When back pain becomes disabling: a regional analysis (original) (raw)
Related papers
Back pain claim rates and the business cycle
Social Science & Medicine, 1997
The causes of reported occupational back pain are controversial. Many observers appear to believe that job insecurity increases back pain compensation claims during recessions. The purpose of this study was to formally examine the impact of macro-economic forcesthe ...
Management of Occupational Low Back Pain: a Case Study of the Missouri Workers’ Compensation System
Psychological Injury and Law, 2016
This manuscript examines the management of low back injury claims in the Missouri Workers' Compensation (WC) program. It is based on research published over the past decade, although it is the first manuscript to integrate findings across studies. It links these findings with other WC-related research to identify broad themes: (1) evidence of treatmentrelated racial/ethnic disparities; (2) evidence of poorer outcomes for African Americans relative to Caucasians; (3) evidence that legal representation, when secondary to dissatisfaction, is associated with poorer outcomes; (4) little evidence supporting the validity of disability ratings as predictors of post-settlement adjustment; and (5) substantial evidence for negative long-term quality-of-life effects, particularly for African Americans and younger workers. Results are discussed with particular attention to the need for psychology involvement to improve WC processes.
Journal of occupational rehabilitation, 2012
Introduction One possibility for reducing the disabling effects of low back pain (LBP) is to identify subgroups of patients who might benefit from different disability prevention strategies. The aim of this study was to test the ability to discern meaningful patient clusters for early intervention based on self-reported concerns and expectations at the time of an initial medical evaluation. Methods Workers seeking an initial evaluation for acute, work-related LBP (N = 496; 58 % male) completed selfreport measures comprising of 11 possible risk factors for chronicity of pain and disability. Outcomes of pain, function, and return-to-work were assessed at 3-month followup. A K-means cluster analysis was used to derive patient subgroups based on risk factor patterns, and then these subgroups were compared with respect to 3-month outcomes. Results Eight of the 11 measures showed significant associations with functional recovery and return-to-work, and these were entered into the cluster analysis. A 4-cluster solution met criteria for cluster separation and interpretability, and the four clusters were labeled: (a) minimal risk (29 %), (b) workplace concerns (26 %); (c) activity limitations (27 %); and (d) emotional distress (19 %). Functional outcomes were best in the minimal risk group, poorest in the emotional distress group, and intermediate in the other two groups. A global severity index at baseline also showed highest overall risk in the emotional distressed group. Conclusions Patterns of early disability risk factors from this study suggest patients have differential needs with respect to overcoming emotional distress, resuming normal activity, and obtaining workplace support. Classifying patients in this manner may improve the cost-benefit of early intervention strategies to prevent long-term sickness absence and disability due to LBP.
Workers' Compensation and Return-to-Work In Low Back Pain
Pain, 1995
The relationship of Workers' Compensation and litigation to low back pain (LBP) outcome is not established in the literature. Our study investigated the characteristics of disabled persons applying for Worker's Compensation or employing a lawyer, the factors predicting receipt of compensation, and the effects of compensation and litigation on employment outcome. One hundred sixty-nine unemployed persons with LBP were assessed by medical history, physical exam, biomechanical testing, psychiatric interview, and MMPI. Subjects were asked whether they had applied for compensation, received it, or had employed a lawyer. Six months later, subjects were asked about their employment and compensation status. Neither compensation status nor involvement of a lawyer significantly improved prediction of employment status 6 months later. Receipt of compensation predicted better outcome in those at risk for poor outcome due to external locus of control. Factors predicting failure to obtain compensation over 6 months, having applied, include education, spinal flexion, ability to do daily activities and affective inhibition. Neurological dysfunction did not predict receipt of compensation in univariate or multivariate analyses; emotional distress reduced the probability of receiving compensation, after controlling for severity of spinal dysfunction. Receipt of compensation and use of a lawyer did not reduce the probability of RTW in disabled persons in the present sample, but increased the likelihood of return to work for groups of individuals at higher risk such as those with external locus of control. Although compensation is awarded on the basis of physical evaluation under the present system, the present findings suggest that the likelihood of receiving compensation is also significantly determined by level of emotional distress.
BMC Musculoskeletal Disorders
Background Chronic musculoskeletal pain affects over 20% of the adult population and is one of the most common reasons for sick leave in Sweden. The aim of this study was to investigate which demographic, health and psychosocial work environment factors are of importance for a lower risk of future work disability and unemployment among workers with low back pain (LBP) and/or neck shoulder pain (NSP), and if familial factors influence these associations. Methods All 5556 persons that reported having LBP and/or NSP in a web-based questionnaire study in 2004–2006 were included. They were followed up for work disability (sick leave > 90 days or disability pension), and unemployment (> 180 days in a year) until 31 December 2013. Hazard ratios (HR) with 95% confidence intervals were calculated using cox proportional hazard models of the whole sample, adjusting for covariates. In addition, co-twin analyses of outcome discordant twin pairs were conducted to assess the impact of famili...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1998
Despite the publication in the mid-1990s of comprehensive practice guidelines for the management of acute low-back pain, both in the United States and elsewhere, this ubiquitous health problem continues to be the main cause of workers' compensation claims in much of the Western world. This paper represents a synthesis of the intervention studies published in the last 4 years and is based on a new approach to categorizing these studies that emphasizes the stage or phase of back pain at the time of intervention and the site or agent of the intervention. Current thinking suggests that medical management in the first 3-4 weeks after the onset of pain should be generally conservative. Several studies of rather heterogeneous interventions focusing on return to work and implemented in the subacute stage (3-4 to 12 weeks after the onset of pain) have shown important reductions in time lost from work (by 30% to 50%). There is substantial evidence indicating that employers who promptly of...
Journal of Manipulative and Physiological Therapeutics, 2011
Objectives-The purpose of this study was to explore the extent to which individuals with back pain or other health conditions, and individuals with no health problems, report having a usual source of care (USC) for their health care needs. Methods-This study evaluated longitudinal Medical Expenditures Panel Survey data (MEPS data pooled for survey calendar years 2000-through-2006). Comparisons were made between adult MEPS respondents identified as having a back pain condition (n=10,194) compared to those without back pain but with other health condition (n=45,541), and those with no back pain and no other condition (n=5,497). Results-Compared to individuals with no health problems, those with back pain were almost 8 times more likely (OR=7.8, p<.001) to report having a USC; and those with other health problems besides back pain were 5 times more likely (OR=5.4, p<.001). For those with a USC, individuals with back pain, and those with other problems but not back pain, were both about one and a half times more likely than those without any health problems to report a specific provider type as their USC (p<.001). Conclusion-Study findings suggest that relatively healthy adults without back pain are less likely to have a USC than those with back pain or other health problems.
Prevalence of back pain among fulltime United States workers
Occupational and Environmental Medicine, 1989
A source of data on the health and working conditions of a probability sample of United States workers, the Quality of Employment Survey for 1972-3 (QES73), is investigated for the first time to determine which groups of workers are more or are less likely to report back pain. Estimated coefficients from a logistic regression are used to calculate odds ratios and confidence intervals for various groups. Few previous studies on back pain among United States workers control for as many potentially confounding variables as are considered in this study and few use data from a national probability sample of workers. The following independent variables are judged to be important positive correlates based on their estimated odds ratios and confidence intervals: farm, service, blue collar, and clerical work; low levels ofschooling and income; jobs needing physical effort; age between and including 50 to 64; and smoking. Marital separation was found to be negatively correlated with back pain. Caution should be exercised in attempting to generalise these findings, since the back pain variable is based on respondents' subjective evaluations. Moreover, the variable does not distinguish between lower or upper back or neck pain, nor is information on the duration or frequency of pain available.