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PubMed2006

Cut-points to prevent low back injury due to force exertion at work.

Force exertion is related to low back injuries (LBI). This paper critically reviews the literature concerning cut-points for back force exertion, presents available guidelines in a concise manner, and identifies areas that need further research. The studies reviewed were grouped according to the criteria used to set the cut-point values. Most often cut-points differ than concur. The approach considering physiological, psychophysical, epidemiological, and biomechanical aspects of back force exertion meets the most known criteria and presents the lowest common denominator of instantaneous load for lifting tasks. Further experimental and epidemiological studies in peak load and cumulative exposure are necessary. Compound indices should also be developed for pushing, pulling, and carrying. Future indices should consider electromyographically determined fatigue, differential viscoelastic properties of tissues, aging, and the cross sectional area of back muscles. We hope that this paper contributes to a more systematic appraisal of back force exertion at work.

Alberta↗
PubMed2006

Utilization and costs of chiropractic care for work-related low back injuries: do payment policies make a difference?

BACKGROUND: Chiropractic care is frequently used in the treatment of work-related low back pain. Chiropractors have been shown to be more sensitive to cost-sharing than other providers. PURPOSE: This study examined the differences in utilization and costs of chiropractic care for work-related low back injuries in seven jurisdictions and whether these differences can be associated with workers' compensation (WC) payment policies. STUDY DESIGN: A retrospective analysis of WC data from a single insurer. METHODS: Analyzed data included individuals with chiropractic care performed between 1999 and 2002. Utilization (visits and services per person, services per visit) and costs (cost per person and cost per visit) were examined. Actual reimbursement index was developed to proxy payment policies based on actual payments made to chiropractors. RESULTS: Utilization and costs varied significantly across the analyzed states. Restrictive payment policies were associated with lower costs of chiropractic care and lower number of services per visit, but had no impact on visits or services per person. CONCLUSIONS: Findings indicate necessary components of effective cost containment, even in the presence of utilization adjustment.

Adult↗
PubMedDate not supplied

Aquatic therapy: making a wave in the treatment of low back injuries.

Aquatic therapy is a viable rehabilitation alternative for the treatment of spinal pain and dysfunction. The unique physical properties of the water make it an ideal medium for the rehabilitation of low back injuries. Aquatic programs can be used in conjunction with a land-based program or as a sole treatment approach. Orthopaedic specialists should consider aquatic rehabilitation in management of spinal injuries to enhance the injured patient's overall functional outcomes.

Activities of Daily Living↗
PubMed1998

Components of initial and residual disability after back injury in nurses.

STUDY DESIGN: A pre- versus postintervention with concurrent control group design was used to investigate the effect of a workplace-based early intervention program on perception of disability in nurses with low back injury. OBJECTIVES: This report examines changes over time in the components of the Oswestry Low Back Pain and Disability Questionnaire in two groups of back-injured nurses-those who received the early intervention program (study) and those who were not offered the program (control). SUMMARY OF BACKGROUND DATA: Early intervention programs can decrease morbidity, time lost from work, and compensation costs. Although perception of disability decreases, some residual disability remains, the nature of which is not clear. METHODS: The Oswestry Low Back Pain and Disability Questionnaire scores of 40 study nurses and 118 control nurses at time of injury and at 6 months after injury were examined. Analysis of variance was used to compare changes in mean overall scores over time. The proportion of nurses reporting disability on individual components of the Oswestry Low Back Pain and Disability Questionnaire at each time period was compared with the results of a chi-square test. RESULTS: Overall Oswestry Low Back Pain and Disability Questionnaire scores were similar between study and control nurses at time of injury, but were significantly lower in study nurses at 6 months after injury. However, scores of individual Oswestry Low Back Pain and Disability Questionnaire components that related to job demands increased over time; this was most apparent in lifting, particularly in study nurses. CONCLUSIONS: Although overall perception of disability decreased 6 months after injury, particularly in study nurses, disability in job-related activities persisted. Residual disability after back injury should be addressed in workplace-based prevention programs.

Adult↗
PubMed2000

Back injuries in the young athlete.

The diagnosis of back pain in the young athlete should be specific and not attributed to nonspecific, mechanical causes. Risk factor identification and intervention are required. Treatment is then initiated in a specific pattern, addressing flexibility and muscular imbalances. Bracing is often used to allow healing of growth tissue. The lumbosacral orthosis may be molded in a lordotic posture to unload the disc or antilordotic posture to relieve the posterior column; however, customizing the lordosis to the individual biomechanics may be required. Spinal stabilization is initiated with therapy for strengthening isolated weaknesses and progressing to coactivation and proprioceptive techniques, such as the balance ball. Returning to competition is preceded with sport-specific training.

Acute Disease↗
PubMed1997

The prevention of back injuries in Swedish health care--a comparison between two models for action-oriented feedback. PROSA Study Group.

This paper considers two different models for action-oriented feedback designed to prevent back injuries in Swedish health care. Feedback was provided by physiotherapists/ergonomists from Occupational Health Services. The models tested were feedback to work groups, and feedback solely to supervisors. Both generated a considerable number of accident-prevention proposals. Proposals of supervisors were implemented to a greater extent. Supervisors tended to advocate training, while work groups were more concerned with improved technical aids. Otherwise, only minor differences were detected between the models in application. The active involvement promoted by feedback, in particular to work groups, was considerable.

Back Injuries↗
PubMed1990

Severity of disability due to occupational low back injury after lumbar laminectomy for degenerative disc disease.

Thirty-two postal workers were rated low risk in preplacement examinations after lumbar laminectomies for degenerative disc disease. They demonstrated an odds ratio for occupational back injury of 5.9 when compared with 192 control subjects matched by age, gender, employment date, and job classification. Each injured employee was subsequently observed for 2 years after injury. Data were collected on time lost from work due to the injury and incidence of surgical treatment. Injured subjects lost a median of 66 and a mean of 292.8 days from work, whereas injured control subjects lost a median of 8.5 and a mean of 24.8 days. Mean time lost per person hired was 73.2 days for subjects compared with 1.6 days for control subjects. Three of eight injured subjects required repeat surgery and three remain totally disabled. No injured control subjects required surgery and all resumed work.

Adult↗
PubMed1983

Back injuries in the athlete.

In summary, the approach to the athlete with low back pain must include an emphasis on aggressive nonoperative intervention, education, and rehabilitation. A diligent attempt must be made to establish a correct diagnosis, though this may be difficult at first. A firm diagnosis allows individualized treatment that meets the strenuous needs of the athlete. Work-up should be standardized to avoid missing what will appear obvious in retrospect. Unlike most of the general patient population, athletes are unlikely to tolerate a long period of "wait and see" therapy. It is necessary to have qualified allied health personnel who can perform a full spectrum to have qualified allied health personnel who can perform a full spectrum of exercise, mobilization, and modality therapies. Return to competition should be gradual but steady, as previous performance levels can usually be obtained following lumbar injuries.

Acute Disease↗
PubMed2001

Doctor proactive communication, return-to-work recommendation, and duration of disability after a workers' compensation low back injury.

Although doctors are increasingly evaluated on the basis of return-to-work (RTW) outcomes, the effect of doctor-patient communication about the workplace and RTW after an occupational injury has received little research attention. The effect of patient-reported doctor communication on duration of disability was examined retrospectively in a 3-year cohort of 325 claimants with a lost-time low back injury. Although doctor proactive communication was associated with a greater likelihood of RTW during the acute phase (< 30 days of disability), this effect disappeared when injury and workload characteristics were taken into account. A positive RTW recommendation was associated with about a 60% higher RTW rate during the subacute/chronic phase (> 30 days of disability) only. Prospective studies are needed to confirm this effect. The impact of physician communication on RTW is largely confounded by injury and workplace factors.

Adult↗
PubMed1995

The Use of Back Belts to Increase Intraabdominal Pressure as a Means of Preventing Low Back Injuries: A Survey of the Literature.

Published reports of relevant empirical research do not suggest a consistent relationship between intraabdominal pressure and the activity of the erector spinae muscles or the magnitude of the intradiscal pressure during lifting. Intraabdominal pressure varies in response to load magnitude and lift method, but there is no pattern of activity that would suggest that an increase in intraabdominal pressure decreases intradiscal pressure. Early models of back biomechanics predicted that the increase in intraabdominal pressure relieved the compressive forces on the low back by providing an extensor moment. In the newer models, intraabdominal pressure functions to stabilize the loaded spine. Studies of human subjects fail to consistently show any clear biomechanical advantage from using a back belt. Some studies suggest a slight decrease in back injury incidence when using a back belt; however, there are conflicting results regarding the severity of the injuries involved and the cost-effectiveness of back belts.

Journal Article↗