On-the-Job Back Injuries and Chronic Disability

[originally published in KCN, June 2009]

chronic disabilityWhile it goes without saying that no employer relishes the thought of having one of his employees on L&I due to a work injury, having that same work injury blossom into a long-term, chronic disability is enough to make any boss lose his lunch.

And while most work injuries do not turn into chronic disabilities, that fact is, some do.  As employers (or employees for that matter), is there any way we can see this coming?  Are there any risk factors to watch for, and if so, are there ways we can reduce these risks?

Thumb-Spine-JournalThese are great questions, and are some that a recent study in the medical journal Spine set out to answer.   Judith Turner, PhD, of the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine, lead the research  that revealed several key risk factors that stacked the odds against an injured worker’s ability to return to work a full year later.

Turner and her colleagues’ award winning study interviewed 1,885 back-injured workers, for the prospective population-based cohort study, 3 weeks after an injury claim was filed.

The number one predictor of a worker still being disabled after one year was a high initial score on a specialized disability questionnaire known as the Roland-Morris (18-24 points out of a possible 24).  Those falling in this highest category were 26 times more likely to have chronic disability one year later.

Other strong factors were identified as well.  Perhaps, none more interesting from my point of view though, than the type of health care provider sought first following the back injury.  Turner found that workers that began their care with a chiropractor had a distinct reduction of odds for chronic disability.  This finding surprised the researchers, an orthopedic news website explained.  They were expecting, as most might, that occupational medicine physicians would be the clear leaders.  “In fact, if anything,” Turner stated, “[the occupational medicine physicians] had somewhat worse outcomes.”

Those outcomes according to the study found 21% of back-injured workers who sought care with an occupational medicine physician first found themselves to be chronically disabled after one year.  Primary care physicians scored at 12%.  But of those seeking a chiropractor first for their work-related back injury, only 5% were disabled at the one year mark.

Chronic Disability graph“That at least raises the possibility,” Turner commented, “that chiropractic care was more effective in improving pain and disability or promoting return to work.”

Yet another reason to visit your neighborhood chiropractor following a work-injury… first.

Another noteworthy risk factor was whether or not shooting leg pain accompanied the lower back pain.  Turner found that those with radiculopathy had 4 to 8 times the odds of still being disabled at one year.

Widespread pain was another risk factor that was identified for chronic disability.

Employees who viewed their job as “hectic” were also more likely to find themselves in the chronic disability group, as those who had employers that did not find ways to return their injured employee back to work with options of lighter duty or reduced hours.

Ironically, those with a history of previous bouts of back pain were not necessarily at a higher risk for long term disability unless their prior episodes caused them to be out of work for one month or more.

Another interesting finding was that older injured workers showed no greater risk for chronic disability than did middle-aged workers.

Turner’s findings have been synthesized into a disability risk screening questionnaire that is soon to be utilized in a pilot program here in Washington state.  It is hoped that through screening and early intervention the rates of chronic disability can be curbed.

____________

Source used for this article:Turner, et. al.  Early predictors of chronic work disability:  a prospective population-based study of workers with back injuries.  Spine.  3(25): 2809-18.  2008.

Rapp.  Function, injury severity early after back injury are predictors of chronic disability:  study finds patients who initially visited a chiropractor had reduced odds of chronic disability.  OrthoSupersite.com;   http://www.orthosupersite.com/view.asp?rID=37137.  February 2009.

A good reason to see a chiropractor first.  (front page graph) Dynamic Chiropractic.  27(10).  May 6, 2009.

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