What Does WCRI's Manual Therapy Study Mean for Payers?

During the past couple of years, the Workers Compensation Research Institute has explored physical therapy outcomes and for good reason. Conservative care has gained acceptance in the medical and workers’ compensation communities, having shown good outcomes especially for low back pain (LBP) and shoulder injuries in numerous studies.

WCRI’s 2020 research indicated that early physical therapy for LPB is associated with overall lower medical costs, lower indemnity payments and shorter temporary disability duration on workers’ compensation claims. This year, researchers sought to determine which physical therapy treatment patterns influenced the utilization and costs of medical resources and outcomes. In September, WCRI published “Outcomes Associated with Manual Therapy for Workers with Non-Chronic Low Back Pain.”

So, what exactly is “manual therapy?”

Manual therapy or MT refers to mobilizing or manipulating joints and soft tissue to increase range of motion and to reduce pain and inflammation in soft tissue. It varies from gently stretching a patient’s leg to a complicated spinal manipulation performed by a highly experienced, specially trained and credentialed therapist. Many people think MT comes only under the purview of chiropractors, but other rehabilitation professionals also provide it.

For the 2021 study, researchers chose to review low back pain (LBP) claims across 28 states during an 18-month period (between 2015-2017) that received MT from non-chiropractic providers, mostly physical therapists. The rationale for selecting physical therapists as the authors explained, “lies in the balance between hands-on manual therapy treatment and individualized exercise programs. Physical therapists may be more likely to provide active therapy, such as exercise and use manual therapies to diagnose and reduce pain so that the patients can be active and care for themselves through exercise and maintaining good posture.”

WCRI considered MT “early” if it began within two weeks of the worker starting physical therapy. Its 2020 study considered physical therapy “early” if it began within 14 days post injury.

Findings

The most common treatment practice was to begin MT within two weeks of initiating physical therapy, and treatment typically lasted six weeks or less. However, there were wide interstate variations, likely due to differences in state policies affecting provider practices and reimbursement.

Early MT was associated with lower utilization of medical services, lower medical and indemnity payments, and shorter temporary disability duration.

The average medical cost per claim was $4,192, which was 27 percent lower than for similar claims when MT care started later. Likewise, the average indemnity payment per claim was 28 percent lower and temporary disability duration per claim was 22 percent shorter when workers received early MT compared with those receiving it later.

The study did find that LBP claims with MT had higher medical costs than claims that received no MT. MT cases received more medical services, including MRIs, slightly more opioid prescriptions, and pain management injections than non-MT LBP cases. The average medical cost per claim was 35 percent higher at the 18-month point and there were smaller, yet statistically significant, differences between the two groups in indemnity payments and temporary disability duration.

In the end though, authors concluded that their findings could not determine the overall cost-effectiveness of MT for several reasons. For one, with data limited to 18-months post injury, researchers could not determine the long-term outcomes on improvements of care. They could not answer questions like, does MT help LBP patients return to work faster? Does it result in long-term improvements in quality of life? Additionally, as with other observational studies, the study’s causation analysis was limited.

Takeaways

This was the first study to examine treatment patterns of MT for US workers with LBP in the United States. While able to control for many factors that could influence treatment choice and outcomes, it did not have adequate clinical data or enough long-term data to assess the overall cost-effectiveness of MT.

Yet it did show that early MT was associated with overall lower medical costs, lower indemnity payments, and shorter temporary disability duration. This reinforces long-held beliefs of practitioners and managed care professionals.

Getting injured workers assessed quickly, getting them into physical therapy quickly and when appropriate, getting them MT quickly will lead to better outcomes for injured workers.

BioBrian Peers is a licensed physical therapist serving as MedRisk’s Vice President of Clinical Services and Provider Management. He is responsible for overseeing and ensuring the quality of MedRisk’s centralized telerehabilitation services, as well as MedRisk’s platinum grade clinical review and peer-to peer provider coaching program. He is board certified as an orthopedic clinical specialist and is recognized as an expert in rehabilitation of the injured worker. Prior to joining MedRisk, Dr. Peers was the owner and operator of an interdisciplinary rehab practice and has held faculty appointments at multiple physical therapy education programs. He has also served as an injury prevention consultant for multiple large corporations and the United States Department of Defense. He holds Bachelor of Science and Master of Physical Therapy degrees from St. Francis University in Loretto, Pennsylvania, an MBA from Louisiana State University in Baton Rouge, Louisiana and a Doctorate in Physical Therapy from the University of St. Augustine, in St. Augustine, Florida.

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