Publications by authors named "Glenn S Pransky"

22 Publications

  • Page 1 of 1

Patient Satisfaction Measurement in Occupational and Environmental Medicine Practice.

J Occup Environ Med 2018 05;60(5):e227-e231

American College of Occupational and Environmental Medicine, Elk Grove, Illinois.

: High patient satisfaction is a desirable goal in medical care. Patient satisfaction measures are increasingly used to evaluate and improve quality in all types of medical practices. However, the unique aspects of occupational and environmental medicine (OEM) practice require development of OEM-specific measures and thoughtful interpretation of results. The American College of Occupational and Environmental Medicine has developed and recommends a set of specific questions to measure patient satisfaction in OEM, designed to meet anticipated regulatory requirements, facilitate quality improvement of participating OEM practices, facilitate case-management review, and offer fair and accurate assessment of OEM physicians.
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http://dx.doi.org/10.1097/JOM.0000000000001331DOI Listing
May 2018

Using Electronic Health Records and Clinical Decision Support to Provide Return-to-Work Guidance for Primary Care Practitioners for Patients With Low Back Pain.

J Occup Environ Med 2017 11;59(11):e240-e244

From the Occupational and Environmental Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr McLellan); The Permanente Medical Group, San Francisco, California (Dr Kownacki); University of Massachusetts Medical School, Sudbury, Massachusetts (Dr Pransky; and ACOEM, Elk Grove Village, Illinois (Ms Dreger).

Objective: The aim of this study was to describe the process by which a group of subject matter experts in the area of return to work developed a resource tool to provide clinical decision support (CDS) for primary care clinicians.

Methods: A common musculoskeletal disorder, low back pain (LBP), was selected, pertinent literature reviewed, and specific recommendations for action in the clinical setting developed.

Results: Primary care practitioners (PCPs) are routinely expected to create work activity prescriptions. The knowledge base for a CDS tool that could be embedded in electronic health records has been developed.

Conclusion: Improved clinical support should help prevent and manage work limitations associated with LBP not caused by work. The proposed decision support should reduce administrative burden and stimulate PCPs to explore the role of occupation and its demands on patients.
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http://dx.doi.org/10.1097/JOM.0000000000001180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957077PMC
November 2017

New Business Structures Creating Organizational Opportunities and Challenges for Work Disability Prevention.

J Occup Rehabil 2016 12;26(4):480-489

Burton Blatt Institute, Syracuse University, Syracuse, NY, USA.

Purpose Flexible work arrangements are growing in order to develop resource-efficient production and because of advanced technologies, new societal values, changing demographics, and globalization. The article aims to illustrate the emerging challenges and opportunities for work disability prevention efforts among workers in alternate work arrangements. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability," held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a roundtable discussion with experts having direct employer experience. Results Both worker and employer perspectives were considered, and four common alternate work arrangements were identified: (a) temporary and contingent employment; (b) small workplaces; (c) virtual work/telework; and (d) lone workers. There was sparse available research of return-to-work (RTW) and workplace disability management strategies with regard to alternate work patterns. Limited research findings and a review of the grey literature suggested that regulations and guidelines concerning disabled workers are often ambiguous, leading to unsatisfactory protection. At the workplace level, there was a lack of research evidence on how flexible work arrangements could be handled or leveraged to support RTW and prevent disability. Potential negative consequences of this lack of organizational guidance and information are higher costs for employers and insurers and feelings of job insecurity, lack of social support and integration, or work intensification for disabled workers. Conclusions Future studies of RTW and workplace disability prevention strategies should be designed to reflect the multiple work patterns that currently exist across many working populations, and in particular, flexible work arrangements should be explored in more detail as a possible mechanism for preventing disability. Labor laws and policies need to be developed to fit flexible work arrangements.
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http://dx.doi.org/10.1007/s10926-016-9671-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104761PMC
December 2016

Sustaining Work Participation Across the Life Course.

J Occup Rehabil 2016 12;26(4):465-479

University of Loughborough, Leicester, UK.

Introduction Many disability prevention strategies are focused on acute injuries and brief illness episodes, but there will be growing challenges for employers to manage circumstances of recurrent, chronic, or fluctuating symptoms in an aging workforce. The goal of this article is to summarize existing peer-review research in this area, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long sponsored collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability", held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the scientific and industry literature, group discussion to identify key areas and challenges, drafting of initial documents, and feedback from peer researchers and a special panel of experts with employer experience. Results Cancer and mental illness were chosen as examples of chronic or recurring conditions that might challenge conventional workplace return-to-work practices. Workplace problems identified in the literature included fatigue, emotional exhaustion, poor supervisor and co-worker support, stigma, discrimination, and difficulties finding appropriate accommodations. Workplace intervention research is generally lacking, but there is preliminary support for improving workplace self-management strategies, collaborative problem-solving, and providing checklists and other tools for job accommodation, ideas echoed in the literature directed toward employers. Research might be improved by following workers from an earlier stage of developing workplace concerns. Conclusions Future research of work disability should focus on earlier identification of at-risk workers with chronic conditions, the use of more innovative and flexible accommodation strategies matched to specific functional losses, stronger integration of the workplace into on-going rehabilitation efforts, and a better understanding of stigma and other social factors at work.
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http://dx.doi.org/10.1007/s10926-016-9670-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104763PMC
December 2016

Extent and Impact of Opioid Prescribing for Acute Occupational Low Back Pain in the Emergency Department.

J Emerg Med 2016 Mar 2;50(3):376-84.e1-2. Epub 2016 Jan 2.

Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts.

Background: Initial management of acute occupational low back pain (AOLBP) commonly occurs in the emergency department (ED), where opioid prescribing can vary from the clinical guidelines that recommend limited use.

Objective: The objective of this study was to explore how opioids are prescribed in the ED and the impact on work disability and other outcomes in AOLBP.

Methods: A retrospective cohort study was conducted. All acute compensable lost-time LBP cases seen initially in the ED with a date of injury from January 1, 2009 to December 31, 2011 were identified within a nationally representative Workers' Compensation dataset. Multivariate models estimated the effect of early opioids (received within 2 days of ED visit) on disability duration, long-term opioid use, total medical costs, and subsequent surgeries.

Results: Of the cohort (N = 2887), 12% received early opioids; controlling for severity, this was significantly associated with long-term opioid use (adjusted risk ratio = 1.29; 95% confidence interval 1.05-1.58) and increased total medical costs for those in the highest opioid dosage quartile, but not associated with disability duration or subsequent low back surgery.

Conclusions: Early opioid prescribing in the ED for uncomplicated AOLBP increased long-term opioid use and medical costs, and should be discouraged, as opioid use for low back pain has been associated with a variety of adverse outcomes. However, ED providers may be becoming more compliant with current LBP treatment guidelines.
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http://dx.doi.org/10.1016/j.jemermed.2015.10.015DOI Listing
March 2016

Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain.

Spine (Phila Pa 1976) 2013 Oct;38(22):1939-46

*Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA; and †University of Massachusetts, Lowell, MA.

Study Design: Retrospective cohort study.

Objective: To determine the effect of early (receipt ≤30 d postonset) magnetic resonance imaging (MRI) on disability and medical cost outcomes in patients with acute, disabling, work-related low back pain (LBP) with and without radiculopathy.

Summary Of Background Data: Evidence-based guidelines suggest that, except for "red flags," MRI is indicated to evaluate patients with persistent radicular pain, after 1 month of conservative management, who are candidates for surgery or epidural steroid injections. Prior research has suggested an independent iatrogenic effect of nonindicated early MRI, but it had limited clinical information and/or patient populations.

Methods: A nationally representative sample of workers with acute, disabling, occupational LBP was randomly selected, oversampling those with radiculopathy diagnoses (N = 1000). Clinical information from medical reports was used to exclude cases for which early MRI might have been indicated, or MRI occurred more than 30 days postonset (final cohort = 555). Clinical information was also used to categorize cases into "nonspecific LBP" and "radiculopathy" groups and further divided into "early-MRI" and "no-MRI" subgroups. The Cox proportional hazards model examined the association of early MRI with duration of the first episode of disability. Multivariate linear regression models examined the association with medical costs. All models adjusted for demographic and medical severity measures.

Results: In our sample, 37% of the nonspecific LBP and 79.9% of the radiculopathy cases received early MRI. The early-MRI groups had similar outcomes regardless of radiculopathy status: much lower rates of going off disability and, on average, $12,948 to $13,816 higher medical costs than the no-MRI groups. Even in a subgroup with relatively minimal disability impact (≤30 d of total lost time post-MRI), medical costs were, on average, $7643 to $8584 higher in the early-MRI groups.

Conclusion: Early MRI without indication has a strong iatrogenic effect in acute LBP, regardless of radiculopathy status. Providers and patients should be made aware that when early MRI is not indicated, it provides no benefits, and worse outcomes are likely.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0b013e3182a42eb6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235393PMC
October 2013

Iatrogenic disability and narcotics addiction after lumbar fusion in a worker's compensation claimant.

Spine (Phila Pa 1976) 2010 May;35(12):E549-52

Lifespan Corporation, Providence, RI, USA.

Study Design: Case report.

Objective: Describe a case of chronic occupational low back pain with various treatments of questionable efficacy, leading to prolonged disability, iatrogenic narcotic addiction, and opioid-induced hyperalgesia.

Summary Of Background Data: Concerns about narcotics and other questionable treatments for chronic low back pain are increasing, especially in those with work-related conditions.

Methods: Medical record review.

Results: The patient had significant, persistent low back symptoms, but good function at work and home. He underwent lumbar fusion to address persistent pain, and subsequently developed failed back surgery syndrome. He was prescribed increasing amounts of opioid analgesics and was recommended for an intrathecal morphine pump, without evaluation of the safety or efficacy of his current regimen. Subsequently, he was hospitalized for opioid detoxification and substance abuse treatment.

Conclusion: Patients with chronic low back pain are at risk for receiving ineffective and potentially harmful treatment. A focus on restoring function instead of complete pain relief may lead to better outcomes in these patients.
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http://dx.doi.org/10.1097/BRS.0b013e3181d2568eDOI Listing
May 2010

The impact of workers' compensation on outcomes of surgical and nonoperative therapy for patients with a lumbar disc herniation: SPORT.

Spine (Phila Pa 1976) 2010 Jan;35(1):89-97

General Medicine Division, Medical Services, MA General Hospital, Harvard Medical School, Boston, MA 02114, USA.

Study Design: Prospective randomized and observational cohorts.

Objective: To compare outcomes of patients with and without workers' compensation who had surgical and nonoperative treatment for a lumbar intervertebral disc herniation (IDH).

Summary Of Background Data: Few studies have examined the association between worker's compensation and outcomes of surgical and nonoperative treatment.

Methods: Patients with at least 6 weeks of sciatica and a lumbar IDH were enrolled in either a randomized trial or observational cohort at 13 US spine centers. Patients were categorized as workers' compensation or nonworkers' compensation based on baseline disability compensation and work status. Treatment was usual nonoperative care or surgical discectomy. Outcomes included pain, functional impairment, satisfaction and work/disability status at 6 weeks, 3, 6, 12, and 24 months.

Results: Combining randomized and observational cohorts, 113 patients with workers' compensation and 811 patients without were followed for 2 years. There were significant improvements in pain, function, and satisfaction with both surgical and nonoperative treatment in both groups. In the nonworkers' compensation group, there was a clinically and statistically significant advantage for surgery at 3 months that remained significant at 2 years. However, in the workers' compensation group, the benefit of surgery diminished with time; at 2 years no significant advantage was seen for surgery in any outcome (treatment difference for SF-36 bodily pain [-5.9; 95% CI: -16.7-4.9] and physical function [5.0; 95% CI: -4.9-15]). Surgical treatment was not associated with better work or disability outcomes in either group.

Conclusion: Patients with a lumbar IDH improved substantially with both surgical and nonoperative treatment. However, there was no added benefit associated with surgical treatment for patients with workers' compensation at 2 years while those in the nonworkers' compensation group had significantly greater improvement with surgical treatment.
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http://dx.doi.org/10.1097/BRS.0b013e3181c68047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828633PMC
January 2010

Validation of a risk factor-based intervention strategy model using data from the readiness for return to work cohort study.

J Occup Rehabil 2010 Sep;20(3):394-405

Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M4C 1J1, Canada.

Background: Low back pain (LBP) is a common and in some cases disabling condition. Until recently, workers presenting with non-specific LBP have generally been regarded as a homogeneous population. If this population is not homogeneous, different interventions might be appropriate for different subgroups. We hypothesized that (1) Clusters of individuals could be identified based on risk factors, (2) These clusters would predict duration and recurrences 6 months post-injury.

Methods: The study focuses on the 442 LBP claimants in the Readiness for Return-to-Work Cohort Study. Claimants (n = 259) who had already returned to work, approximately 1 month post-injury were categorized as the low risk group. A latent class analysis was performed on 183 workers absent from work, categorized as the high risk group. Groups were classified based on: pain, disability, fear avoidance beliefs, physical demands, people-oriented culture and disability management practice at the workplace, and depressive symptoms.

Results: Three classes were identified; (1) workers with 'workplace issues', (2) workers with a 'no workplace issues, but back pain', and (3) workers having 'multiple issues' (the most negative values on every scale, notably depressive symptoms). Classes 2 and 3 had a similar rate of return to work, both worse than the rate of class 1. Return-to-work status and recurrences at 6 months were similar in all 3 groups.

Conclusion: This study largely confirms that several subgroups could be identified based on previously defined risk factors as suggested by an earlier theoretical model by Shaw et al. (J Occup Rehab 16(4):591-605, 2006). Different groups of workers might be identified and might benefit from different interventions.
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http://dx.doi.org/10.1007/s10926-009-9218-8DOI Listing
September 2010

Who's in charge? Challenges in evaluating quality of primary care treatment for low back pain.

J Eval Clin Pract 2008 Dec 24;14(6):961-8. Epub 2008 Mar 24.

Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748, USA.

Rationale And Objectives: Low back pain (LBP) is a common condition with frequent health care visits and work disability. Quality improvement efforts in primary care focused on guidelines adherence, provider selection and education, and feedback on appropriateness of care. Such efforts can only succeed if a health care provider is in charge of care over a substantial period. This study was conducted to provide insights about actual patterns of provider involvement in LBP care and implications for quality evaluation.

Methods: Established primary care patients with occupational LBP and health care covered by a workers' compensation insurer were selected. Primary care physician (PCP) involvement was examined relative to overall health care utilization. Four methods of classifying PCP involvement were used to assess the association between PCP involvement and health care and work disability outcomes over a 2-year follow-up period.

Results: Primary care physician was rarely the sole provider during episodes of occupational LBP. PCP was the initial non-emergency room provider in 55% of cases, and was the most prevalent provider during at least one episode of care in 45% of cases. Different methods of classification led to different conclusions about the association between PCP involvement and work disability or number of health care visits. Multiple providers were involved throughout the clinical course of the small number of cases that accounted for most of the health care visits and work disability; in these cases, the role of PCP in care was difficult to determine.

Conclusions: Administrative data alone are adequate for provider comparisons only in relatively simple cases. Provider comparisons based on initial treating provider likely overstate the importance of early care, particularly in more complex cases. For LBP, quality improvement models based on PCP-directed interventions or reinforcing guideline adherence may not impact outcomes. A patient-centred model may be necessary to achieve outcome improvements.
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http://dx.doi.org/10.1111/j.1365-2753.2007.00890.xDOI Listing
December 2008

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

J Occup Environ Med 2007 Oct;49(10):1124-34

Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, MA 01748, USA.

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.
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http://dx.doi.org/10.1097/JOM.0b013e31814b2e74DOI Listing
October 2007

What is different about workers' compensation patients? Socioeconomic predictors of baseline disability status among patients with lumbar radiculopathy.

Spine (Phila Pa 1976) 2007 Aug;32(18):2019-26

General Medicine Division, Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

Study Design: Combined analysis of 2 prospective clinical studies.

Objective: To identify socioeconomic characteristics associated with workers' compensation in patients with an intervertebral disc herniation (IDH) or spinal stenosis (SpS).

Summary Of Background Data: Few studies have compared socioeconomic differences between those receiving or not receiving workers' compensation with the same underlying clinical conditions.

Methods: Patients were identified from the Spine Patient Outcomes Research Trial (SPORT) and the National Spine Network (NSN) practice-based outcomes study. Patients with IDH and SpS within NSN were identified satisfying SPORT eligibility criteria. Information on disability and work status at baseline evaluation was used to categorize patients into 3 groups: workers' compensation, other disability compensation, or work-eligible controls. Enrollment rates of patients with disability in a clinical efficacy trial (SPORT) and practice-based network (NSN) were compared. Independent socioeconomic predictors of baseline workers' compensation status were identified in multivariate logistic regression models controlling for clinical condition, study cohort, and initial treatment designation.

Results: Among 3759 eligible patients (1480 in SPORT and 2279 in NSN), 564 (15%) were receiving workers' compensation, 317 (8%) were receiving other disability compensation, and 2878 (77%) were controls. Patients receiving workers' compensation were less common in SPORT than NSN (9.2% vs. 18.8%, P < 0.001), but patients receiving other disability compensation were similarly represented (8.9% vs. 7.7%, P = 0.19). In univariate analyses, many socioeconomic characteristics significantly differed according to baseline workers' compensation status. In multiple logistic regression analyses, gender, educational level, work characteristics, legal action, and expectations about ability to work without surgery were independently associated with receiving workers' compensation.

Conclusion: Clinical trials involving conditions commonly seen in patients with workers' compensation may need special efforts to ensure adequate representation. Socioeconomic characteristics markedly differed between patients receiving and not receiving workers' compensation. Identifying the independent effects of workers' compensation on outcomes will require controlling for these baseline characteristics and other clinical features associated with disability status.
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http://dx.doi.org/10.1097/BRS.0b013e318133d69bDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860950PMC
August 2007

Point of view.

Spine (Phila Pa 1976) 2006 Jul;31(16):1858-9

Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748, USA.

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http://dx.doi.org/10.1097/01.brs.0000227298.57211.fcDOI Listing
July 2006

Length of disability prognosis in acute occupational low back pain: development and testing of a practical approach.

Spine (Phila Pa 1976) 2006 Mar;31(6):690-7

Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, MA 01748, USA.

Study Design: Retrospective cohort study.

Objectives: Practical evaluation of a rapid prognostic screening method to predict length of disability after acute occupational low back pain (OLBP).

Summary Of Background Data: Few studies have evaluated the prognostic value of administrative data and selected clinical variables in typical practice settings.

Methods: 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.

Results: 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.

Conclusions: 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.
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http://dx.doi.org/10.1097/01.brs.0000202761.20896.02DOI Listing
March 2006

Factors affecting the organizational responses of employers to workers with injuries.

Work 2006 ;26(1):75-84

Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748, USA.

The organizational responses of employers to work-related injuries is one of several significant influences on return-to-work outcomes. Thus, understanding the factors that lead to better or worse organizational responses to work injuries may ultimately help to improve success in this area. The purpose of this study was to systematically explore factors that might influence the organizational responses of employers to injured workers, based on employee perceptions. Cross-sectional survey data were collected from 2,943 subjects with work-related injuries which had occurred less than eight weeks prior to survey completion. Measured variables included pre-injury demographic and job factors, injury circumstances, and a measure of post-injury events that comprised the organizational response. Multivariate linear regression results show that age, gender, job dissatisfaction before injury, prior difficulty performing job tasks, injury severity, back injury and lost time were all associated with negative organizational responses, suggesting potential opportunities for intervention.
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February 2006

Injuries at work in the US adult population: contributions to the total injury burden.

Am J Public Health 2005 Jul;95(7):1213-9

Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748, USA. gordon.

Objectives: We estimated the contribution of nonfatal work-related injuries on the injury burden among working-age adults (aged 18-64 years) in the United States.

Methods: We used the 1997-1999 National Health Interview Survey (NHIS) to estimate injury rates and proportions of work-related vs non-work-related injuries.

Results: An estimated 19.4 million medically treated injuries occurred annually to working-age adults (11.7 episodes per 100 persons; 95% confidence interval [CI]=11.3, 12.1); 29%, or 5.5 million (4.5 per 100 persons; 95% CI=4.2, 4.7), occurred at work and varied by gender, age, and race/ethnicity. Among employed persons, 38% of injuries occurred at work, and among employed men aged 55-64 years, 49% of injuries occurred at work.

Conclusions: Injuries at work comprise a substantial part of the injury burden, accounting for nearly half of all injuries in some age groups. The NHIS provides an important source of population-based data with which to determine the work relatedness of injuries. Study estimates of days away from work after injury were 1.8 times higher than the Bureau of Labor Statistics (BLS) workplace-based estimates and 1.4 times as high as BLS estimates for private industry. The prominence of occupational injuries among injuries to working-age adults reinforces the need to examine workplace conditions in efforts to reduce the societal impact of injuries.
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http://dx.doi.org/10.2105/AJPH.2004.049338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449342PMC
July 2005

Early retirement due to occupational injury: who is at risk?

Am J Ind Med 2005 Apr;47(4):285-95

Liberty Mutual Research Center for Safety and Health, Center for Disability Research, Hopkinton, Massachusetts 01748, USA.

Background: As the workforce is rapidly ageing, research on the consequences of occupational injuries in older workers is becoming more important. One adverse outcome unique to older workers, early retirement, has significant negative social and economic consequences for workers and employers. Although linked to poor worker health, the roles of workplace factors and occupational injury have not been well-defined.

Method: Changes in retirement plans attributed to an occupational injury were studied in a population-based sample of 1,449 New Hampshire workers aged
Result: Eleven percent planned to retire earlier due to their work injury, and their outcomes were significantly worse. In a multivariate model, pre-injury dissatisfaction with the job and with medical care, and poor physical and mental health status were related to intent to retire early.

Conclusion: These factors may represent opportunities for early identification and intervention with individuals at high risk for poor post-injury outcomes. Longitudinal studies are needed to confirm the importance of these preliminary findings.
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http://dx.doi.org/10.1002/ajim.20149DOI Listing
April 2005

Outcomes in work-related injuries: a comparison of older and younger workers.

Am J Ind Med 2005 Feb;47(2):104-12

Liberty Mutual Research Institute for Safety and Health, Center for Disability Research, Hopkinton, Massachusetts 01748, USA.

Background: The "graying of the workforce" has generated concerns about the physical capacity of older workers to maintain their health and productivity on the job, especially after an injury occurs. There is little detailed research on age-related differences in work outcomes after an occupational injury.

Methods: A self-report survey about occupational, health, and financial outcomes, and related factors was administered 2-8 weeks post-injury to workers aged < 55 and > or = 55 who had lost time due to a work injury.

Results: Despite more severe injuries in older workers, most outcomes were similar in both age groups. In multivariate models, age was unrelated or inversely related to poor outcomes. Injury severity, physical functioning, and problems upon return to work were associated with adverse work injury outcomes.

Conclusions: Older workers appear to fare better than younger workers after a work injury; their relative advantage may be primarily due to longer workplace attachment and the healthy worker effect.
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http://dx.doi.org/10.1002/ajim.20122DOI Listing
February 2005

Practical aspects of functional capacity evaluations.

J Occup Rehabil 2004 Sep;14(3):217-29

Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, Massachusetts, USA.

Physicians, employers, insurers, and benefits adjudicators often rely upon functional capacity evaluations (FCEs) to determine musculoskeletal capacity to perform physical work, often with legal or occupational consequences. Despite their widespread application for several decades, a number of scientific, legal, and practical concerns persist. FCEs are based upon a theoretical model of comparing job demands to worker capabilities. Validity of FCE results is optimal with accurate job simulation and detailed, intensive assessments of specific work activities. When test criteria are unrelated to job performance, or subjective evaluation criteria are employed, the validity of results is questionable. Reliability within a subject over time may be adequate to support the use of serial FCE data collection to measure progress in worker rehabilitation. Evaluation of sincerity of effort, ability to perform complex or variable jobs, and prediction of injury based upon FCE data is problematic. More research, especially studies linking FCE results to occupational outcomes, is needed to better define the appropriate role for these evaluations in clinical and administrative settings.
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http://dx.doi.org/10.1023/b:joor.0000022763.61656.b1DOI Listing
September 2004

Outcomes of workers' compensation claimants with low back pain undergoing intradiscal electrothermal therapy.

Spine (Phila Pa 1976) 2004 Feb;29(4):435-41

Liberty Mutual Center for Disability Research, Hopkinton, MA 01748, USA.

Study Design: Case series.

Objective: To describe the outcomes of workers' compensation (WC) claimants who have had a lumbar intradiscal electrothermal therapy (IDET) procedure.

Summary Of Background Data: IDET was developed as a less invasive treatment alternative to fusion after failure of conservative treatment for discogenic low back pain (LBP). Initial IDET case series from single practices have reported improved pain, function, and return to work outcomes. Little is known about results when performed by a variety of providers or in WC populations.

Materials And Methods: LBP cases that underwent IDET between December 1, 1998 and February 29, 2000 were identified from WC records. Data sources included hardcopy claim files, administrative medical billing data, and computerized claim file narrative reports. Outcomes included narcotic use 6 months or more after IDET, additional invasive treatment after IDET (low back injections or surgery), and improved work status 24 months after IDET.

Results: One hundred forty-two cases from 23 states were identified, with 97 different providers performing the procedure. Mean duration of symptoms before IDET was 26 months. Mean follow-up duration after IDET was 22 months. Ninety-six (68%) of the cases did not meet one or more of the published inclusion criteria. Seventy-eight cases (55%) received at least two narcotic prescriptions 6 months or more after IDET. Fifty-three (37%) had at least one lumbar injection and 32 (23%) had lumbar surgery after IDET. A total of 55 (39%) were working at 24 months after IDET; of these, 28 (20%) were not working and 27 (19%) were working before IDET. Narcotic use after IDET was associated with narcotic use before IDET, the same provider performing discography and IDET (provider self-referral), and positive signs of radiculopathy (C = 0.80). Need for invasive lumbar procedures after IDET were associated with provider self-referral, narcotic use before IDET, and older age (C = 0.73). Continued work absence after IDET was associated with provider self-referral, male gender, litigation, narcotic use before IDET, and older age (C = 0.83). Conformance with published selection criteria for IDET was not associated with provider self-referral or outcomes, nor was duration before IDET associated with outcomes.

Conclusion: The procedure may be less effective when performed by a variety of providers than suggested by initial case series performed by single providers or practices in work-related LBP cases. Provider self-referral and narcotic use before IDET are significant risk factors for poor outcomes. Randomized controlled trials are needed to determine whether there is a subset of patients with discogenic back pain who derive substantial and sustained benefit from this procedure.
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http://dx.doi.org/10.1097/01.brs.0000092376.41688.1aDOI Listing
February 2004

Methodological challenges in studying recurrence of low back pain.

J Occup Rehabil 2003 Mar;13(1):21-31

Liberty Mutual Center for Disability Research, 71 Frankland Road, Hopkinton, Massachusetts 01748, USA.

Recurrences of low back pain (LBP) have been shown to be both frequent and costly, with reported recurrence rates ranging from 5 to 82%. Numerous methodological approaches have been developed to identify recurrence but there has been no standardized definition of LBP recurrence or required follow-up time. The objective of this study was to compare the methodological approaches used to analyze LBP recurrence in seminal contributions and to describe the differences in definitions of LBP recurrence and follow-up structure. Twelve seminal articles were identified for review during which four types of LBP recurrence definition and two types of follow-up structure were recognized. Definitional and follow-up differences considerably contributed to variations in computed recurrence rates due either to measurement or other methodological shortcomings, such as loss to follow-up and sick person effect. The results suggest that there is a need to develop a standardized definition of LBP recurrence and a standardized approach to follow-up to allow direct comparisons of published research findings. The use of alternative definitions is also likely to impact analyses of risk factors contributing to LBP recurrence and direct and indirect costs associated with treating LBP.
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http://dx.doi.org/10.1023/a:1021893706683DOI Listing
March 2003
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