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PubMed1999

Geographic variation in expenditures for Workers' Compensation hospitalized claims.

OBJECTIVE: Past literature finds considerable variation in the cost of physician care and in the utilization of medical procedures. Variation in the cost of hospitalized care has received little attention. We examine injury costs of hospitalized claims across states. DESIGN: Multivariate regression analysis is used to isolate state variations, while controlling for personal and injury characteristics, and state characteristics. SETTING: Injuries to workers filing Workers' Compensation lost workday claims. PARTICIPANTS: About 35,000 randomly sampled Workers' Compensation claims from 17 states filed between 1979 and 1988. MAIN OUTCOME MEASURE: Medical payments per episode of three injury groups: upper and lower extremity fractures and dislocations, other upper extremity injuries, and back strains and sprains. RESULTS: Statistical analyses reveal considerable variation in expenditures for hospitalized injuries across states, even after controlling for case mix and state characteristics. A substantial portion of the variation is explained by state rate regulations; regulated states have lower costs. CONCLUSIONS: The large variation in costs suggests a potential to affect the costs of hospitalized care. Efforts should be directed at those areas that have higher costs without sufficient input price, quality, or case mix justification.

Arm Injuries↗
PubMed2006

Fear of movement/(re)injury predicting chronic disabling low back pain: a prospective inception cohort study.

STUDY DESIGN: Prospective inception cohort study. OBJECTIVE: To investigate prospectively whether pain-related fear predicts future perceived disability and participation in patients with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA: There are indications that fear of movement/(re)injury, as measured by the Tampa Scale for Kinesiophobia, is present early in an episode of LBP, and that it might be a predictor of future perceived disability and participation. METHODS: A cohort of 555 patients with acute LBP included by general practitioners and physical therapists in primary care settings was followed for 6 months. RESULTS: Results indicate that baseline fear of movement/(re)injury was predictive of future perceived disability and, to a lesser extent (and together with duration and radiation), of participation. CONCLUSIONS: The results suggest that interventions aimed at reducing pain-related fear in the acute stage of LBP might prevent restrictions of activity and participation because of pain, and might be a way of preventing the transition from acute to chronic LBP.

Adult↗
PubMed2000

Evaluating risk of re-injury among 1214 army airborne soldiers using a stratified survival model.

BACKGROUND: Many factors interact to influence an injured individual's risk of sustaining a second injury. However, the quantitative assessment of subsequent injury risk has been limited, primarily due to methodologic constraints. The purpose of this study is to present analytical methodology not previously employed in injury epidemiology to identify risk factors for subsequent injury. METHODS: Data were collected from a retrospective cohort of 1214 U.S. Army Airborne soldiers. Lower extremity and low-back musculoskeletal injuries were identified from outpatient medical records. The Prentice, Williams, and Peterson (PWP) model, stratified by injury event, was used to identify risk factors for initial and subsequent injuries. A Cox proportional hazards model to the time of last injury was used to determine the magnitude of the increased risk associated with having a previous injury history. RESULTS: Risk factors for initial injuries were similar to those seen in other epidemiologic studies of military populations. However, this study found that race/ethnicity, physical fitness, medical provider training, and initial injury types (traumatic versus other) were associated with subsequent injury risk. Additionally, the observed risk of injury was seven times greater among previously injured individuals. CONCLUSIONS: In this population, the risk factors for injury differed by event (initial or subsequent injury), and prior injury history was a risk factor for subsequent injury. The associations between demographic characteristics, the nature of the initial injury, and risk of subsequent injury suggest that changes in the evaluation and medical management of injured individuals may decrease the risk of subsequent injury.

Adolescent↗
PubMed1986

Sprain and strain injuries in the Navy: the possible role of physical fitness in their prevention.

This investigation was undertaken to determine the nature and extent of sprain/strain (S/S) injuries in the Navy and identify occupations that are at high risk of sustaining these injuries. Hospitalization data, including discharge diagnosis and number of days hospitalized, were obtained from inpatient medical records provided by the Naval Medical Data Services Center, Bethesda, MD, and maintained at the Naval Health Research Center, San Diego, CA. All hospitalizations for enlisted personnel in each occupational rate were counted and total number of hospitalizations for each diagnostic category were determined. During the period July 1965 through December 1976, 5584 Navy male enlisted personnel were hospitalized for S/S injuries sustained while on duty. Approximately 56% of these injuries involved the back, 37.5% involved the leg, and 2.9% represent arm and hand injuries. The total number of days hospitalized, i.e., noneffective days, compiled by Navy personnel during this time period, was 82,451. Back injuries accounted for 54.4% of the total number of non-effective days. Findings suggest a relationship between high occupational physical demands and increased S/S injury incidence.

Hospitalization↗
PubMed2001

Work injury management of refractory low back pain: relations with ethnicity, legal representation and diagnosis.

While psychosocial factors are known to influence treatment outcomes in low back pain patients, relatively little is known about how they may influence work injury management of low back pain. This study examined medical and psychosocial factors associated with work injury management decisions relative to patients with occupational low back pain. A retrospective review of 132 patients who had settled their injury claims showed that two psychosocial factors, ethnicity and litigation status, were associated with work injury management. Temporary total disability costs and impairment ratings were lower for African Americans than for Caucasians, but only in the absence of legal representation. Similarly, patients with specific pathology underwent more treatment, especially diagnostic testing, than patients with non-specific back pain, but only in the presence of legal representation. Having evidence of a specific lesion and legal representation were also associated with claimants' final disability ratings. Results are discussed in terms of a model of social judgment in which properties of the judge, target, and context influence judgments. Implications for work injury management and disability determination, as well as future research are discussed.

Adult↗
PubMed1996

The frequency of golf injuries.

Although golf has not been recognized as a sport associated with injuries, epidemiologic studies document that back and elbow injuries are most common in male amateur golfers. Lower back and wrist injuries occur in the male golf professional while female professional golfers are more likely to suffer injuries to the wrist and lower back, respectively. The elbow, followed by the lower back, is the most likely area of injury associated with female amateur golfers. These injuries are related to overuse, poor conditioning, and improper swing mechanics. It is the hope of this author that more studies regarding the mechanics, prevention, and treatment of these injuries will be stimulated by this journal and others.

Golf↗
PubMed1994

Pre-injury emotional trauma and chronic back pain. An unexpected finding.

STUDY DESIGN: A retrospective study investigated pre-injury emotional trauma in out-of-work, blue collar patients with chronic back pain (N = 27) who participated in a 30-hour workshop in which a wide range of cognitive skills was taught to help patients with rehabilitation and return them to work. OBJECTIVES: This study identified categories of pre-injury emotional trauma, calculated summary statistics, and performed category comparisons. METHODS: The categories of abandonment, emotional abuse, physical abuse, and sexual abuse emerged from the data. Frequencies and percentages in each category were calculated. Chi-square tests compared the differences in emotional trauma and gender. RESULTS: Statistically more patients reported abandonment and emotional abuse than physical and sexual abuse. There were no differences in trauma rates by gender. The results of the study revealed a high rate of pre-injury emotional trauma in patients with chronic back pain. CONCLUSION: Including pre-injury emotional trauma in psychologic evaluations of patients with chronic back pain and high psychologic test scores is recommended.

Back Pain↗
PubMed1996

Injury in rugby league: a four year prospective survey.

OBJECTIVE: To investigate the incidence of injury in English professional rugby league over a period of four playing seasons. METHODS: All injuries that were received by players during match play were recorded. Each injury was classified according to site, type, player position, team playing for, activity at the time of injury, and time off as a result of injury. RESULTS: The overall injury rate was 114 (95% confidence interval 105 to 124) per 1000 playing hours, the most frequent type of injury were muscular injuries [34 (29 to 40) per 1000 playing hours], while the most frequently injured site was the head and neck region [38 (16 to 25) per 1000 playing hours]. Players received the largest percentage of injuries when being tackled [46.3% (41.9 to 50.7)], most injuries required less than one week away from playing and training [70.1% (66.1 to 74.2)], and forwards had a higher injury rate than backs (139 v 93 injuries per 1000 hours). CONCLUSIONS: The high rates of injury in rugby league are undoubtedly due to the high amount of bodily contact in the game. Being tackled has the highest risk of injury, because of being hit forcibly by other players. Forwards suffer higher injury rates than backs, probably because they are involved in a larger number of physical collisions.

Craniocerebral Trauma↗
PubMed2003

The effects of repetitive motion on lumbar flexion and erector spinae muscle activity in rowers.

OBJECTIVE: The purpose of this study was to investigate changes in lumbar flexion together with the pattern and level of muscle activity of selected erector spinae during a rowing trial.Design. Cross-sectional repeated measures design. BACKGROUND: Low back pain is a common problem in rowers. The amount of lumbar flexion occurring during rowing might influence the possibility of injury. METHODS: Sixteen young adult school rowers participated in the study. Changes in lumbar flexion and muscle activity were recorded across the drive phase, at three stages of an ergometer based rowing trial. Lumbar flexion was calculated by computerised motion analysis of surface markers attached to the spinous processes of L1 and S1. Surface electromyography techniques were used to examine the magnitude of activity from three erector spinae muscles. The median frequency of the electromyographic signal was examined to quantify fatigue in the erector spinae muscles during isometric maximal effort muscle activation prior to and after the rowing trial. RESULTS: Lumbar flexion increased significantly (P<0.05) during the rowing trial, as did the magnitude of electromyographic activity from sites over the lumbar multifidus, iliocostalis lumborum and longissimus thoracis muscles. The median frequency decreased significantly (P<0.05) in each muscle examined. CONCLUSIONS: The findings showed that rowers attain relatively high levels of lumbar flexion during the rowing stroke, and these levels are increased during the course of the rowing trial. Indirect evidence of muscle fatigue in erector spinae muscles was also apparent, and this observation may in part be responsible for the increased levels of lumbar flexion observed. RELEVANCE: Excessive lumbar flexion may influence the potential for injury to spinal structures. An awareness of increased lumbar flexion and muscle fatigue in the erector spinae muscles may be important for injury prevention programs for rowers.

Adolescent↗
PubMedDate not supplied

Manual materials handling: the cause of over-exertion injury and illness in industry.

It is reported from various sources that overexertion due to lifting, pushing, pulling, and carrying objects accounts for about 27 percent of all compensable industrial injury and illness in the United States. Resulting strain/sprain injuries account for over 50 percent of workmen's compensation clams in many industries. Almont two-thirds of these involve back pain, with reported compensation and medical payments totaling well over one billion dollars annually in the U.S. An estimated 300,000 plus workers will be affected each year, 5 to 10 percent of whom will have a permanent disability and often will be unemployable. This paper attempts to describe four basic approaches used to study this occupational health problem. In so doing, a concerted effort is made to identifiy the gaps in knowledge which need to be more fully researched. The approaches utilized to understand and control the hazards of manual materials handling are: 1) epidemiological studies of job and worker attributes to identify those that individually and in combination cause musculoskeletal incidents, 2) psychophysical studies to ascertain the volitional tolerance of workers to the stress mitigated by manual materials-handling activities, 3) biomechanical studies of the musculoskeletal system during common exertions required in manual materials-handling activities, and 4) physiological studies of the strain imposed on the cardiovascular system during repeated load-handling activities. The state of knowledge from each of these approaches is summarized briefly, and a case is made that much research is still needed to substantiate the necessary controls to lessen the economic burden and human suffering associated with manual materials-handling acts in industry.

Adolescent↗
PubMed1998

Catastrophizing, pain, and disability in patients with soft-tissue injuries.

The present study examined the role of catastrophizing in predicting levels of pain and disability in a sample of individuals who had sustained soft-tissue injuries to the neck, shoulders or back following work or motor vehicle accidents. Participants were 86 (27 men, 59 women) consecutive referrals to the Atlantic Pain Clinic, a multidisciplinary treatment centre for the management of persistent pain disorders. Findings revealed that catastrophizing, measured by the Pain Catastrophizing Scale (PCS; Sullivan, M.J.L. et al., Psychol. Assess., 7 (1995) 524-532) was significantly correlated with patients' reported pain intensity, perceived disability and employment status. The results of a regression analysis further showed that catastrophizing contributed to the prediction of disability over and above the variance accounted for by pain intensity. In addition, catastrophizing was associated with disability independent of the levels of depression and anxiety. The rumination subscale of the PCS was the strongest predictor of pain and disability. Theoretical and clinical implications of the findings are discussed.

Accidents, Traffic↗
PubMed2006

Postoperative change of the cross-sectional area of back musculature after 5 surgical procedures as assessed by magnetic resonance imaging.

Many investigators have reported that persistent low back pain may occur after posterior surgical intervention, and studies have investigated the histologic and histochemical changes in back muscle after posterior lumbar spine surgery. The purpose of the current study is to compare the pre- and postoperative cross-sectional area of the back musculature among 5 surgical groups including anterior lumbar interbody fusion, which has no direct invasion of the back musculature, using magnetic resonance imaging, and to correlate the clinical results with the degree of atrophy. The cross-sectional area of the back musculature was measured before and after surgery in T2-weighted axial magnetic resonance images using a computer-linked digitizer. The degree of atrophy (atrophy ratio) was calculated as a ratio of the postoperative cross-sectional area to the preoperative cross-sectional area. Clinical results were evaluated using the Japanese Orthopaedic Association's scores for the management of low back pain. Atrophy of the back musculature was confirmed in each group. However, no significant difference was seen in the atrophy ratio between the groups. Back musculature atrophy occurred even in anterior lumbar interbody fusion, which does not involve any direct surgery of the back muscle. A positive correlation was noted between the atrophy ratio and operation time only in posterior surgery, especially in nonfusion surgery. In conclusion, the current study suggests that a shorter operation time may minimize back muscle injury, and shows that factors inducing back musculature atrophy include not only direct invasion of the back muscle via a posterior approach, but also postoperative external fixation.

Adult↗