Work injury management of refractory low back pain: relations with ethnicity, legal representation and diagnosis

While psychosocial factors are known to influence treatment outcomes in low back pain patients, relatively little is known about how they may influence work injury management of low back pain. This study examined medical and psychosocial factors associated with work injury management decisions relative to patients with occupational low back pain. A retrospective review of 132 patients who had settled their injury claims showed that two psychosocial factors, ethnicity and litigation status, were associated with work injury management. Temporary total disability costs and impairment ratings were lower for African Americans than for Caucasians, but only in the absence of legal representation. Similarly, patients with specific pathology underwent more treatment, especially diagnostic testing, than patients with non-specific back pain, but only in the presence of legal representation. Having evidence of a specific lesion and legal representation were also associated with claimants' final disability ratings. Results are discussed in terms of a model of social judgment in which properties of the judge, target, and context influence judgments. Implications for work injury management and disability determination, as well as future research are discussed.