Integrated Physical Medicine Improves Outcomes in Musculoskeletal Disorders

Employer-sponsored health clinics offering integrated physical medicine services—physical medicine, chiropractic, and acupuncture — can improve clinical outcomes while lowering the costs of care for patients with back pain and other common musculoskeletal conditions, reports an open-access paper in the May Journal of Occupational and Environmental Medicine.

Dena Bravata, MD, MS, of Stanford University and colleagues assessed the benefits of physical medicine services at 12 employer-sponsored health clinics. Among other innovative features, the clinics provided on-site access to physical therapists, chiropractors, and acupuncturists — integrated with primary care, behavioral health, and other services. The researchers analyzed clinical and economic outcomes of nearly 2,500 patients with musculoskeletal disorders seen at the clinics over 16 months.

Patients at the employer-sponsored clinics were able to access physical medicine services within about a week — much faster than a control group receiving traditional care in the community. Integrated physical medicine also led to greater improvements in physical functioning and fear of pain. These benefits were achieved with eight fewer clinic visits, leading to significant cost reductions: by $630 per patient episode overall and by $472 for patients with back or neck pain.

Other outcomes were also better at employer-sponsored clinics, including a sharp reduction in opioid prescriptions for noncancer pain. Patients were highly likely to say they would recommend integrated employer-sponsored care.

Musculoskeletal complaints are among the most common reasons for medical visits, carrying enormous costs for employers. Providing integrated physical medicine services at employer-sponsored clinics in or near the workplace is an innovative approach to providing effective, efficient care for these conditions.

"Early access to physical medicine interventions is associated with improved patient outcomes at lower cost to the employer," Dr. Bravata and coauthors write. "These results suggest that employer-sponsored clinics can improve timely access to evidence-based physical medicine services."
About the Author
Dr. Bravata may be contacted for interviews at

ACOEM (, an international society of more than 4,000 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.

About the Journal of Occupational and Environmental Medicine
The Journal of Occupational and Environmental Medicine ( is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.


Lord DJ, Wright JR, Fung R, et al. Integrated physical medicine at employer-sponsored health clinics improves quality of care at reduced cost. J Occup Environ Med. 2019;61(5):382-90.