Clinical management and the duration of disability for work-related low back pain

Clinical practice guidelines recommend a conservative approach to management of acute low back pain (LBP). The present study sought to determine whether health care utilization and the physician's initial management of work-related LBP were associated with disability duration. Clinical management information was obtained for 98 randomly selected, workers' compensation claimants with acute, uncomplicated, disabling work-related LBP. Length of disability was based on indemnity (wage replacement) payments. Disability was significantly associated with increased utilization of specialty referrals (P = 0.013) and provider visits (P < 0.001), use of magnetic resonance imaging (P = 0.003), and use of opioids for more than 7 days (P = 0.013). Effects of early diagnostic imaging (first 30 days of care) on length of disability were observed (P = 0.001). Patients whose treatment course did not involve extended opioid use and early diagnostic testing were 3.78 times more likely (95% confidence interval, 1.6 to 8.9) to have gone off disability status by the end of the study. The nature of the association between these initial clinical management aspects and LBP disability duration merits further exploration.     

两种运动疗法对工作相关性腰背痛康复的疗效观察

选取2019年8月至2020年8月于本院进行康复运动疗法的47例工作相关慢性非特异性腰背痛(low back pain, LBP)患者作为研究对象。将25例采用站立背伸式多裂肌运动疗法患者作为观察组,22例采用传统俯卧超人式多裂肌运动疗法患者作为对照组,比较两组患者的疼痛视觉模拟评分(VAS)、多裂肌厚度(MT)以及《依从性量表》得分。与治疗前相比,两组患者治疗后的VAS评分显著低于治疗前(P<0.05),MT无明显改变(P>0.05),观察组治疗依从性得分明显高于对照组;VAS评分、MT差值两组间差异无统计学意义(P>0.05)。两种康复疗法均能有效缓解工作相关LBP症状,站立背伸式多裂肌运动疗法更加简便易行,具有良好的依从性,值得临床推广应用。     

Risk factors for work-related low back pain in the People's Republic of China

A critical review was conducted of studies of work-related low back pain in the People's Republic of China. The published literature in both the English and Chinese languages from 1983 to 1997 was reviewed for studies that permitted the calculation of prevalence ratios. Thirty-five papers were identified initially, and after quality inclusion/exclusion criteria were applied, 16 (14 in Chinese and two in English) were selected for more detailed review. Prevalence ratios were statistically elevated in all but two of the selected studies. Prevalence ratios for individual groups ranged from 2.0 to 8.5 for bending and twisting, 1.5 to 14.3 for static posture, 1.9 to 5.5 for whole-body vibration, and 2.6 to 9.4 for low-temperature exposure. The literature was limited by the absence of standardized and robust measures of low-back-pain outcomes and exposures and by the omission of fundamental details from research reports. Even with these limitations, the review findings suggest that three physical risk factors, all well known in the international literature, are associated with the prevalence of low back pain in the People's Republic of China.     

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. Am. J. Ind. Med. 32:153–163, 1997. © 1997 Wiley-Liss Inc.     

A model for the prevention of iatrogenic disease associated with work-related low back pain

A review of national statistics related to workers' compensation strongly suggests that the current system for managing work-related back pain is not only ineffective but may actually promote disability. It is this author's view that a comprehensive unifying solution exists within the military forward treatment model used to prevent iatrogenic disability in battle fatigue casualties. Because military personnel and employed workers are similarly entitled it is felt that this proven model may likewise be effective in the prevention of iatrogenic disability in the worker with a job-related back injury. The model, acronymed SPICE, includes five components: Simplicity, Proximity, Immediacy, Centrality, and Expectancy.     

Psychological factors affecting isokinetic trunk strength testing in patients with work-related chronic low back pain

Psychological factors are assumed to play a major role in pain-related work disability. Assessment of pain-related disability using a functional capacity evaluation, usually includes assessment of trunk strength and range of motion. Isokinetic strength testing is a method used to measure strength and function of isolated muscles and has been reported to be an objective, quantifiable assessment of trunk function. Given that psychological factors are purported to play a role in pain-related disability, it would be important to assess their influence on measurement of physical function. The present study was conducted to assess the influence of psychological variables on isokinetic trunk strength performance. One hundred and eighty-six consecutive male outpatients referred to a work-rehabilitation center were given a functional capacity evaluation. All patients had been out of work for at least 3 months with the chief complaint of low back pain. The evaluation included isokinetic trunk strength testing and measurement of psychological variables (pain levels, distress, pain coping, pain behavior, somatization, expectation to return to work) that have been known to contribute to pain-related disability. Data analyses revealed significant correlations among psychological variables and measures of trunk strength and function. The findings provide support for a relationship between psychological variables and isokinetic strength testing performance.     

Risk factors for work-related low back pain in registered nurses, and potential obstacles in using mechanical lifting devices

Back pain disability is a serious and costly problem affecting the nursing profession. The purposes of this study were to determine risk factors for work-related low back pain (WRLBP) in registered nurses and to record the reported use or reasons for nonuse of mechanical lifts. Our hypothesis was that workers who attributed the cause of WRLBP to their own actions would be knowledgeable about back safety, would be more likely to use lifts, and would report less WRLBP. A random sample of 270 registered nurses was selected from two acute care hospitals in central Illinois to identify WRLBP risk factors. This cross-sectional study gathered information on individual, physical workload, psychological, and organizational factors that may present a risk for WRLBP. Information was also collected on the use of safety devices and back pain symptoms. The response rate was 50.4%. Nearly 84% of respondents had WRLBP in the past, and 36.2% had WRLBP in the past year that limited movement or interfered with routine activities. Among the risk factors significantly associated with WRLBP were more years worked in nursing, frequent lifting, and low social support. Only 11% reported that they routinely used mechanical lifting devices, and the primary reason given for failure to use lifting equipment was unavailability of equipment. The reasons for the lack of use of mechanical lifts should be investigated and addressed.     

The association between timing and duration of chiropractic care in work-related low back pain and work-disability outcomes

OBJECTIVE: To examine the timing and duration of chiropractic care in occupational low back pain (OLBP) and their association with work-disability duration and recurrent disability using workers' compensation (WC) claims data. METHODS: Patients from four states who received chiropractic care for uncomplicated OLBP were identified through WC claims. Univariate and multivariate analyses were used, controlling for utilization of chiropractic care and other factors. RESULTS: Chiropractic care was initiated within 30 days after the onset of OLBP by 89% of claimants. Of those claimants, 48% ended chiropractic care within the first 30 days. After controlling for multiple factors, we found that shorter chiropractic care duration was still significantly associated with a lower likelihood of work-disability recurrence (OR = 0.39) and 8.6% shorter work-disability duration. CONCLUSION: Our findings did not support a benefit of longer chiropractic care in preventing work-disability recurrence or reducing work-disability duration in OLBP.     

Occupational low back pain

Low back injury is one of the most common conditions in the workplace. The causes are multifactorial and must be sought during the physician's examination. Failure to perform a comprehensive history and physical examination ultimately can lead to treatment failure and injury recurrence. A comprehensive history and physical may help clinicians to differentiate organic and nonorganic causes of low back pain. Different diagnoses need specific rather than generalized treatment programs. Teaching clinicians the nuances of the history and physical examination in a setting with an injured worker is the goal of this article.     

Prevalence,characteristics, and work-related risk factors of low back pain among hospital nurses in Taiwan: A cross-sectional survey

Background  

Low back pain is a common health problem among hospital nurses. However, the prevalence, characteristics, and work-related risk factors of low back pain have not been widely investigated in Taiwan.     

Initial patient and clinician expectations of return to work after acute onset of work-related low back pain

OBJECTIVE: The objective of this study was to compare patient and provider expectations of return to work (RTW) after acute onset of low back pain (LBP). METHODS: Workers sick-listed after onset of LBP (N = 300) completed a questionnaire about work, injury, and psychosocial disability risk factors and rated their likelihood of full RTW within 4 weeks. Clinicians provided an independent estimate of work absence, and patients were followed for 3 months. RESULTS: Clinician and patient expectations were weakly correlated, and both were predictive of actual RTW outcomes. Patient expectations were associated with differences in pain, mood, prior back pain, job demands, functional limitation, and marital status. Factors associated with clinician prognosis were similar but with more emphasis on physical examination findings. CONCLUSIONS: Even before treatment, patients may form a negative expectation for RTW that is associated with a longer duration of work absence.     

Individual and occupational determinants of low back pain according to various definitions of low back pain

OBJECTIVES: To test associations between non-specific low back pain and several risk factors when definitions of low back pain vary. DESIGN/SETTING/PARTICIPANTS: A cross sectional study was set up in 1991, 725 workers from four occupational sectors answered a self administrated questionnaire including the Nordic questionnaire and questions about intensity of pain and individual and occupational factors. MAIN RESULTS: Prevalence of low back pain varied from 8% to 45% according to the definition used. Psychosomatic problems, bending or carrying loads were often associated to low back pain, whereas other risk factors were related to some specific dimensions of the disorder. CONCLUSIONS: Risk factors of low back pain vary with the definition. This could explain inconsistencies found in literature reviews. To be able to compare data, it seems important to be precise what definition is used and to use comparable questionnaires.