Do back belts prevent back injury?
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Back Injuries↗
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Factor structure of the pain disability index in workers compensation claimants with low back injuries.
OBJECTIVE: To examine the factor structure of a telephone-administered Pain Disability Index (PDI) and the effects of race and sex on the PDI. DESIGN: Computer-assisted telephone interviews of a cohort with occupational low back injuries. SETTING: General community. PARTICIPANTS: Missouri workers compensation claimants (N=1329) with low back injuries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: PDI, levels of pain severity, Social Security Disability Insurance status, and the Fear-Avoidance Behavior Questionnaire. RESULTS: Results for the total sample and by race/sex group indicated support for a 2-factor model of the PDI corresponding to voluntary activities (eg, social, occupational, recreational) and obligatory activities (eg, activities of daily living, eating, sleeping). Additional psychometric analyses of the voluntary and obligatory subscales indicated adequate reliability and construct validity overall and in each of the race/sex groups. African Americans reported more pain-related disability on both subscales than whites. Women reported more disability on the voluntary subscale than men. CONCLUSIONS: The results support use of the PDI as a bidimensional measure of pain-related disability, with strong psychometric properties. They also support its administration by telephone.
Adolescent↗
A prospective study of work perceptions and psychosocial factors affecting the report of back injury.
A longitudinal, prospective study was conducted on 3,020 aircraft employees to identify risk factors for reporting acute back pain at work. The premorbid data included individual physical, psychosocial, and workplace factors. During slightly more than 4 years of follow-up, 279 subjects reported back problems. Other than a history of current or recent back problems, the factors found to be most predictive of subsequent reports in a multivariate model were work perceptions and certain psychosocial responses identified on the Minnesota Multiphasic Personality Inventory (MMPI). Subjects who stated that they "hardly ever" enjoyed their job tasks were 2.5 times more likely to report a back injury (P = 0.0001) than subjects who "almost always" enjoyed their job tasks. The quintile of subjects scoring highest on Scale-3 (Hy) of the MMPI were 2.0 times more likely to report a back injury (P = 0.0001) than subjects with the lowest scores. The multivariate model, including job task enjoyment, MMPI Scale-3, and history of back treatment, revealed that subjects in the highest risk group had 3.3 times the number of reports in the lowest risk group. These findings emphasize the importance of adopting a broader approach to the multifaceted problem of back complaints in industry and help explain why past prevention efforts focusing on purely physical factors have been unsuccessful.
Adult↗
Expenditures for nonspecific back injuries in the workplace.
This study reports results based on the 29,421 Tennessee Workers' Compensation claims that were closed in 1986. The study encompasses over $160 million in paid claims. Nearly 8000 cases (27%) involved back injuries, of which more than 90% were nonspecific. Forty percent of the total expenditures were for these nonspecific back injuries. Counterpart data on 8696 injuries involving extremities are included for comparison. Medical expenses account for about 40% of all payments. Data concerning time intervals between injury and return to work are provided. Separate analyses reveal characteristics of those subjects in the highest total expenditure decile, the 2941 subjects who received 57% of total dollar payments. This report provides fiscal data supporting recent appeals for a reappraisal of the clinical management of nonspecific back problems.
Back Injuries↗
Back injuries in gymnastics.
The complaint of low back pain in the adolescent must never be taken lightly. A high index of suspicion should be particularly entertained in a child participating in gymnastic training or competition. As noted in this article, steps can now be taken, particularly if a specific diagnosis is made early, to institute specific treatment with a high likelihood of success. Young gymnasts complaining of back pain must never be passed off as having sustained a back strain or "muscle spasms" and treated symptomatically. Persistent back pain beyond two weeks warrants, in our opinion, a complete evaluation, careful history and physical examination, a four-view radiographic assessment of the spine, and, if necessary, bone scans or other more advanced techniques to make a specific diagnosis of the cause of the pain.
Adolescent↗
Risk indicators for reported over-exertion back injuries among female nursing personnel.
We conducted a case-referent study to identify and quantify work-related and non-work-related risk indicators for reported over-exertion back injuries among nursing personnel. The source population was all nursing personnel employed in the Stockholm County hospitals during a 32-month period. The 240 cases and 614 referents completed questionnaires about occupation, type of clinic, working hours, shift work, patient transfers, perceived exertion, back pain, prior back injury, job strain, body mass index (BMI), smoking, immigrant status, physical training, and self-rated fitness. The highest relative risks (RR) were observed for work-related factors: working at an orthopedic clinic (RR = 5.2; 95% CI = 2.7-10.2), > or =1 patient transfer/shift (RR = 2.7; 95% CI = 1.6-4.5), and working full-time (RR = 2.4; 95% CI = 1.6-3.6). Training in the use of transfer devices, and regular use of transfer devices, reduced the relative risk from patient transfer. Among the non-work-related factors, only body mass index > or =25 kg/m2 and immigrant status was associated with a slight increase in relative risk.
Accidents, Occupational↗
The influence of organizational factors on occupational low back injuries.
The unique home care environment puts nurses at risk of low back injuries. Protecting nurses may mean the difference between delivering cost-effective quality care and no care at all. This study, conducted in Alberta, Canada, disclosed a lack of organizational resources and use of occupational health services in home care providers. Involving frontline staff as management partners may provide a solution for the development of an effective injury prevention program in home care.
Adult↗
The prognostic consequences in the making of the initial medical diagnosis of work-related back injuries.
STUDY DESIGN: A cohort of 1848 workers, representative of all sectors of industry, who were compensated for a low back injury in 1988 but not in the previous 2 years, was followed over 24 months. OBJECTIVES: To determine the prognostic value of the physician's initial diagnosis of back problems. SUMMARY OF BACKGROUND DATA: In the absence of a standardized classification of diagnoses of back pain, this study aimed to provide an element of validity to a classification previously proposed that consists of "specific" and "nonspecific" back pain. METHODS: Medical charts were reviewed at the Quebec Worker's Compensation Board to extract the diagnosis made by the treating physicians within 7 days of the first day of absence from work. Diagnoses were categorized into "specific" (lesions of vertebrae and discs) and "nonspecific" (pain, sprains, and strains). The history of compensated work absence for low back pain in the following 24 months was obtained. RESULTS: A specific diagnosis was found in 8.9% (165) of the workers, accounting for 31.0% of the patients who accumulated 6 months or more of absence in 2 years. Increasing age and daily amount of compensation also were associated with an increased risk of chronicity. CONCLUSIONS: The physician's initial diagnosis was highly associated with the risk of chronicity. The explanation for this result is complex, involving the nature of the underlying lesion as well as the impact of the diagnosis "label" on the worker and on the physician-patient relationship.
Absenteeism↗
A controlled trial of an educational pamphlet to prevent disability after occupational low back injury.
STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To test the ability of an educational pamphlet to improve recovery in terms of pain, work status, and health care utilization after occupational low back injury. BACKGROUND: Low back pain and disability persist as occupational health problems of epidemic proportions. Because interventions based on biomechanical models have had limited impact, recent educational approaches to preventing back problems have stressed psychosocial recovery issues. METHODS: A pamphlet was developed by compiling activity resumption, self-care, and attitudinal advice from recent publications. The pamphlet was sent at random to half of all consenting workers reporting back pain within 11 days of occupational injury between 7/96 and 6/97. Three and 6 months later, back pain, work status, health care use, and pamphlet impact outcomes were assessed through structured telephone interviews. RESULTS: Of the 726 eligible workers, 486 consented to participate. Consenters and nonconsenters and intervention and control groups were similar in initial demographic variables. The pamphlet had no statistically significant impact at the 0.05 significance level on pain severity or reduction, health care visits, or work absence. Of the 229 pamphlet recipients, 129 thought it had provided useful information, but only 25 thought it had helped them return to work more quickly. CONCLUSIONS: In this trial, a pamphlet stressing psychosocial recovery issues did not prevent or reduce postinjury pain, health care use, or work absence.
Adult↗
Lost time back injuries: their rrelationship to heavy work and preplacement back x-rays.
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Absenteeism↗
Back injuries among nursing personnel: the relationship of personal characteristics, risk factors, and nursing practices.
Reducing the total number of work related back injuries among nurses is important, but reducing those injuries that are severe enough to result in lost time and/or disability is critical. Results of this study indicate that female nurses in the early phases of assignment on long term care units are at greatest risk for back injury, but risk factors that relate significantly to the severity of the injury are tour of duty (evening) and weight of the nurse (200 + pounds). Recommendations suggested by this study include: evaluation of lifting techniques and practices; orientation whenever assignments are changed; accurate assessment of nurse, client, and situation; and the regular use of an assessment tool which incorporates all of these factors.
Absenteeism↗
The functional restoration approach to the treatment of chronic pain in patients with soft tissue and back injuries.
A prospective randomized study of 542 injured workers with continuing pain compared 271 workers who were treated at either one of two clinics that provided functional restoration with a control group of 271 subjects. Chronic pain was caused by low back injury in 78% of patients; 79% of those treated were at work 12 months after completion of treatment compared with 78% of the control subjects. When the patients were divided into subsets, based on the accident date and followed monthly, the duration of absence from work, the compensation costs, the disability award costs, and the total costs were less for those treated than the control subjects, but these were not statistically significant. Using the difference in total costs as a measure of relative success, back injuries had better results than other injuries in this study.
Absenteeism↗
Analysis of 2932 workers' compensation back injury cases. The impact on the cost to the system.
In 1982 the Workers' Compensation Board of New York State authorized payment of +42,084,999 for closed cases of spinal injuries; 30 states paid a combined +1.9 billion for medical treatment and/or compensation for back injuries. The other states did not have the requested information available. Analysis of 2932 spinal injury cases evaluated for disability in a 7-year period showed a mean of 23.4 months of medical treatment in 1706 cases concluded with no disability. Also, 91% of the claimants represented by counsel were not working, whereas 77% not so represented were working. Most of the consultative medical reports, insurance carriers' and claimants', veered on the adversarial and favored the respective interested party. The cost of workers' compensation back injury claims is very high. The conclusion is inescapable that iatrogenic and jurisgenic factors have a direct effect (in the cohort of cases analyzed) on the prolongation of medical care, and delay in returning to gainful employment, and, consequently, contributing to the high cost.
Accidents, Occupational↗
A longitudinal, prospective study of industrial back injury reporting.
The authors prospectively evaluated 3020 volunteers of the Boeing-Everett plant to assess risk factors that predispose workers to file industrial back injury claims. During four years of follow-up observation, more than 279 subjects reported acute back problems. The effect of the only predictive physical variable was explainable by a history of medical treatment. The most predictive individual factors were (1) job task dissatisfaction and (2) distress as reported on Scale 3 of the Minnesota Multiphasic Personality Inventory (MMPI). This data perhaps explains why the focus on purely physical and injury-related factors has met with little success in dealing with what has become the most expensive orthopedic problem. Clinically, nonphysical factors that significantly impact the reporting of back injuries may also affect patients' responses to medical treatment.
Accidents, Occupational↗
Teaching and social support: effects on knowledge, attitudes, and behaviors to prevent low back injuries in industry.
An educational program designed to reduce low back injuries was modeled after several well-known back schools and taught to postal workers in a randomized trial of about 4,000 workers. Physical therapists taught 3 hours of class sessions, including knowledge, skills, and individual work station assessment, to small groups of workers and supervisors, with reinforcement every 6 months afterward. At 2 1/2 years, a random sample of 209 workers was surveyed for program impact on intermediate outcomes. We observed increased knowledge among experimental unit workers, but no significant improvements in behaviors associated with back health or in proportion of workers with tired backs. Experimental unit workers who had received training by the time of the survey were less likely to report helping/reinforcement for healthy behaviors than controls or untrained experimental unit workers. The program might have led trained workers to perceive a lack of support and reinforcement for back safety among coworkers and supervisors by sensitizing them to what is possible and raising expectations. There appeared to be group social effects in the dissemination of knowledge and perhaps of helpful behaviors; however, it is apparent that worker social support for change in health behaviors is a complex phenomenon that cannot always be relied upon to enhance program goals.
Back↗
Use of modified Boston brace for back injuries in athletes.
The Boston Brace System was developed to attain functional realignment of the scoliotic spine. This system uses prefabricated thermoplastic pelvic modules which can be rapidly fitted to an individual patient. These modules are available in 20 sizes and designed with a forward flexion of 30 degrees on the anterior margin and 15 degrees on the posterior surface. The resultant antilordotic straightening of the lumbar spine is important in correcting the scoliotic spine and has been found to be therapeutically effective in managing a number of other conditions of the spine, including back injuries in the young athlete. A review of the results of treatment of 31 young athletes for back injuries over the past 3 years with the brace, with an average followup of 15 months, reveals good or excellent results in 28 of the 31, or 90%. Best results were attained in spondylolysis. Therapy for discogenic back pain with the brace was effective in only 50%. Modifications of initial brace design included changing from a posterior opening to an anterior opening module and from polypropylene to polyethylene brace construction. Most patients have continued full athletic participation while in the brace.
Athletic Injuries↗
Duration of work disability after low back injury: a comparison of administrative and self-reported outcomes.
BACKGROUND: Workers' compensation wage replacement data have recently been used to estimate time to return to work (RTW) and the number of work days lost after occupational injury. The degree to which indemnity-based measures reflect self-reported work disability has until now not been studied. METHOD: Kaplan-Meier curves of administrative and self-reported measures of duration of work disability were compared within a sample of 433 low back injury claimants followed up for 1 to 3.7 years. RESULTS: Administrative measures consistently and significantly underestimated the duration of disability when compared to self-reported measures of RTW. The difference between the estimated mean number of work days lost for comparable administrative and self-reported measures ranged from 142 to 334 days. CONCLUSIONS: Number of work days lost after low back injury is substantially underestimated by measures based on the duration of wage replacement benefits. This calls into question the adequacy of indemnity benefits and underscores the need for disability prevention programs.
Adult↗
Injury in the medical workplace. Educating employees to prevent back injury, stress, and slips and falls.
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Accidental Falls↗