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PubMed1996

Early prediction of chronic disability after occupational low back injury.

STUDY DESIGN: An inception cohort design was used to study a consecutive sample of back-injured workers. OBJECTIVE: To refine and to test the Vermont Disability Prediction Questionnaire's ability to indicate an individual's relative risk for chronic disability after occupational low back injury. SUMMARY OF BACKGROUND DATA: Although most back-injured workers return to work quickly, the minority who do not account for the majority of associated costs and health care. Early identification of workers at high risk for disability would facilitate intervention strategies. METHODS: During the study recruitment period, people aged 18-60 years reporting occupational low back injury to the Vermont Department of Labor and Industry within 11 days of onset were eligible. A Vermont Disability Prediction Questionnaire was mailed to the 442 subjects who could be contacted and who gave informed consent. One hundred sixty-three of the 166 subjects who completed and returned the questionnaire within 15 days of initial injury were telephoned 3 months later to determine work status. Those who returned the questionnaire were compared with those who would not consent or did not return the questionnaire in time according to age, sex, residence, wages, work hours per week, and length of employment. Employment status (inability to work because of low back pain) was evaluated by telephone interview 3 months after initial injury. RESULTS: The follow-up interviewer was blinded to the Vermont Disability Prediction Questionnaire scores. of the 163 subjects, 16 (10%) were not working because of low back pain. Using a simple dichotomous scoring system for 11 questionnaire items, a cut-off score of 0.48 identified 3-month postinjury work status, with 0.94 sensitivity and 0.84 specificity. CONCLUSIONS: The Vermont Disability Prediction Questionnaire is a brief, easily administered and scored tool for identifying back-injured workers at relative risk for chronic disability. Such early identification should increase the efficiency of disability prevention strategies by directing them toward people who need them most. The accuracy of the questionnaire needs to be tested in a variety of different clinical and socioeconomic settings.

Adult↗
PubMed1997

The biomechanics of low back injury: implications on current practice in industry and the clinic.

The purpose of this paper is to introduce some concepts of low back injury for use towards developing better injury risk reduction strategies and advancing rehabilitation of the injured spine. Selected issues in low back injury are briefly reviewed and discussed, specifically, the types of tissue loads that cause low back injury, methods to investigate tissue loading, and issues which are important considerations when formulating injury avoidance strategies such as spine posture, and prolonged loading of tissues over time. Finally, some thoughts on current practice are expressed to stimulate discussion on directions for injury reduction efforts in the future, particularly, the way in which injuries are reported, the use of simple indices of risk such as load magnitude, assessment of the injury and development of injury avoidance strategies. This paper was written for a general biomechanics audience and not specifically for those who are spine specialists.

Ambulatory Care↗
PubMedDate not supplied

Reducing the physical and fiscal pain of back injury.

In the British Columbia health care industry from 1988 to 1990 occupational back injury accounted for 37 per cent of the time lost to injuries and 47 per cent of costs associated with wage loss. In 1988, the Royal Inland Hospital in Kamloops, British Columbia, implemented an early-intervention and occupational rehabilitation program. By 1990, this program had reduced the hospital's average time lost to back injury by 43 per cent. This article describes the procedures and benefits of the program.

Absenteeism↗
PubMed1989

Low back injury in industry: the value of a recovery program.

Low back pain is the most frequent chronic disabling condition in the United States in patients younger than 45 years, and it is the second largest cause of employee absenteeism. In this retrospective study involving extreme working conditions at an industrial plant, we found that 20% of all employees incurred a back injury (occupational and nonoccupational) during the 12-month study period, costing more than 5,000 days of work lost, and approximately $920,000. Based on these findings a three-phased program of education/prevention, physical therapy, and an on-site rehabilitation workshop was implemented. After the first operational year, the net saving to the corporation was $255,000, and all employees who participated in the program returned to work within 60 days. We conclude that good job design, employee education on back injury prevention, and immediate on-site rehabilitation for injuries incurred can reduce employee disability and lost work time thus benefiting the employer and employee alike.

Absenteeism↗
PubMed1993

Lower limb and back injury patterns of elite netball players.

The purpose of this study was to investigate the relationships between lower limb and back injuries with perceived landing patterns and podiatric variables for injured and uninjured elite netball players. 228 players of a possible 240 participants at the 1988 Australian netball championships completed injury questionnaires and were assessed for injury status. Approximately 92% of those who were part of the injury surveys were also given a podiatric assessment. Pearson chi 2 and unpaired t-tests were used to assess relationships between injury status in 2 groups (history of injury, and injuries sustained during the championships) and perceived landing patterns during play and podiatric variables. A significant association was found between history of lower limb and back injuries and level of competition. Open age netballers reported more injuries than the younger players. During each championship, a similar number of players (23%) were injured irrespective of playing level. 71% of these players sustained a grade 1 injury, 15.4% a grade 2 injury and 13.5% presented with severe grade 3 injuries. 2 players were diagnosed with an anterior cruciate ligament injury and a further 3 players sustained a fracture during the championships. Most of the injuries were ligamentous (40.5%) with some overuse tendinitis (11.5%) problems. The injury history profiles of the elite players surveyed showed that ankle and knee injuries were the most common lower limb injuries with incidences of 58 and 22%, respectively. More than a quarter of the players had overuse type injuries (24% retropatellar pain, 38% shin soreness) and 33% complained of back problems during their careers. 18 significant relationships were found between injuries sustained during a player's career and podiatric measures. Only 22.5% of a player's foot types were classified as normal while 42% presented with rearfoot varus and 20% were grouped into pronated foot postures.

Adolescent↗
PubMed1996

Back injury prevention interventions in the workplace: an integrative review.

The purpose of this integrative review is to describe the state of knowledge about the effect of worksite back injury prevention programs on selected study outcomes. Fifteen experimental and quasi-experimental studies published between 1987 and 1994 were identified through a comprehensive literature search. The research studies were reviewed and analyzed using a data collection abstracting tool. Four types of back injury prevention intervention programs were identified: back belts, back schools, exercise/flexibility training, and educational classes. Positive program outcomes were reported for all four program types; however, the back school and the exercise/flexibility training programs were studied more frequently and demonstrated a greater proportion of positive results than the other two program types. Conclusions should be viewed cautiously due to the small number of studies reviewed and their methodological limitations. Implications for occupational health nursing practice and future research related to worksite back injury prevention are offered.

Exercise Therapy↗
PubMed1995

Ergonomic factors contributing to back injury. Third in a series.

The last two articles in this series pointed out that back injuries do not occur overnight unless acute trauma occurs. Rather, they are the result of cumulative trauma--they develop gradually over a period of time. Even though back injuries appear to be related to a single event (i.e., "While lifting the patient up I felt my back pop."), they are actually related to repeated events that predispose a person's body to the final breakdown event.

Back Injuries↗
PubMed1991

Low-back injuries in a heavy industry. II. Labor market forces.

Trends in rates of low-back strains, low-back impact injuries, and non-low-back injuries among field employees of a petroleum drilling company, 1979-1985, were examined to investigate the relationship between economic factors and the incidence of low-back and other injuries. Economic indicators included the rate of resignations, a surrogate for turnover, and the rate of layoffs. Only lost-time low-back strain rates increased during times of worker layoffs. Non-low-back injury rates were highest during periods of high turnover and no layoffs. Although the increasing age of the work force and the anxiety generated by an industry-wide depression may have played a role, it is likely that the increase in lost-time low-back strain injuries was a worker response to possible layoff.

Accidental Falls↗
PubMed1997

Design factors in epidemiologic cohort studies of work-related low back injury or pain.

The connection between work-related exposures and the onset of back injury or pain is complex and not clearly understood. This paper raises design issues related to the planning and conduct of cohort studies of industrial low back pain (or injury)(LBP), with care given to definition and measurement of exposure and outcome events. These issues include sample size, outcome definition, study biases, and practical considerations when seeking and maintaining company collaboration with a research effort. Without resolving these issues, the authors conclude: (1) cohort studies of worksite-based LBP are needed to elucidate the causal associations between work tasks and LBP onset, (2) both acute and cumulative exposures should be assessed as risk factors for low back injury or pain, and (3) attention should be paid to the planning of such studies and minimization of potential biases that can limit the validity of the results. These design issues will benefit researchers and companies engaged in the planning and conduct of cohort studies of industrial LBP.

Accidents, Occupational↗
PubMed1999

Risk factors for back injury in 31,076 retail merchandise store workers.

Risk factors for work-associated strain or sprain back injuries were investigated in a cohort of 31,076 material handlers from 260 retail merchandise stores in the United States. The workers studied were those with significant material-handling responsibilities--daily lifting and movement of merchandise. Workers in jobs with the greatest physical work requirements had an injury rate of 3.64 per 100 person-years versus 1.82 in workers with lesser work requirements. The unadjusted injury rate for males was 3.67 per 100 person-years compared with 2.34 per 100 person-years for females, but the excess for males was confounded by higher physical work requirements for men in the stocker/receiver job category. The injury rate ratio for short versus long duration of employment was 3.53 (95% confidence interval: 2.90, 4.30); for medium versus long duration of employment, it was 1.38 (95% confidence interval: 1.18, 1.62). The elevated rate ratios were maintained when the data were stratified by subsets with different rates of turnover. The results suggest that workers with the greatest physical work requirements and those with the shortest duration of employment are at the highest risk of back injuries. However, selection forces causing worker turnover within this cohort of active workers are not well characterized and have the potential to bias the measures for time-related factors such as duration of employment.

Accidents, Occupational↗
PubMed2006

Factors associated with early opioid prescription among workers with low back injuries.

UNLABELLED: Prescription of opioids for nonmalignant musculoskeletal pain has increased substantially in recent years, but there is little information on the incidence of, or factors associated with, such prescription for work-related back pain. In a prospective cohort study (N = 1,067), we examined associations between worker sociodemographic and other characteristics and opioid prescription within six weeks of the first medical visit for workers' compensation claims for work loss due to back injury. We examined administrative, pharmacy, and worker-reported data. In bivariate logistic regression models, Hispanics were less likely than non-Hispanic whites to receive opioid prescriptions, and very high body mass index, daily tobacco use, greater pain and physical disability, pain radiating below the knee, injury severity categorizations (from medical records) of major sprain and radiculopathy, and worse mental health were associated with opioid prescription. Adjusting for demographics, pain intensity, and physical disability, opiate prescription was significantly associated with daily tobacco use, pain radiating below the knee, and injury severity categories (major sprain and radiculopathy). Knowledge of worker characteristics associated with early opioid prescription may be useful in future studies of the role of early pain treatment in influencing subsequent course of pain and disability among workers with back injuries. PERSPECTIVE: Little is known about patient characteristics that may influence physicians' decisions concerning prescription of opioids for acute back pain. Not surprisingly, workers with more severe back injuries are more likely to be prescribed opioids, but reasons for prescription disparities based on ethnicity and tobacco use warrant further study.

Adult↗
PubMed2004

Physical workload, ergonomic problems, and incidence of low back injury: a 7.5-year prospective study of San Francisco transit operators.

BACKGROUND: The etiologic role of biomechanical factors for low back injury (LBI) needs to be confirmed in prospective studies that control for psychosocial factors. METHODS: Complete baseline information on 1,233 vehicle operators was gathered during medical examinations and by questionnaire. First LBI during 7.5 years of follow-up was ascertained from insurance records. Hazard ratios and etiologic fractions were analyzed with Cox regression models stratified by injury severity and controlling for age, sex, height, weight, ethnicity, and biomechanical and psychosocial job factors. Severe LBI was defined as medically diagnosed postlaminectomy syndrome, spinal stenosis, herniated lumbar disc, sciatica, or spinal instability. RESULTS: An exponential dose-response relationship was found between weekly driving hours and incidence of first LBI. Indicators of physical workload were more strongly associated with more severe low back injuries compared to less severe injuries. Rates of severe LBI increased 39% for every 10-hr increase in weekly driving (hazard ratio 1.39, 95% confidence interval 1.15-1.68). Higher risks of severe LBI were also found among operators performing heavy physical labor on cable cars (hazard ratio 2.76, 95% confidence intervals 1.24-6.14) or reporting more ergonomic problems at baseline (HR for upper quartile 1.65 (95% confidence interval 1.08-2.50). Estimates of etiologic fractions suggest that reduction of ergonomic problems to the low level currently experienced by 25% of drivers would result in a 19% reduction of severe LBI among all drivers. A change from full- (more than 30 hr) to part-time driving (20-30 hr) could reduce the number of severe LBI by 59%, although this gain would be reduced to 28% at the company level if injuries expected among additional employees, hired to maintain full service are included. CONCLUSIONS: Duration of professional driving and ergonomic problems are independent and preventable risk factors for LBI even after adjustment for psychosocial factors.

Adult↗
PubMed1962

Initial care of acute back injuries.

The mechanism of injury to the back should be obtained with the utmost accuracy and set down in the history as a separate paragraph under that heading. This is usually best obtained by questioning and requestioning the patient during the course of the examination. A history of any previous back affections should also be obtained at the first visit. The detailed examination of the back is not complete without a general physical examination.X-ray studies should be done immediately in all cases in which the injury has been caused by direct violence or forceful indirect violence (as in "jackknife" injury). Terms such as "disc disease," "ruptured intervertebral disc" and various others that convey a similar meaning should not be used as the initial diagnosis and should be withheld until such a diagnosis is definitely established. The plan of treatment may include a period in hospital or of rest at home, or it may be carried out with the patient ambulatory. Corsets and braces should be prescribed only when they are to serve a definite function and the same can be said of physiotherapy.

Back↗
PubMed2003

Back injury prevention: a lift team success story.

Work related back injuries among hospital personnel account for high volume, high cost workers' compensation claims. These injuries can be life altering experiences, affecting both the personal and professional lives of injured workers. Lifting must be viewed as a skill involving specialized training and mandated use of mechanical equipment, rather than as a random task performed by numerous health care providers. The use of a lift team specially trained in body mechanics, lifting techniques, and the use of mandated mechanical equipment can significantly affect injury data, financial outcomes, and employee satisfaction. The benefits of a lift team extend beyond the effect on injury and financial outcomes--they can be used for recruitment and retention strategies, and team members serve as mentors to others by demonstrating safe lifting techniques. Ultimately, a lift team helps protect a valuable resource--the health care worker.

Back Injuries↗
PubMed1995

Reducing employee back injuries in the perioperative setting.

An ergonomic consultant conducted an evaluation of a 14-room surgical suite that had a high rate of employee back injuries. The consultant made five specific recommendations regarding moving patients, maneuvering carts and equipment, using gallbladder boards, walking on wet floors, and accessing power outlets. Most of the recommendations were implemented and well received. Eighteen months after the implementation of the consultant's recommendations, there was a 25% reduction in the number of back injuries among the OR staff members.

Accidents, Occupational↗