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&R) 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&R utilization and work-disability duration of 2,216 people
across the U.S. who fractured a bone, received PM&R services, and had at
least seven days off work. In the first phase of the analysis each
individual was assigned a PM&R 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&R utilization scores and
work-disability duration.
RESULTS: Differences in urban versus rural PM&R utilization included less
total PM&R 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&R
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.
