Abstract

BACKGROUND: Rural residents with work-related fractures utilize healthcare differently and return to work (RTW) sooner than their similarly-injured urban peers. OBJECTIVE: To elucidate the relationship between physical medicine and rehabilitation (PM) service usage and work-disability duration following work-related injury. DESIGN: Retrospective cohort study, employing a two-phase sequential analysis. The project involved a longitudinal analysis of PM utilization and work-disability duration of 2,216 people across the U.S. who fractured a bone, received PM services, and had at least seven days off work. In the first phase of the analysis each individual was assigned a PM utilization score based on how similar his or her usage was to that typical of rural residents. The second phase tested the relationship between assigned PM utilization scores and work-disability duration. RESULTS: Differences in urban versus rural PM utilization included less total PM services and fewer passive services in the first 8 weeks for rural claimants. Among those off work for more than a month, rural residents used more active services just prior to RTW, with a gradual decreasing of services leading up to RTW. Controlling for covariates, aggregate PM utilization scores were found to relate to time to first RTW(Hazard Ratio = 1.66, p 0.005). CONCLUSIONS: Findings suggest that using services in a way that is more consistent with rural patterns is associated with decreased work-disability durations. Consistent with previous studies, results suggest that passive services, prolonged episodes of care, and failure to focus on transitioning to self-management are related to longer work-disability durations.