WCRI Report Examines Challenges of Low Back Pain and Comorbid Health Issues

Workers’ compensation patients who report comorbidities, especially mental health comorbidities (anxiety, depression, sleep dysfunction), had a stronger association with smaller functional recoveries than those who only reported physical health comorbidities such as diabetes, hypertension, obesity.

That’s according to a recent Workers Compensation Research Institute (WCRI) report examining the impacts of common physical and mental comorbidities on workers recovering from lower back injuries and pain.

The study included 68,850 episodes of physical therapy care provided to low back pain patients paid under workers’ compensation, covering diverse demographic and medical characteristics commonly observed in outpatient physical therapy clinics.

The study found the prevalence of comorbidities among workers’ compensation patients was significant, with two-thirds (67%) of the sample reporting at least one comorbidity at intake and 23% experiencing both physical and mental health comorbid conditions.

Comorbidities are medical conditions that workers may have in addition to work injuries. If workers’ compensation covers certain comorbid conditions, then consideration must be given to coordinating and delivering care alongside lower back pain and injury treatment.

The prevalence of comorbidities, especially mental health comorbidities, was higher in workers with chronic low back pain compared with those with acute low back pain.

• 28% of workers reported being diagnosed with hypertension
• 21% reported having arthritis
• 17% reported sleep dysfunction
• 16% reported depression
• 16% reported anxiety or panic disorders
• 9% to 11% of workers reported diabetes, lung conditions, gastrointestinal disease and severe obesity (a body mass index of 40 or more)
• 21% reported having three to five comorbid medical conditions
• 3% of workers reported more than five comorbidities

Past studies have suggested that early assessments of behavioral health issues and targeted interventions can improve return to work and other worker outcomes. Better engagement, evaluation and treatment of associated mental health comorbid conditions could improve functional outcomes.

Comorbidities such as sleep dysfunction, severe obesity, and kidney disease were independently associated with smaller functional improvements following physical therapy.

According to the independent, non-profit research organization, the study limited the episodes of care to orthopedic care, representing 96% of all workers’ compensation episodes of care in the FOTO data. Orthopedic care provides rehabilitative treatments addressing the primary needs of patients that arise from any diagnosis in the orthopedic impairment category.

The study estimated a model including industrial and pain management cases, which may have different levels of severity. Industrial care provides intensive return-to-work clinical treatments that include functional capacity evaluations, work conditioning and work simulation. “Pain management” uses a multidisciplinary pain management clinical model. This study found that the estimates from these models based on all care types (orthopedic, industrial and pain management care) were generally similar to those obtained using the orthopedic care type.

Issues related to comorbidities present challenges to policymakers and payors. Workers’ compensation provides coverage for work-related conditions directly or indirectly caused or aggravated by the specified injury event. However, some states allow treatment for conditions unrelated to the injury for a limited time if the comorbidity limits treatment options known to improve and shorten the recovery time from the injury.

This information can be helpful to identify and address all comorbidities, especially high-risk comorbidities, to limit their impact on patient recovery following physical therapy. Even if it is not practical for comorbidities to be treated during treatment of the work injury, the information can be of value in optimizing resources and time to discharge from physical therapy.