Izabela Z. Schultz

Determinants of occupational disability following a low back injury: a critical review of the literature.

The aim of this research was to determine prognostic indicators of work disability in occupational back pain as reported in the literature, by systematically searching the research literature, assessing the methodological quality of the research, and synthesizing the findings into a concise summary. An article was considered eligible for review if research participants had an injury of the back, the article was based on original research, published in English, and involved a cohort with back pain less than 6 months post injury with at least one follow up assessment. Each article was independently reviewed by two “blinded” reviewers using 19 appraisal criteria for methodological quality of prognostic studies. Nineteen studies met the methodological standard to be included. Time since onset, demographic factors, functional disability, psychological distress, pain reports, previous episodes, and work environment were identified as important prognostic factors. Most studies compartmentalized the factors they considered. What is needed is a comprehensive multivariate biopsychosocial job-related model of work disability.

Models of return to work for musculoskeletal disorders.

Background: Musculoskeletal pain disorders are the most prevalent, costly, disabling, and commonly researched conditions in the workplace, yet the development of overarching conceptual models of return to work (RTW) in these conditions has been lagging. Method: A critical review of the literature was performed using multiple medical and health search engines in order to provide an evaluation of the evolution and the state of the art of health and disability models with a focus on specific models of RTW. Results: The main tenets, implications for diagnosis, treatment, and disability compensation, are the key perspectives analyzed for the following specific models of RTW: biomedical, psychosocial, forensic, ecological/case management, biopsychosocial, and two more recent models developed by the Institute of Medicine and the World Health Organization, respectively. Conclusions: Future development of models that are truly transdisciplinary, and address temporal and multidimensional aspects of occupational disability, remains a goal.

Biopsychosocial Multivariate Predictive Model of Occupational Low Back Disability

Study Design. To establish outcome, 253 workers with subacute and chronic low back conditions were assessed with a comprehensive multimethod biopsychosocial protocol at baseline, 3 days after the initial examination, and 3 months later. Objective. To validate empirically a biopsychosocial model for prediction of occupational low back disability. Summary of Background Data. Costs of low back occupational disability continue to spiral despite stabilization of low back injury rates. An empirically based model to predict occupational disability in workers with low back injuries is required. Methods. Workers with subacute low back injuries (4–6 weeks after injury, n = 192) and those with chronic back pain (6–12 months after injury, n = 61) were the study participants. The biopsychosocial protocol included five groups of variables: 1) sociodemographic, 2) medical, 3) psychosocial, 4) pain behavior, and 5) workplace-related factors. Predictive validity was investigated through a 3-month follow-up assessment, at which time the return to work outcome was determined. Stepwise logistic regression models were developed to predict work status. Results. The final integrated model consisted of variables from a wide biopsychosocial spectrum: vitality, health transition, feeling that job is threatened due to injury, expectations of recovery, guarding behavior, perception of severity of disability, time to complete walk, and right leg typical sciatica. Conclusions. The “winning” variables identified in the integrated model are dominated by cognitions, which are accompanied by disability behaviors. A cognitive–behavioral model with an adaptation-oriented rather than a pathology-oriented focus is favored for early intervention with high-risk workers since cognitions are amenable to change.

Prognosis and the identification of workers risking disability: Research issues and directions for future research

Introduction: Screening procedures based on prognostic data are an important prerequisite for prevention of disability due to low-back pain. This paper reviews the research on prognosis to delineate the most pertinent research challenges, and outlines directions for future research to improve the scientific quality and screening accuracy of prognostic efforts. Methods: Reviews of prognosis research were examined to identify key methodological and research issues. Results: Certain issues such as sampling procedures, research designs, data analyses, prognostic indicators, and follow-up procedures limit the value of prior studies. Absence of a clear conceptual framework hampers interpretation of findings and moving research questions forward. The recurrent nature of back pain and the need to effectively include the impact of employer actions and the job market were also identified as significant issues. Conclusions: Future research will be enhanced by addressing conceptual and definitional issues, applying tested and sensible measures, and careful follow-up of the study population.

Handbook of complex occupational disability claims : early risk identification, intervention, and prevention

Handbook of complex occupational disability claims , Handbook of complex occupational disability claims , کتابخانه دیجیتال جندی شاپور اهواز

Predicting return to work after low back injury using the Psychosocial Risk for Occupational Disability Instrument: a validation study.

Introduction: This paper reports on the predictive validity of a Psychosocial Risk for Occupational Disability Scale in the workers’ compensation environment using a paper and pencil version of a previously validated multimethod instrument on a new, subacute sample of workers with low back pain. Methods: A cohort longitudinal study design with a randomly selected cohort off work for 4–6 weeks was applied. The questionnaire was completed by 111 eligible workers at 4–6 weeks following injury. Return to work status data at three months was obtained from 100 workers. Sixty-four workers had returned to work (RTW) and 36 had not (NRTW). Results: Stepwise backward elimination resulted in a model with these predictors: Expectations of Recovery, SF-36 Vitality, SF-36 Mental Health, and Waddell Symptoms. The correct classification of RTW/NRTW was 79%, with sensitivity (NRTW) of 61% and specificity (RTW) of 89%. The area under the ROC curve was 84%. Conclusions. New evidence for predictive validity for the Psychosocial Risk-for-Disability Instrument was provided. Implications: The instrument can be useful and practical for prediction of return to work outcomes in the subacute stage after low back injury in the workers’ compensation context.

Models of Diagnosis and Rehabilitation in Musculoskeletal Pain-Related Occupational Disability

Musculoskeletal, pain-related occupational injuries are among the most common and disabling impairments in the working population and pose a formidable health care problem for industry. Annually, 2% of the national work force incurs industrialrelated back injuries, with approximately 1.4% of these resulting in a period of work absence (1). Despite the good prognosis for most episodes, musculoskeletal injuries consume considerable resources in medical care, absence from work, productivity losses and compensation benefits. Spitzer (1) found that about three-quarters of workinjured employees return to work in two to three weeks. Only about 7% had not returned by six months; however, these few accounted for about 75% of costs to the compensation system in lost hours, indemnities, and utilization of health services.

Reliability of the lumbar flexion, lumbar extension, and passive straight leg raise test in normal populations embedded within a complete physical examination

Study Design. The study measured the reliability of the passive straight leg raise (SLR) test and lumbar range of motion (LROM) tests measured as continuous variables embedded within a comprehensive physical examination. Objectives. To determine the reliability of the SLR and LROM test scores when they are measured with a Cybex electronic inclinometer (Lumex, Inc., New York, NY) within a physical examination. Summary of Background Data. Good published empirical reliability exists for the Cybex and for SLR and LROM tests when the measurements are taken in isolation from other physical examination procedures. Reliability of the Cybex for continuous SLR and LROM measurement within a physical examination has not been assessed, however. Methods. Forty-five participants were seen by one of two physician/physiotherapist teams. Participants were examined by both team members. The first examiner conducted the first tests and retested 1 week later (intrarater reliability). The second examined the participants the day after their first appointment (inter-rater reliability). Results. Only two scores showed substantial reliability (defined as r ≥ 0.60). These scores were left (r = 0.81) and right (r = 0.79) SLR intrarater reliability. All other scores fell below the specified cutoff. Conclusions. SLR and LROM scores used clinically are collected during comprehensive physical examinations. Most scores gathered under these conditions were not reliable. These findings have implications for the use of clinically derived SLR and LROM scores.

Pain behavior and the development of pain-related disability : The importance of guarding

ObjectiveTo examine prospectively the association between the 4 categories of objectively assessed pain behavior and various disability outcomes. In the present study, relationships among the 4 categories of pain behavior and various disability-related outcomes were examined. MethodsOne hundred forty-eight workers were identified within 6 weeks of a first episode of low-back pain in the workplace. During a physical examination, observations were made of guarding, words, sounds, and facial expressions of pain. Three months later, participants were evaluated with respect to return to work and standardized self-report measures of pain-related disability. Administrative records were examined to determine the number of days lost and costs associated with their rehabilitation. ResultsOnly guarding showed consistent prospective associations with all disability outcomes. When examined in the context of other variables that have been associated with disability in the same population, guarding showed consistent independent associations. DiscussionGuarding behavior may play a role in the transition from acute to chronic pain. The findings underscore the multidimensional nature of pain behavior and suggest that there is value in examining overt pain behaviors in prospective studies of the development of chronic occupational pain disability.

Handbook of occupational health and wellness

Handbook of occupational health and wellness / , Handbook of occupational health and wellness / , کتابخانه دیجیتال جندی شاپور اهواز