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At least 595 records · Page 33Linked to original sources
PubMed2004

The prognostic value of functional capacity evaluation in patients with chronic low back pain: part 1: timely return to work.

STUDY DESIGN: Historical cohort study. OBJECTIVES: We examined the validity of the Isernhagen Work Systems' Evaluation in predicting timely return to work. SUMMARY OF BACKGROUND DATA: Functional Capacity Evaluations are used commonly to determine readiness for return to work, yet little is known of their validity. METHODS: Workers' compensation claimants undergoing Functional Capacity Evaluations following work-related low back injury were studied. Two cohorts were formed, one on which exploratory analyses were conducted and a second for confirmation. Evaluation indicators were the number of tasks in the protocol rated as failed and performance during the floor-to-waist lift task. The primary outcome investigated was time receiving total temporary disability benefits (as a surrogate of return to work) and a secondary outcome was time until claim closure in the year following Evaluation. Cox proportional-hazards regression was used to determine the prognostic effect of Evaluation crudely and after controlling for potential confounders. RESULTS: Few patients (4%) were found to pass all Evaluation tasks, yet most experienced total temporary disability suspension and claim closure within 1 year following Functional Capacity Evaluations. Better Evaluation performance was related to faster time to suspension of total temporary disability benefits and claim closure after controlling confounding factors, but explained little of the variation in these outcomes (approximately 10%). Performance on the floor-to-waist lift was as predictive as the number of failed tasks in the entire Functional Capacity Evaluations protocol. CONCLUSIONS: Better performance on Evaluation was weakly associated with faster recovery; however, the amount of variation explained was small. One task in the Evaluation was as predictive as the entire protocol.

Adult↗
PubMed1993

Delayed post-traumatic vertebral collapse (Kummell's disease): case report with serial radiographs, computed tomographic scans, and bone scans.

A case of delayed posttraumatic vertebral collapse (Kummell's disease) is described and documented with serial radiographs, computed tomographic scans, and bone scans. The bone scan was normal before the back injury occurred and showed increased radionuclide uptake 3 weeks after injury and before vertebral collapse. Plain radiographs and computed tomographic scans taken during the interval between injury and collapse revealed no evidence of fracture or bone destruction. The authors believe this represents the first example of Kummell's phenomenon documented with serial computed tomographic and bone scans, and provides further support to the ischemic necrosis theory as the underlying process.

Aged↗
PubMed1995

Lifting Belts: A Review.

This article reviews and evaluates the literature related to the effectiveness of protective restraints on abdominal strength, lower back injuries, and workers' discomfort. The studies indicate that back belts have potential disadvantages as well as advantages. Belts seem to reduce lifting stress. They may, however, lead to a false sense of security while being worn and may also weaken the body, so injury occurs when they are not being worn. There also seems to be comfort problems with some belts. More scientific research is needed before any conclusions can be drawn about positive, negative, or long-term effects of lifting belts.

abdominal supports↗
PubMed1995

The total costs of illness: a metric for health care reform.

Systems thinking is a fundamental element of quality management and should be a fundamental element of health care reform. An implication of systems thinking is that one aim of health care should be to minimize the total costs of illness, not simply the direct medical expenditures. If we are to continue to improve health care over time, we should measure its impact on the total costs of illness to the patient, family, employer, and society. Thus a system of measurement is needed that quantifies total costs of illness and also suggests how these constituencies can collaborate to improve processes and reduce total costs. This article introduces the total costs of illness concept, contrasts it with societal costs of illness, describes a measurement system we developed to quantify it, and describes a case study examining the total costs of back injury illness to employers. We found that medical expenditures accounted for less than half of the total costs of illness, the average total costs of illness varied by over 350 percent among employers, and a simple metric (days off work) explained 62.5 percent of the variance in total costs of illness.

Accidents, Occupational↗
PubMedDate not supplied

Progression towards a 'no manual lifting' policy within the intensive care unit.

Nurses within the critical care environment are at increased risk of back injury, due to the high dependence of the patients. A move towards a 'no manual lifting' policy is desirable to reduce the costs of staff sickness, compensation claims and to comply with new legislation. Implementation of a 'no manual lifting policy' within intensive care poses a unique challenge due to the special needs of the critically ill patient. The call has gone out to avoid all manual lifting in all but exceptional and life-threatening situations.

Back Injuries↗
PubMed1996

Methodologic issues in intervention research--health care.

To better understand the methodological challenges faced by intervention research in health care, workshops reviewed two intervention studies to reduce back injuries among nursing home staff and two studies on the use of precautions to prevent occupational transmission of bloodborne pathogens. These studies adapted rigorous designs to real-world settings and made good use of multiple measures to detect effects and communicate this information to policy makers. The studies grappled with issues about implementation integrity and would benefit from better theory of administrative practices associated with a safety-conscious work environment.

Back Injuries↗
PubMed2003

Lifting teams in health care facilities: a literature review.

1. Manual lifting and transfer activities are job tasks frequently associated with back injuries in nursing personnel. One approach with potential to decrease these injuries is the lifting team. 2. In program evaluations completed to date, there have been numerous benefits and several limitations attributed to use of lifting teams in health care facilities. 3. Benefits of lifting teams include reductions in lost time workdays, restricted workdays, workers' compensation claims, and injuries to lifting team members; satisfaction of patients, staff, and lifting team members; and capacity of the lifting team to absorb the majority of high risk lifts and transfers on shifts in which they operate. 4. Lifting teams may not be appropriate for all settings, require infrastructure and lifting team equipment to support their use, and require careful consideration related to staffing. However, when their use is appropriate, efforts to overcome their limitations can be accomplished with careful evaluation of outcome measures and indicators.

Accidents, Occupational↗
PubMed2004

Manual handling and the lawfulness of no-lift policies.

Recent discussions over the plight of a woman who had spent a year sleeping in her wheelchair because the local NHS trust refused to allow her to be lifted into bed highlight the dilemma facing nurses when they are required to manually handle patients (Andrews and Robinson 2003). Nurses are acutely aware that the manual handling of patients can result in back injury (McGuire and Dewar 1993). Yet they are also aware that they owe a duty to patients to provide nursing care to meet their needs and that might only be achieved through manual handling. There is evidence that hospitals in particular have still not met the requirements of the Manual Handling Operations Regulations (Trevelyan 2000). The hazards of working in the community environment have generally been better addressed as part of the assessment for and delivery of individual care packages. This article considers the law's approach to balancing the opposing needs of nurses' and patients' health needs.

Back Injuries↗
PubMed2003

Post-traumatic paroxysmal exercise-induced dystonia: case report and review of the literature.

A young Chinese man sustained a back injury in a motorcycle accident in 2000 and had left lower limb weakness due to a lumbosacral plexopathy, diagnosed clinically and electromyographically. With rehabilitation, he recovered full function, but developed paroxysmal dystonia of the left leg only with prolonged exertion. He responded well to oral baclofen, relapsed when he stopped taking it, and remains well on low dose maintenance therapy. Dystonia occurring after trauma is well documented, but paroxysmal exercise-induced dystonia occurring after trauma has yet to be described. Paroxysmal exercise-induced dystonia responds variably to anticonvulsant therapy, but the literature does not report response to baclofen, especially in low doses.

Adult↗
PubMed2004

The workers' compensation system: worker friend or foe?

BACKGROUND: The workers' compensation system was designed to help injured workers who have substantial medical expenses and perhaps have lost a great deal of income. This study determines both similarities and differences in how workers experience their interactions with the workers' compensation systems in Florida and Wisconsin. METHODS: Ethnographic open-ended interviews with 204 workers from Florida and 198 workers in Wisconsin were conducted. All the workers had back injuries in 1990 and were either paid workers' compensation temporary disability benefits for at least 4 weeks or received permanent disability benefits or compromise settlements. RESULTS: Some interactions with the workers' compensation system were positive. However, the majority of respondents in both states experienced their encounters with the workers' compensation system as cumbersome, frustrating, and demeaning. CONCLUSIONS: Mistrust, stigmatization, payment delays, and refusal of insurer personnel to pay benefits contribute to workers' negative experiences with the workers' compensation system. These insurer behaviors raise the costs to injured workers of workers' compensation benefits and thus may reduce the propensity of eligible workers to apply for benefits.

Accidents, Occupational↗
PubMed2000

Assessment of the relationship between box weight and trunk kinematics: does a reduction in box weight necessarily correspond to a decrease in spinal loading?

Typically, the simplest and most cost-efficient ergonomic solution to offset the rising costs of low back injuries is to reduce the box weight that is lifted. However, there is limited research on how a worker interacts with the box. In the present study, we quantify the utility of reducing the weight that is lifted - specifically, how changes in the box weight affect trunk kinematics, trunk moments, and ultimately, spinal loads. In the experiment, 15 participants lifted a variety of box weights (from 9.1 to 41.7 kg) from knee height, carried it a distance of 5 feet (1.5 m), and placed it on a shelf at elbow height. For the lower weights, small increases in box weight (3-9 kg) were offset by the trunk dynamics (sagittal velocity), resulting in no difference in spinal loads. At the same time, spinal loads were found to be significantly higher for weights above 25 kg. Thus, when making ergonomic changes (reduction of box weight), it is important to consider how workers will interact with the box. These results indicate that purely weight-based ergonomic controls might not sufficiently reduce the risk of low back disorders. Furthermore, this study provides additional evidence of the utility of using more complex spinal load models (dynamic, multiple muscle models) when evaluating highly dynamic and complex tasks.

Adult↗
PubMed2000

Effectiveness of early physical therapy in the treatment of acute low back musculoskeletal disorders.

This study was designed to evaluate the effects of early physical therapy intervention on treatment outcomes for workers with acute low back injuries. A total of 3867 cases were randomly selected from the database of a large occupational health care provider. Cases were assigned to either the early therapy intervention group or one of the two comparison groups on the basis of their delay to physical therapy. The treatment outcomes for the three groups were compared. The results showed that patients in the early therapy intervention had more favorable outcomes than the two comparison groups. Specifically, patients in the early intervention group had fewer physician visits, fewer restricted workdays, fewer days away from work, and shorter case duration. These results provide a strong indication for the effectiveness of early therapy intervention. The financial implications of the findings is discussed.

Absenteeism↗
PubMed2000

Effects of squat lift training and free weight muscle training on maximum lifting load and isolinetic peak torque of young adults without impairments.

BACKGROUND AND PURPOSE: Manual lifting is a frequent cause of back injury, and there is no evidence as to which training mode can provide the best training effect for lifting performance and muscle force. The purpose of this study was to examine the effects of a squat lift training and a free weight muscle training program on the maximum lifting load and isokinetic peak torque in subjects without known neuromuscular or musculoskeletal impairments. SUBJECTS: Thirty-six adults (20 male, 16 female) without known neuromuscular or musculoskeletal impairments participated. The subjects' mean age was 21.25 years (SD=1.16, range=20-24). METHODS: Subjects were divided into 3 groups. Subjects in group 1 (n=12) performed squat lift training. Subjects in group 2 (n=12) participated in free weight resistance training of their shoulder abductors, elbow flexors, knee extensors and trunk extensors. Subjects in group 3 (n=12) served as controls. The maximum lifting load and isokinetic peak torques of the trunk extensors, knee extensors, elbow flexors, and shoulder abductors of each subject were measured before and after the study. Training was conducted on alternate days for 4 weeks, with an initial load of 80% of each subject's maximum capacity and with the load increased by 5% weekly. RESULTS: All groups were comparable for all measured variables before the study. After 4 weeks, subjects in groups 1 and 2 demonstrated more improvement in maximum lifting load and isokinetic peak torque of the back extensors compared with the subjects in group 3, but the 2 training groups were not different. CONCLUSION AND DISCUSSION: The findings demonstrate that both squat lift and free weight resistance training are equally effective in improving the lifting load and isokinetic back extension performance of individuals without impairments.

Adult↗
PubMed1995

Sports injuries in children and adolescents. Questions and controversies.

Certain topics and controversies involving young athletes are addressed, including unclear criteria for volume and intensity of training and acute and overuse injuries of the knee. Osteochondritis dissecans, tibial spine avulsions, peri-pelvic apophyseal avulsions, and back injuries are discussed.

Adolescent↗
PubMed2005

Job strain, iso-strain, and the incidence of low back and neck injuries. A 7.5-year prospective study of San Francisco transit operators.

Work-related musculoskeletal disorders account for the largest single category of lost-time occupational injury or disease episodes in industrialized countries. In this study we analyzed the impact of the psychosocial work environment, conceptualized by the demand-control-support model, on the incidence of low back and neck injury in a cohort of 1221 public transit operators followed for 7 years and 6 months. The two main exposure variables were "job strain" (mismatch of high psychological demands and low decision latitude) and "iso-strain" (job strain plus exposure to low social support at work). Analyses controlled for demographic factors, physical workload, and pain at baseline. For low back injuries, increased hazard rates were found for job strain and iso-strain based on tertiles, with hazard ratios (HR) of 1.30 (95% CI=0.96-1.75) and 1.41 (95% CI=0.98-2.01), respectively. Job strain and iso-strain based on median split or analyzed as continuous variables were not associated with low back injuries. For neck injuries, job strain and iso-strain based on median split showed HRs of 1.27 (95% CI=0.99-1.63) and 1.33 (95% CI=1.01-1.77), respectively. Job strain and iso-strain based on tertiles had HRs of 1.52 (95% CI=1.13-2.05) and 1.73 (95% CI=1.21-2.45), respectively. When analyzed as continuous variables, a one-point increase on the job strain and iso-strain scales led to an 8% (95% CI=0.98-1.19) and 14% (95% CI=1.02-1.27) increased hazard of neck injuries, respectively. This study shows the importance of the psychosocial work environment in the etiology of musculoskeletal injuries among transit operators. Since reviews have shown that psychosocial workplace conditions in this occupational group can be changed, these findings indicate a potential for prevention at the workplace.

Adult↗
PubMed2004

Is the trunk movement more perturbed after an asymmetric than after a symmetric perturbation during lifting?

Low back injury is associated with sudden movements and loading. Trunk motion after sudden loading depends on the stability of the spine prior to loading and on the trunk muscle activity in response to the loading. Both factors are not axis-symmetric. Therefore, it was hypothesized that the effects on trunk dynamics would be larger after an asymmetric than after a symmetric perturbation. Ten subjects lifted a crate in which, prior to lifting, a mass was displaced to the front or to the side without the subjects being aware of this. Crate and subject movements, crate reaction forces and muscle activity were recorded. From this, the stability prior to the perturbation was estimated, and the trunk angular kinematics and moments at the lumbo-sacral joint were calculated. Both perturbations only minimally affected the trunk kinematics, although the stability of the spine prior to the lifting movement was higher in the sagittal plane than in the frontal plane. In both conditions the stability appeared to be sufficient to absorb the applied perturbation.

Adult↗
PubMed1989

Specific illnesses, injuries, and job hazards associated with absenteeism.

Thirty-six specific illnesses and injuries and 17 job hazards are assessed according to their contribution to absenteeism. Data are drawn from the 1977 Quality of Employment Survey, which is national probability sample of 1515 workers who worked 20 or more hours per week in 1977. Both frequencies and lengths of absences are analyzed. Illnesses and injuries that appear to contribute most to absenteeism are back injuries, broken bones, colds and flus, physical strain injuries, hits and falls, and joint inflammation. Job conditions resulting in the greatest amount of absenteeism are dangerous methods and machines, exertion, bad weather, human error, and dangerous workspaces. Although women reported physical strain injuries and working in awkward positions as the most frequent causes of absenteeism, men found back pain and working with dangerous machines to be the greatest causes of their absenteeism.

Absenteeism↗
PubMed2006

Analysis of squat and stoop dynamic liftings: muscle forces and internal spinal loads.

Despite the well-recognized role of lifting in back injuries, the relative biomechanical merits of squat versus stoop lifting remain controversial. In vivo kinematics measurements and model studies are combined to estimate trunk muscle forces and internal spinal loads under dynamic squat and stoop lifts with and without load in hands. Measurements were performed on healthy subjects to collect segmental rotations during lifts needed as input data in subsequent model studies. The model accounted for nonlinear properties of the ligamentous spine, wrapping of thoracic extensor muscles to take curved paths in flexion and trunk dynamic characteristics (inertia and damping) while subject to measured kinematics and gravity/external loads. A dynamic kinematics-driven approach was employed accounting for the spinal synergy by simultaneous consideration of passive structures and muscle forces under given posture and loads. Results satisfied kinematics and dynamic equilibrium conditions at all levels and directions. Net moments, muscle forces at different levels, passive (muscle or ligamentous) forces and internal compression/shear forces were larger in stoop lifts than in squat ones. These were due to significantly larger thorax, lumbar and pelvis rotations in stoop lifts. For the relatively slow lifting tasks performed in this study with the lowering and lifting phases each lasting approximately 2 s, the effect of inertia and damping was not, in general, important. Moreover, posterior shift in the position of the external load in stoop lift reaching the same lever arm with respect to the S1 as that in squat lift did not influence the conclusion of this study on the merits of squat lifts over stoop ones. Results, for the tasks considered, advocate squat lifting over stoop lifting as the technique of choice in reducing net moments, muscle forces and internal spinal loads (i.e., moment, compression and shear force).

Adult↗