See all ›
11 CitationsSee all ›
131 ReferencesPrognosis in Acute Occupational Low Back Pain: Methodologic and Practical Considerations
Abstract
Work-related or occupational low back pain (OLBP) is the leading cause of disability due to work-related conditions. The clinical course of this disorder is highly variable. Accurate prediction of disability outcomes in acute OLBP can lead to better selection of those likely to benefit from intensive interventions, identification of specific issues for intervention, and more efficient patient selection in clinical trials. The basis for disability prognostication has been developed through studies of outcomes in acute OLBP. These include investigations based on administrative data, workplace studies, and clinical studies in physicians' offices or workplaces. Each study design has inherent strengths and limitations that affect the accuracy of the resulting predictive models. Practical concerns for use of prognostic models in clinical settings include generalizability of results, feasibility of data collection and interpretation, acceptability to patients, cost, and linking prognosis to effective interventions. Ethical concerns include informed consent, confidentiality issues and inappropriate negative labeling. An informed choice of prognostic model and associated measures based on specific goals is needed to develop an appropriate application for a particular clinical or research situation. Future research may lead to greater use of these models, improving outcomes for workers with OLBP.
- CitationsCitations11
- ReferencesReferences131
- Several variables (e.g., monotonous work, conflicts at work) have been assessed in only one or two prospective cohort studies; thus, these variables have had insufficient evidence in most systematic reviews. Other notable problems include differences in statistical modeling techniques, duration of follow-up, population setting and sampling strategy, and the inclusion of different sets of covariates when testing independent associations with outcomes [32, 33]. Research in this area might be strengthened by adopting greater consistency in variable selection and methodology among researchers designing future patient cohort studies.
[Show abstract] [Hide abstract] ABSTRACT: Objective: To develop a consensus plan for research and practice to encourage routine clinician screening of occupational factors associated with long-term back disability. Methods: A 3-day conference workshop including 21 leading researchers and clinicians (the "Decade of the Flags Working Group") was held to review the scientific evidence concerning clinical, occupational, and policy factors in back disability and the development of feasible assessment and intervention strategies. Results: The Working Group identified seven workplace variables to include in early screening by clinicians: physical job demands, ability to modify work, job stress, workplace social support or dysfunction, job satisfaction, expectation for resuming work, and fear of re-injury. Five evaluation criteria for screening methods were established: reliability, predictive performance, feasibility, acceptability, and congruence with plausible interventions. An optimal screening method might include a stepped combination of questionnaire, interview, and worksite visit. Future research directions include improving available assessment methods, adopting simpler and more uniform conceptual frameworks, and tying screening results to plausible interventions. Discussion: There is a clear indication that occupational factors influence back disability, but to expand clinician practices in this area will require that patient screening methods show greater conceptual clarity, feasibility, and linkages to viable options for intervention.- The range of risk factors shown in Table 1reflects the contrasting beliefs among researchers concerning the conceptualization, assessment, and relative importance of individual risk factors. Several authors have pointed out that these risk factors may well overlap and have high correlations353637. For example, it's unclear whether there is a common pathway between emotional distress, pain beliefs, and poor expectations for recovery that leads to work disability or whether each of these variables contributes independently[35].
[Show abstract] [Hide abstract] ABSTRACT: To assess, from the review literature, the extent to which effective strategies for reducing work absence after acute low back pain (LBP) match empirical risk factors. From 17 recent review articles (2000-2005), disability risk factors and interventions were cross-tabulated to assess levels of relative concordance. Potentially modifiable risk factors included 23 variables describing 3 workplace and 3 personal domains. Effective interventions included 25 strategies that were personal (physical or behavioral), engineering, or administrative in nature. There was a strong risk factor concordance for workplace technical and organizational interventions, graded activity exposure, and cognitive restructuring of pain beliefs. There was less risk factor concordance for exercise, back education, and RTW coordination. Few interventions focused on relieving emotional distress or improving job dissatisfaction, two well-supported risk factors. Gaps between the epidemiological and intervention research of back disability prevention could be reduced by testing mediators of intervention effects or by stratifying outcomes according to pre-intervention risk factors.- [Show abstract] [Hide abstract] ABSTRACT: Disability following acute occupational low back pain (OLBP) represents a significant and preventable health outcome, yet confusion about prognostic factors have limited the development of effective, targeted interventions for those at greatest risk. The purpose of this study was to synthesize findings from available studies of prognostic factors for OLBP disability in a clinically-relevant framework. A systematic search of the MEDLINE database was conducted to identify empirical studies assessing the value of various prognostic factors to predict extended disability after an acute episode of OLBP. Relevant studies were screened based on a number of inclusionary criteria. Prognostic factors were catalogued, summarized, and evaluated based on agreement across studies, and clinical recommendations were developed based on the evidence. Of 361 studies of OLBP disability found, 22 met specific criteria for inclusion. Significant prognostic factors included low workplace support, personal stress, shorter job tenure, prior episodes, heavier occupations with no modified duty, delayed reporting, severity of pain and functional impact, radicular findings and extreme symptom report. Physicians can decrease OLBP disability by using standardized questionnaires, improving communication with patients and employers, specifying return to work accommodations, and employing behavioural approaches to pain and disability management. Future studies should evaluate interventions guided by prognosis.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: This project aimed to review the concepts and utility of screening for the risk of long-term incapacity associated with the common, relatively minor, health complaints associated with receipt of social security benefits (predominantly musculoskeletal disorders, mental health problems, and cardio-respiratory symptoms). Methods: A systematic electronic literature search yielded existing reviews concerning clinical and psychosocial data. Alternative search strategies were required to obtain unindexed reports of large individual studies based on socio-demographic and administrative data. From some 1000 retrieved titles, 28 reviews and 31 individual studies met the selection criteria, and provided the material for a structured review. Results: The findings show there is strong evidence that both socio-demographic and clinical psychosocial data contain strong predictors for long-term incapacity, yet they do not combine into a simple, robust, and universal screening tool. Whilst screening is possible and potentially valuable, its utility is strongly dependent on timing and purpose. Socio-demographic data can be strong predictors at an early stage, but may be immutable. Psychosocial predictors are effective somewhat later, yet have the advantage of being suitable for guiding rehabilitation strategies. Conclusions: There is a practical window for screening for long-term incapacity that extends between about one and six months. Socio-demographic and clinical data are interrelated, and their utility may vary over time; both may be combined into a logical and practical sequence in the screening process.
- [Show abstract] [Hide abstract] ABSTRACT: Inception cohort (<or=14 days after pain onset) with 1-month follow-up. To determine whether disability risk factors provided by patients and clinicians at a first medical visit for acute occupational low back pain predict outcomes. Improving health and work outcomes for patients with occupational low back pain may require early identification of risk factors for persistent pain and disability. Previous studies of back pain prognosis have not assessed patients at the time of initial provider contact, and many have not differentiated between occupational and nonoccupational injuries. Patients (183 female, 385 male) presenting to occupational health clinics with recent onset occupational low back pain (<or=14 days duration) completed a 16-item survey of potential disability risks including demographic, injury, workplace, psychosocial, and symptom factors. After the initial visit, clinicians completed an additional 10-item questionnaire of symptoms and initial prognosis. Outcome variables of functional limitation and work status were assessed 1 month after pain onset. In multivariate analyses, functional improvement and return to work were more strongly predicted by employer factors (job tenure, physical work demands, availability of modified duty, earlier reporting to employer) and self-ratings of pain and mood than by health history or physical examination. A logistic regression model had a sensitivity of 74.3% to predict those remaining out of work and a specificity of 70.1%. Early screening for disability risk factors may be helpful to identify those patients at greatest risk for delayed recovery from occupational low back pain. Intervention strategies for high-risk patients might be improved by focusing on job factors, pain coping strategies, and expectations for recovery.
- [Show abstract] [Hide abstract] ABSTRACT: Retrospective cohort study. Practical evaluation of a rapid prognostic screening method to predict length of disability after acute occupational low back pain (OLBP). Few studies have evaluated the prognostic value of administrative data and selected clinical variables in typical practice settings. Nurse case manager (NCM) input for 16 variables and 7 administrative data variables were collected for 494 OLBP cases with at least 30 days of disability. Length of disability (LOD) was ascertained by individual indemnity payment analysis. Cases were censored after accumulating 365 days of temporary total disability or if they received a lump sum settlement. Prognostic variables were evaluated by Cox proportional hazards modeling. In a multivariate model, prolonged LOD was associated with older age, shorter job tenure, female gender, presence of language barriers, comorbidity, prior work absence, delayed referral, attorney involvement nonsupportive of return to work (RTW), and low RTW motivation. Although only 12% of overall variance in LOD was explained by the model, high-risk and low-risk terciles were readily distinguished. In a typical setting, data collection and risk prediction by nurses or case managers are feasible and provide specific information that can be used to identify who should receive intervention, as well as some guidance on factors that should be addressed.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.
This publication is from a journal that may support self archiving.
Learn more