Physician Consultation Alone for Chronic Low Back Pain Spine (Phila Pa 1976) 2003 (Oct 1); 28 (19): 2185–2191 ~ FULL TEXT For patients with chronic low back pain (CLBP), the short, specific manipulative treatment program with stabilizing exercises and a physician’s clinical examination, information, encouragement, and simple advice was more effective in reducing pain and disability than was merely a physician’s consultation and an educational booklet. Both treatment methods enhanced HRQoL and reduced the use of health-care services and costs. Results within these groups seem clinically significant. Whether the difference in 1–year outcomes between the groups is clinically significant remains debatable. However, patients recovered with no greater costs by the short manipulative-treatment method. We believe that our treatment modality is effective for most mechanical-origin CLBP patients.
	Chiropractic Treatment of Workers' Compensation Claimants in the State of Texas MGT of America, Austin, Texas ~ February 2003 ~ FULL TEXT This retrospective study of workers’ compensation claims from 1996 to 2001 was conducted to determine the use and efficacy of chiropractic care in Texas. The researchers reviewed 900,000 claims during that time period to determine if chiropractic was cost-effective compared to medical treatment. They found that chiropractic treatment costs were the lowest of all providers. The study data demonstrated that increased utilization of chiropractic care could lead to declining costs relative to lower back injuries.
	Economic Case for the Integration of Chiropractic Services into the Health Care System J Manipulative Physiol Ther 2000 (Feb); 23 (2): 118–122 ~ FULL TEXT In this study the author explores the effects of the integration of chiropractic care into the health care system. The author indicates that greater use of chiropractic care would lead to reduced costs and improved outcomes. As support, the author points to studies which demonstrate that chiropractic is effective for neuromusculoskeletal disorders and the evidence that patients often prefer chiropractic care over a medical approach.
	Cost Comparison of Chiropractic and Medical Treatment of Common Musculoskeletal Disorders: A Review of the Literature After 1980 Topics in Clinical Chiropractic 1999; 6 (2): 57–68 ~ FULL TEXT The majority of retrospective studies in general report results in favor of chiropractic treatment. Three of the five prospective studies are in favor of medical treatment. None of the identified studies included all direct costs of care. Well designed prospective randomized studies that include complete economic analysis are needed.
	Managed Care Preapproval and its Effect on the Cost of Utah Worker Compensation Claims J Manipulative Physiol Ther 1997 (Jul); 20 (6): 372–376 Treatment costs in cases managed by chiropractic physicians increased 12% between 1986 and 1989. Treatment cost in cases managed by medical physicians increased 71% in the same time period. Compensation (wage replacement) costs increased 21% for the chiropractic group and 114% for the medical group.
	The Outcomes and Costs of Care for Acute Low Back Pain Among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons The North Carolina Back Pain Project New England J Medicine 1995 (Oct 5); 333 (14): 913–917 ~ FULL TEXT This study sought to compare patients’ recovery and satisfaction for those with acute low back pain receiving care from the following six groups: Urban Primary Care Physicians; Rural Primary Care Physicians; Urban Doctors of Chiropractic (DCs); Rural DCs; Orthopedic Surgeons; and Primary Care Providers at a Group Model HMO. After six months, functional recoveries, return to work and complete back pain recoveries were similar for all groups. Satisfaction with care was highest for those visiting DCs.
	Preliminary Findings of Analysis of Chiropractic Utilization and Cost in the Workers' Compensation System of New South Wales, Australia J Manipulative Physiol Ther 1995 (Oct); 18 (8): 503–511 The total utilization rate for chiropractic intervention in spinal injuries for workers' compensation claimants was 12%. Payments for physiotherapy and chiropractic treatment totalled over $25.2 million and represented 2.4% of total payments for all cases. Average chiropractic treatment cost for a sample of 20 randomly selected cases was $299.65; average medical treatment cost per case was $647.20. Further analysis of the 20 selected cases seemed to show an average cost per claim that was significantly different from WCA database figures.
	A Comparison of Health Care Costs for Chiropractic and Medical Patients J Manipulative Physiol Ther 1993 (Jun); 16 (5): 291–299 Nearly one-fourth of patients were treated by chiropractors.   Patients receiving chiropractic care experienced significantly lower health care costs as represented by third party payments in the fee-for-service sector. Total cost differences on the order of $1,000 over the 2-yr period were found in the total sample of patients as well as in subsamples of patients with specific disorders. The lower costs are attributable mainly to lower inpatient utilization. The cost differences remain statistically significant after controlling for patient demographics and insurance plan characteristics.
	Cost Per Case Comparison of Back Injury Claims of Chiropractic Versus Medical Management for Conditions With Identical Diagnostic Codes J Occup Med 1991 (Aug); 33 (8): 847–852 This study indicated that costs were significantly higher for medical claims than for chiropractic claims; in addition, the number of work days lost was nearly ten times higher for those who received medical care instead of chiropractic care.

A Workers' Compensation Collection A Unique Series of Articles Disabling Low Back Oregon Workers' Compensation Claims. Part I: Methodology and Clinical Categorization of Chiropractic and Medical Cases J Manipulative Physiol Ther 1991 (Mar); 14 (3): 177–184 The two provider groups differed in the proportion of claimants who had physical factors contributing to low back compromise.   DC claimants were less likely than MD claimants to have sought initial treatment in the emergency room, more likely to have a history of chronic, recurrent low back pain and more likely to have suffered exacerbation episodes. These differences suggest a greater level of chronicity among chiropractic claimants. Disabling Low Back Oregon Workers' Compensation Claims Part II: Time Loss J Manipulative Physiol Ther 1991 (May); 14 (4): 231–239 for claimants with a history of chronic low back problems,   the median time loss days for MD cases was 34.5 days, compared to 9 days for DC cases. It is suggested that chiropractors are better able to manage injured workers with a history of chronic low back problems and to return them more quickly to productive employment. Disabling Low Back Oregon Workers' Compensation Claims Part III: Diagnostic and Treatment Procedures and Associated Costs J Manipulative Physiol Ther. 1991 (Jun); 14 (5): 287–297 Claimants in Oregon with disabling low back injuries attending chiropractors were found to have more treatments over a longer duration and at greater cost than claimants attending medical physicians with similar clinical presentations. These findings are attributed to: a) a higher proportion of chiropractic claimants than medical physician claimants with low back risk factors which may have adversely affected the course of recovery (chronic or recurrent low back conditions, obesity, extremity symptomatology, frequency of exacerbations); b) differences in age and gender of DC and MD claimants; c) the greater physician-patient contact hours characteristic of chiropractic practice; d) differences in therapeutic modalities employed; and e) the physician reimbursement permitted under Oregon workers' compensation law. The findings of this study emphasize the need for prospective studies of treatment outcome.

Patient Evaluations of Low Back Pain Care From Family Physicians and Chiropractors West J Med 1989 (Mar); 150 (3): 351–355 ~ FULL TEXT Patients of chiropractors were three times as likely as patients of family physicians to report that they were very satisfied with the care they received for low back pain (66% versus 22%, respectively). Compared with patients of family physicians, patients of chiropractors were three times more likely to have been satisfied with the amount of information they were given, to have perceived that their provider was concerned about them, and to have felt that their provider was comfortable and confident dealing with their problem.

An Analysis of Florida Workers' Compensation Medical Claims for Back-related Injuries J American Chiro Association 1988; 25 (7): 50–59 This study is an analysis of worker's compensation claims in Florida from June through December of 1987. All of the claims analyzed were related to back injuries. The greater purpose of this study was to compare the cost of osteopathic, medical and chiropractic doctors. The cost of drugs were not included in the analysis. The results of the study lead to the finding that individuals who had compensable injuries and were treated by chiropractors often times were not forced to be hospitalized. It was also revealed that chiropractic care is a "relatively cost-effective approach to the management of work-related injuries."