Rae Wu

Worker recovery expectations and fear-avoidance predict work disability in a population-based workers' compensation back pain sample

Study Design. Prospective, population-based cohort study. Objectives. To examine whether worker demographic, pain, disability, and psychosocial variables, assessed soon after work-related back pain disability onset, predict 6-month work disability. Summary of Background Data. Greater age, pain, and physical disability, and certain psychosocial characteristics may be risk factors for prolonged back pain-related work disability, although many studies have been small, findings have been inconsistent, and some psychosocial variables have not been examined prospectively. Methods. Workers (N = 1,068) completed telephone interviews assessing demographic, pain, disability, and psychosocial variables 18 days (median) after submitting Workers’ Compensation back pain disability claims. Administrative measures of work disability 6 months after claim submission were obtained. Results. At 6 months, 196 workers (18.4%) were receiving work disability compensation. Age, race, education, and baseline pain and disability were significant predictors of 6-month disability. Adjusting for baseline demographics, pain, disability, and other psychosocial variables, high work fear-avoidance (odds ratio, 4.6; 95% confidence interval, 1.6–13.7) and very low recovery expectations (odds ratio, 3.1, 95% confidence interval, 1.5–6.5) were significant independent predictors. Conclusions. Among individuals with acute work-related back pain, high pain and disability, low recovery expectations, and fears that work may increase pain or cause harm are risk factors for chronic work disability.

The association between pain and disability

&NA; A clearer understanding of how pain intensity relates to disability could have important implications for pain treatment goals and definitions of treatment success. The objectives of this study were to determine the optimal pain intensity rating (0–10 scale) cutpoints for discriminating disability levels among individuals with work‐related carpal tunnel syndrome (CTS) and low back (LB) injuries, whether these cutpoints differed for these conditions and for different disability measures, and whether the relationship between pain intensity and disability was linear in each injury group. Approximately 3 weeks after filing work injury claims, 2183 workers (1059 CTS; 1124 LB) who still had pain completed pain and disability measures. In the LB group, pain intensity rating categories of 1–4, 5–6, and 7–10 optimally discriminated disability levels for all four disability measures examined. In the CTS group, no pain intensity rating categorization scheme proved superior across all disability measures. For all disability measures examined, the relationship between pain intensity and disability level was linear in the CTS group, but nonlinear in the LB group. Among study participants with work‐related back injuries, when pain level was 1–4, a decrease in pain of more than 1‐point corresponded to clinically meaningful improvement in functioning, but when pain was rated as 5–10, a 2‐point decrease was necessary for clinically meaningful improvement in functioning. The findings indicate that classifying numerical pain ratings into categories corresponding to levels of disability may be useful in establishing treatment goals, but that classification schemes must be validated separately for different pain conditions.

ISSLS Prize Winner: Early Predictors of Chronic Work Disability : A Prospective, Population-Based Study of Workers With Back Injuries

Study Design. Prospective population-based cohort study. Objective. To identify early predictors of chronic work disability after work-related back injury. Summary of Background Data. Identification of early predictors of prolonged disability after back injury could increase understanding concerning the development of chronic, disabling pain, and aid in secondary prevention. Few studies have examined predictors across multiple domains in a large, population-based sample. Methods. Workers (N = 1885) were interviewed 3 weeks (average) after submitting a lost work-time claim for a back injury. Sociodemographic, employment-related, pain and function, clinical, health care, administrative/legal, health behavior, and psychological domain variables were assessed via worker interviews, medical records, and administrative databases. Logistic regression analyses identified early predictors of work disability compensation 1 year after claim submission. Results. Significant baseline predictors of 1-year work disability in the final multidomain model were injury severity (rated from medical records), specialty of the first health care provider seen for the injury (obtained from administrative data), and worker-reported physical disability (Roland-Morris disability questionnaire), number of pain sites, “very hectic” job, no offer of a job accommodation (e.g., light duty), and previous injury involving a month or more off work. The model showed excellent ability to discriminate between workers who were/were not disabled at 1 year (area under the receiver operating characteristic curve = 0.88, 95% CI = 0.86–0.90). Conclusion. Among workers with new lost work-time back injury claims, risk factors for chronic disability include radiculopathy, substantial functional disability, and to a lesser extent, more widespread pain and previous injury with extended time off work. The roles of employers and health care providers also seem important, supporting the need to incorporate factors external to the worker in models of the development of chronic disability and in disability prevention efforts.

Comparison of the Roland–morris Disability Questionnaire and Generic Health Status Measures: A Population-based Study of Workers’ Compensation Back Injury Claimants

Study Design. Workers’ compensation back injury claimants completed baseline and follow-up telephone interviews in a prospective population-based cohort study. Objective. To compare the Roland–Morris Disability Questionnaire (RDQ) to widely used generic health status measures in a sample of workers with recent work-related back injuries in terms of validity, reliability, responsiveness to change, and floor and ceiling effects. Summary of Background Data. Little research has directly compared the validity and responsiveness of the RDQ to that of the Short-Form 12 or Short-Form 36 health status measures among individuals with back pain. Furthermore, there is little information concerning the validity, reliability, and responsiveness of the RDQ as a measure of functional outcomes for workers with back injuries. Methods. Approximately 8 weeks (median) after filing low back injury claims, 309 workers completed the RDQ, Short-Form 12, and Short-Form 36 scales and gave information about their work status in computer-assisted telephone interviews. An average of 5 months later, 284 workers (91.9%) completed the measures again. Results. The RDQ demonstrated excellent internal consistency and validity through correlations with other measures of physical functioning, ability to discriminate between those working and those not working, and much more responsiveness to change than the Short-Form 12 and Short-Form 36 scales. However, 15% of the sample did not answer one or more RDQ items. Conclusions. The RDQ is a valid measure of physical disability among workers with back injuries. Its greater responsiveness to change suggests its superiority to the Short-Form 12 and Short-Form 36 as an outcome measure in this population.

Measuring work disability: what can administrative data tell us about patient outcomes?

Objective: The purpose of this study was to assess the association between administrative measures of work disability and self-reported work, pain, and functional status. Methods: We conducted baseline and follow-up interviews to assess pain, functional status, work status, and demographic factors in workers with low back injuries, carpal tunnel syndrome, and upper and lower extremity fractures. Administrative measures of work disability were obtained from the Washington State Department of Labor and Industries. Results: Pain intensity and impairment levels were lowest in those who had not received any disability payments, somewhat higher for those who were no longer receiving time loss benefits, and highest for workers receiving time loss payments at the time of interview. Conclusions: Administrative measures of work disability are significantly associated with self-reported outcomes and can be an efficient tool for tracking and evaluating outcomes of medical treatments, surgical procedures, and occupational health programs.