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Ischemic injury of cells in the central nervous system is typically set in motion by influx of extracellular Ca(2+). In this issue of Neuron, Stys and colleagues propose that ischemic injury in spinal cord axons is partly the result of ryanodine receptor-mediated release of Ca(2+) from the endoplasmic reticulum (ER), a site of intracellular Ca(2+) storage.
OBJECTIVE: To determine the effect of preauthorization of chiropractic services costs in non-surgical back injury cases in a managed care environment. The program was implemented in the chiropractic provider group by the Worker Compensation Fund of Utah. The results were compared with those of similar injury claims in a separate provider group in which there was no preauthorization program. DESIGN: The study was a retrospective review of approximately 5000 claims from 1986 and 5000 claims from 1989 of injured workers in the Utah Worker Compensation Fund. We extracted approximately 1000 nonsurgical back-related injury claims from each year. MAIN OUTCOME MEASURE: Cost comparisons between medical and chiropractic provider groups in the management of nonsurgical compensable back pain in both 1986 and 1989. RESULTS: Treatment costs in cases managed by chiropractic physicians increased 12% between 1986 and 1989. Treatment cost in cases managed by medical physicians increased 71% in the same time period. Compensation (wage replacement) costs increased 21% for the chiropractic group and 114% for the medical group. CONCLUSION: Retrospective analysis of worker compensation databases continue to struggle with issues related to measurement of severity, appropriate condition identification, adequate inclusion of all related costs and unbiased case selection. Treatment costs appeared to be controlled under the auspices of a preapproval program required of the chiropractic physician whereas medical costs escalated in the absence of price controls.
Home health care workers have high rates of back injuries and other musculoskeletal problems. This article addresses issues surrounding work-related overexertion injuries in home health care workers, including summaries of relevant research on workers in home settings as well as in traditional health care settings such as hospitals and nursing homes. The main work factors associated with these injuries are forceful exertions and awkward postures during patient- care tasks, especially while lifting and moving patients. Ergonomics-the design of work tasks to best accommodate natural human capabilities-is the most promising approach for preventing injuries, and for enhancing the comfort and safety of workers and patients.
PURPOSE: Chronic low back pain (CLBP) remains one of the most difficult and costly medical problems in the industrialized world. A review of nineteenth and early twentieth century spine rehabilitation shows that back disorders were commonly treated with aggressive and specific progressive resistance exercise (PRE). Despite a lack of scientific evidence to support their efficacy, therapeutic approaches to back rehabilitation over the past 30 yr have focused primarily upon passive care for symptom relief. Recent spine rehabilitation programs have returned to active reconditioning PRE centered around low back strengthening to restore normal musculoskeletal function. Research has shown that lumbar extension exercise using PRE significantly increases strength and decreases pain in CLBP patients. It appears that isolated lumbar extension exercise with the pelvis stabilized using specialized equipment elicits the most favorable improvements in low back strength, muscle cross-sectional area, and vertebral bone mineral density (BMD). These improvements occur with a low training volume of 1 set of 8 to 15 repetitions performed to volitional fatigue one time per week. CLBP patients participating in isolated lumbar extension PRE programs demonstrate significant reductions in pain and symptoms associated with improved muscle strength, endurance, and joint mobility. Improvements occur independent of diagnosis, are long-lasting, and appear to result in less re-utilization of the health care system than other more passive treatments. Low back strengthening shows promise for the reduction of industrial back injuries and associated costs.
As members of injury prevention and injury management teams, physical therapists and occupational therapists have the opportunity to evaluate back stress associated with patient-lifting activities. In this study, three mathematical formulas are presented that can be used to objectively assess health care workers' maximum safe lifting capacity for moving patients. Recommendations to reduce the rate of back injury in health care workers include the use of lifting machines for moving patients, mandatory in-service education on body mechanics, and employee assistance programs that improve job satisfaction and worker morale.
In response to the significant number and severity of work-related back injuries and other musculoskeletal disorders among nurses, the American Nurses Association (ANA) has launched the Handle With Care(R) campaign. The campaign seeks to build a health care industry-wide effort to prevent back and other musculoskeletal injuries. This is being done through developing partnerships and coalitions, education and training, increasing use of assistive equipment and patient-handling devices, reshaping nursing education to incorporate safe patient handling, and pursuing federal and state ergonomics policy by highlighting technology-oriented safe-patient handling benefits for patients and nurses. In the absence of ergonomics regulations at national or state levels that protect health care workers, ANA has taken on alternative approaches to encourage a movement to control ergonomic hazards in the health care workplace and prevent back injuries among the nation's nursing workforce.
Few epidemiologic studies have evaluated sex differences in work-related injury rates. In this study, the authors examined injury trends by type of injury, severity of injury, and how the injury occurred among a cohort of 9,582 female and 26,898 male electric utility workers employed during 1980-1992 by the Southern California Edison Company. Sex-specific unadjusted injury rates were higher throughout the period for male workers. However, after adjustment for occupation, job experience, and age, elevated rate ratios indicate that female workers have higher injury rates. Mantel-Haenszel summary rate ratios and 95% confidence intervals were 1.49 (1.43-1.54) for all types of injuries, 1.27 (1.16-1.39) for head and neck injuries, 1.48 (1.38-1.58) for upper extremity injuries, 1.11 (1.01-1.21) for back injuries, and 2.11 (1.97-2.25) for lower extremity injuries. The rate ratios were slightly higher for more severe injuries, which suggests that potential reporting bias was not a likely explanation for these findings. The authors conclude that differences between male and female workers in training, physical capacity, task assignments, and other factors could explain these injury trends.
The records of the first 805 patients who had been referred by general practitioners at this health centre to the attached physiotherapist were examined in November 1985, three years after the physiotherapy department was opened. Seventy per cent (549) of the patients had been treated within one week, treatment having started on the same day for 8.5% (67) of the patients. This compares with a mean of six weeks for direct access to a district general hospital that is eight miles away and between six and 13 months for the three nearest orthopaedic consultants who are 13 miles away. The most common conditions treated were knee injuries (16.5%), followed by cervical (15.5%) and shoulder (13.8%) injuries. Surprisingly, only 9% were back injuries. The non-attendance rate was 2.2% and only 7% of patients failed to complete treatment. Nearly all the patients were able to attend the clinic, only 4% requiring home treatment. By March 1986, 90 treatments a week were being carried out at a cost of 6.11 pounds per patient. Compared with official hospital figures, this represents a savings of 21,500 pounds a year for a practice of 12,000 patients.
Surveillance of agricultural work-related illness and non-fatal injuries is limited and considered to be a major gap in prevention and policy-making capacity. This pilot study evaluated the utility of the Marshfield Epidemiologic Study Area (MESA) and its farm residency cohort to identify and monitor potential priorities for prevention and control. MESA is a defined geographic region that serves as a resource for conducting population-based health research. Nearly all of the residents receive their health care from the Marshfield Clinic and affiliated hospitals, providing archived electronic medical information to characterize past and present diagnoses. Based on scientific literature and national research priorities, five broad health issues (injuries, back problems, hearing loss, respiratory conditions, and dermatologic conditions) were selected. To estimate age-specific and age-adjusted incidence and prevalence, we followed a fixed cohort of 1995 MESA residents through 2002. Standardized incidence ratios and standardized prevalence ratios were also estimated to quantify the potential impact of farm residency. Linking MESA, its farm residency cohort, and the clinic's data archives allowed successful identification of significant associations with agricultural exposure for a few conditions and subconditions related to consensus priorities in agricultural health, particularly among men. These included extrinsic alveolitis, organic dust toxic syndrome, back pain, osteoarthrosis, and certain injuries. However, the system was generally not able to demonstrate strong influence of farm residency on disease occurrence for many conditions specifically selected for their likely capacity to show such influence. Future surveillance systems should supplement clinical data with other sources of information on health events and should be adequately powered to focus on narrower ranges of health conditions.
The musculoskeletal status at entry into a fitness programme and the incidence of injuries during the first four months of the programme were evaluated in 991 men and women who were aged 20-63 years. At entry, about half of the subjects reported having received treatment for musculoskeletal ailments previously, or that currently they were experiencing musculoskeletal pain and/or discomfort, and about one-third of the subjects reported one or more movement limitations. New injuries during the first four months of the programme were reported by 38% of subjects, with an average duration of impairment of 3.8 weeks, and 43% of those who were injured sought medical treatment. The most frequent type, location, and cause of injury were "joint sprains/strains" (66%), the lower leg (70%), and jogging (33%), respectively. Musculoskeletal problems (previous treatment, current pain or discomfort or movement limitations) in the leg did not predict leg injuries during the programme, but back problems did predict back injuries. Age, sex, body mass index, a parental history of musculoskeletal disease, a sporting history, and the frequency of vigorous exercise during the first four months did not predict injury. The study emphasized: first, the vulnerability of previously-sedentary persons to musculoskeletal injury and the consequent need for care in the management of fitness programmes; secondly, the need for the evaluation of such programmes if they are to have a rational rather than an intuitive basis; and thirdly, the need for epidemiological research on the musculoskeletal system as a basis for systematic efforts, partly through education and ergonomics, to reduce wear and tear on the musculoskeletal system.
The oedematous and traumatised protruding section of the rectal tissue of an adult free-ranging female African black rhinoceros (Diceros bicornis) was surgically amputated. Immediately before completion of surgery, the rhinoceros died of anaesthetic-related cardiac arrest. At necropsy a deformed pelvis and sacrum associated with a healed fracture of the left ileal wing were noted. New bone formation in and around the left ventral sacral foramina may have resulted in neuropathy of particularly the 3rd and 4th left ventral sacral nerves, which (in the horse) supply the majority of the nerve fibres innervating the caudal rectum and anus. The cause of the injury is not known, although back injuries, presumably sustained during mating by bulls, have been recorded in white rhinoceros. An encounter with elephants could also have been responsible for the injury in this case.
Musculoskeletal disorders in the workplace cause thousands of injuries and cost industry billions of dollars yearly. Work injury prevention programs have been developed and implemented as a means for cost containment. A variety of preventive strategies have been investigated in primary research. The purpose of this review article is to examine the effectiveness of back injury and pain prevention programs in the workplace. Nine studies published between 1995 and 2000 were reviewed and analyzed. Studies used primarily one of three types of preventive strategies: 1) back belts, 2) education and task modification, and 3) education and task modification with workstation redesign. The effectiveness of back belts to prevent back pain and injury remains inconclusive. Positive outcomes were associated with studies reporting high compliance that used job-specific and individualized/small group education and training approaches. Themes that arose following a critical review of primary research studies are discussed.
Golf injuries to the lower back and elbow are common problems in both the professional and amateur player, and any information regarding the successful treatment of these injuries has important implications for the medical practitioner. This paper presents the successful management and outcome of two case studies associated with low back pain and lateral epicondylitis in golf. Exercise therapy and conditioning has been shown to be an effective treatment modality for these two types of injury. In particular, a dynamic exercise programme which incorporates golf functional rehabilitation, is a modern and accepted method by both the patient and the clinician. Effective programmes need to be golf-specific to maintain the interest of the participant and yet at the same time they need to be able to accommodate other factors such as age, gender and the level of the golfer. Furthermore, it is critical that the clinical practitioner has a fundamental knowledge of normal swing mechanics and a working knowledge of the musculoskeletal requirements needed to swing a golf club. In the case of the lower back injury, evaluation was based on detailed computer tomography and centred on the conditioning of the transversus abdominis muscle. Although this muscle is not considered to be paraspinal, it has particularly important implications in the maintenance of spinal stability so that other more specific golf functioning exercises and rehabilitation can be performed. For the case study of lateral epicondylitis detailed evaluation and consideration of neuropathy was an important factor in the diagnostic process. In part, it was necessary to deviate from conventional treatment to produce an effective outcome. A comprehensive resistance-strength-training programme and golf functional 'hitting' programme was used to treat the problem. The conformity by the patient to complete the exercise regimen has been an issue of concern for clinicians managing and treating golf-related problems. Many golfers are 'fanatical' and unless they can see that by continuing the programme their injury will be overcome, it is difficult trying to restrict their time on the golf course. The two case studies described in this article highlight how an extensive and dynamic golf functional programme could be used as an effective method for managing and preventing golf injuries.
OBJECTIVES: Health care workers who have patient transfer duties are at risk for back injury. Transferring patients between beds and gurneys is a rigorous pulling task that requires back, leg, and arm strength. This study analyzed the efficiency of commercially available transfer devices, namely a patient roller, patient shifter, and draw sheet. METHOD: With the use of one or two force scales attached to each transfer device, the amount of force needed to transfer 15 participants, weighing from 101 lb to 240 lb, back and forth between a bed and a gurney was measured. Ten transfers per device per participant were performed. RESULTS: The patient roller was superior to the patient shifter and draw sheet in reducing transfer forces. Additionally, gurney-to-bed transfers tended to be more demanding for all transfer devices and for heavier participants. CONCLUSIONS: The patient roller was the most efficient transfer device in moving participants compared with the draw sheet and patient shifter. Transfer forces can be estimated with the use of linear equations, with patient weight, direction of transfer, and transfer device as the independent variables. These estimated forces can assist occupational therapists in the returning their injured health care coworkers to patient transfer duties. The results further indicated that high forces are required to transfer patients; therefore, patient-transfer personnel should obtain assistance when moving patients.
The purpose of this study was to investigate the incidence and prevalence of injuries among elite weight lifters and power lifters, with a special focus on shoulder injuries and possible injury-provoking exercises. In 1995, a questionnaire was administered to 110 male and female elite lifters to evaluate injuries and training characteristics. A follow-up of the athletes from 1995 was conducted in 2000, and a new 2000 elite group was also queried. In 1995 and again in 2000, the athletes sustained, on average, 2.6 injuries per 1000 hours of activity. Most common in 1995 were low back injuries, with an injury rate of 0.43 per 1000 hours, and shoulder injuries, with a rate of 0.42 per 1000 hours. Shoulder injuries dominated in 2000, with an injury rate of 0.51 per 1000 hours of activity. There was a difference in injury pattern between weight lifters, who mostly sustained low back and knee injuries, and power lifters, in whom shoulder injuries were most common. No correlation was found between shoulder injuries and any specific exercise. Although the total injury rate was the same during the two periods of study, the rate of shoulder injuries had increased.
BACKGROUND AND OBJECTIVES: The public is not well informed about matters relating to regional anesthesia. Previous studies concerning regional anesthesia have involved patients, surgeons, and anesthesiologists. This study is the first in-depth survey of the attitudes of the general public toward a number of commonly perceived fears about regional anesthesia. METHODS: A province-wide telephone survey was conducted in Alberta, Canada. The sample surveyed was representative of the adult population of the province and included an equal balance of urban and rural participants. General and regional anesthesia were defined, a scenario involving major knee surgery was described, and participants were asked to choose between regional and general anesthesia. Respondents were then questioned so their attitudes toward commonly perceived fears associated with regional anesthesia could be assessed. RESULTS: A total of 1,216 people were surveyed. A preference for regional or general anesthesia was not expressed in this scenario. Approximately 27% of respondents were very concerned about permanent paralysis, back injury, perioperative pain, seeing the surgical procedure, and the prospect of a needle in the back. Only 6% of individuals were concerned about headaches. CONCLUSIONS: The public's fears and conceptions about regional anesthesia are greatly distorted. The anesthesia community has not been successful in keeping the public informed about regional anesthesia. Future anesthesia-related educational programs should address the concerns of the public about anesthesia matters, particularly regional anesthesia.
The purpose of this study was to evaluate the efficacy of friction-reducing devices used for lateral patient transfers. A mannequin used to represent a dependent patient was transferred laterally from bed to stretcher. One male investigator repeated this task using 11 comparable lateral transfer aids or techniques. Applied force was measured using a dynamometer; postural analysis was prepared from still photography. Mean applied force, spinal forces, and population strength capabilities were calculated. The most efficacious mechanism for lateral patient transfers had extendable pull straps, low-friction material, and optimally located handles. Findings of this study will aid occupational health and safety clinicians and hospital-based caregivers in the selection of appropriate technologies to be used during lateral patient transfers. These devices improve patient safety and reduce the risk of back injury to caregivers.
Over the years, many types of programs have been instituted in attempts to reduce the incidence of back injuries in the long term care industry. However, incidence rates continue to climb.