Disability determination: validity with occupational low back pain

Area of Science:

• Occupational health
• Health equity
• Pain management

Background:

• Disability determination for occupational low back pain is complex.
• Spinal pathoanatomy weakly correlates with pain and function.
• Sociodemographic factors can confound disability judgments.

Purpose of the Study:

• To assess the impact of impairment, race, and socioeconomic status on disability ratings.
• To evaluate the relationship between disability ratings and post-settlement functional status.
• To investigate potential inequities in workers' compensation for low back pain.

Main Methods:

• Study included 580 African American and 892 white workers' compensation claimants with occupational low back pain.
• Data collected on diagnosis, surgery, medical costs, and disability ratings at settlement.
• Claimants surveyed an average of 21 months post-settlement for functional status.

Main Results:

• Diagnosis, surgery, and medical costs (impairment indicators) correlated with disability ratings.
• African American race was negatively associated with disability ratings and impairment indicators.
• Disability ratings showed weak correlation with functional status at 21-month follow-up.

Conclusions:

• Racial disparities exist in the treatment and disability determination for occupational low back pain.
• The weak link between disability ratings and long-term function questions the validity of current processes.
• Findings raise concerns about social justice in managing occupational back pain claims.