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Length of disability prognosis in acute occupational low back pain: development and testing of a practical approach
Glenn S Pransky1, Santosh K Verma, Lee Okurowski
1Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, MA 01748, USA. glenn.pransky@libertymutual.com
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.
