Biomedical subjects

S J Scheer

Publications and source records attributed to S J Scheer.

10 recordsLinked to original sources

PubMed1997

Randomized controlled trials in industrial low back pain. Part 3. Subacute/chronic pain interventions.

The most significant costs attributed to settlement of workplace back injury claims are related to chronic low back pain (LBP). Unfortunately, our knowledge of this fact has not led to a reduction of the considerable costs paid out annually by employers and insurers to deal with the chronic pain syndrome. This article is the third in a series of reviews on randomized controlled trials found in the English language medical literature between 1975 and 1993. Of more than 4,000 LBP citations, 35 studies met-the selection criteria of randomization, reasonable concurrent controls and work return comparisons. This review focuses on the 12 studies utilizing nonsurgical interventions for subacute and chronic LBP, including multidisciplinary pain clinics, exercise, cognitive-behavioral strategies, and others. A 26-point quality system was again used to compare the methodologic rigor of each study. The majority of prospective studies investigating return to work after chronic LBP have methodological limitations; additional research is clearly needed to more confidently answer the question of what interventions improve work capacity in patients with chronic LBP.

Behavior Therapy↗

PubMed1997

Industrial rehabilitation medicine. 1. Why is industrial rehabilitation medicine unique?

This self-directed learning module is part of the chapter on industrial rehabilitation medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Industrial rehabilitation medicine encompasses injuries and illnesses that occur in the workplace and are covered under workers' compensation. The central thesis of this article is that industrial rehabilitation medicine is a unique area because the workers' compensation system influences the behavior of injured workers. The article is divided into three sections. The first briefly reviews the history of workers' compensation in the United States, and describes eight key features of compensation systems. The second explores several hypotheses to explain why injured workers frequently have less favorable outcomes than noncompensation patients with similar medical conditions. Some explanations focus on dysfunctional psychologic reactions such as "compensation neurosis" and "disability syndrome." Others focus on contextual factors, including return to work policies by employers and financial incentives or disincentives for return to work. The third section outlines reasons why the physiatrist is often the "preferred provider" in industrial rehabilitation medicine. One crucial consideration is that many of the most important disabling work injuries are those with which physiatrists are familiar. Also, physiatric training and philosophy prepare the physician to focus on function, to work with a rehabilitation team, and to be sensitive to psychologic factors that might impede an injured worker's recovery. All of these skills are important in the treatment of injured workers.

Chronic Disease↗

PubMed1997

Industrial rehabilitation medicine. 2. Case studies in occupational low back pain.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on industrial rehabilitation medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The evaluation and management of patients presenting with low back pain are skills that practicing physiatrists need to acquire. This chapter gives a step-by-step format, along with the thought processes involved, for managing patients with three types of low back pain presentations.

Absenteeism↗

PubMed1997

Industrial rehabilitation medicine. 3. Case studies in upper extremity cumulative trauma disorders.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on industrial rehabilitation medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This section contains three case studies discussing nerve, joint, and soft tissue pathology and work disability due to upper extremity pain. New areas of interest covered in this section include the controversy regarding the work causality of upper extremity disorders, a detailed review of the impact of upper quadrant postural dysfunction on symptom perpetuation, and the assessment and nonsurgical management of thoracic outlet syndrome.

Adult↗

PubMed1997

Industrial rehabilitation medicine. 4. Strategies for disability management.

This self-directed learning module provides a practical overview of the general rehabilitative management of work disability. It is the fourth of four articles on the topic of industrial rehabilitation medicine for the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This section includes an algorithm to highlight strategies for early involvement of the physiatrist in the comprehensive management of injured workers. It also examines the broader role of the physiatrist as independent medical examiner. Finally, it explores the complexities surrounding case closure for the chronically disabled injured worker.

Algorithms↗

PubMed1997

Ergonomics.

Ergonomics is the application of natural laws governing human work in order to maximize safety and efficiency in the workplace. Ergonomic assessment includes job analysis from the biomechanical, physiologic, and physical viewpoints. The three most commonly described categories of ergonomic intervention are worker training, worker selection, and job redesign. In the last analysis, workplace redesign, using both engineering and administrative methods, is likely to be the most effective intervention.

Biomechanical Phenomena↗

PubMed1996

Randomized controlled trials in industrial low back pain relating to return to work. Part 2. Discogenic low back pain.

The purpose of this review was to determine the efficacy of treatments for discogenic low back pain (LBP) by examining all randomized controlled trials (RCTs) of discogenic LBP published in the English language literature between 1975 and 1993 with "return to work" (RTW) as the end point. From more than 4,000 LBP citations, nearly 600 articles were initially reviewed; 35 studies met our selection criteria. Twenty-two studies were discussed in Part 1 (Acute Interventions) or will be discussed in Part 3 (Chronic Interventions). In this review, of 13 RCTs assessing interventions for LBP with sciatica, 9 were appropriate for their focus on, and radiologic confirmation of, discogenic LBP. The treatments assessed included chemonucleolysis, surgical discectomy, and epidural steroid injection. A 26-point system to assess the quality of methodologic rigor was used for each article. Our literature survey found a need for additional studies comparing surgery, conservative care, epidural steroids, traction, and other approaches to determine their individual effects for RTW after discogenic disease.

Adrenal Cortex Hormones↗

PubMed1995

Randomized controlled trials in industrial low back pain relating to return to work. Part 1. Acute interventions.

Employers and insurers are interested in being able to use cost-effective interventions for returning injured workers to the workplace. Unfortunately, truly objective information is lacking. The purpose of this and two subsequent review articles was to perform thorough scrutiny and methodologic comparison among all obtainable, published randomized and controlled studies on low back pain (LBP) interventions leading to return to work. The study was confined to English language articles published from 1975 through 1993. Of more than 4,000 LBP citations, more than 500 were chosen for review. Of that number, 35 articles met the selection criteria of randomization, reasonable controls, and work return comparisons. This paper focuses on the 10 articles relating to interventions for acute (less than 4 weeks) LBP, and considers bed rest, exercise, spinal manipulation, back school, and case management. A 26-point quality system was used to compare the methodologic rigor of each article. This literature survey demonstrated the meager scientific foundations on which our industrial rehabilitation programs are based.

Bed Rest↗

PubMed1992

Industrial rehabilitation medicine. 1. An overview.

This self-directed learning module provides a framework for the general concepts in industrial rehabilitation medicine. It is the first of four articles on this topic for the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This section includes material related to the work environment and the physician-patient relationship. In addition, material on the Americans with Disabilities Act informs the reader about the new consciousness employers will need to develop toward disabled workers.

Cumulative Trauma Disorders↗

PubMed1992

Industrial rehabilitation medicine. 2. Assessment of the problem, pathology, and risk factors for disability.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on industrial rehabilitation medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article covers ergonomic assessment of upper limb and low back injury, medical diagnostics for upper extremity cumulative trauma disorder (UE-CTD) and low back pain, and an evaluation of delayed recovery following work injury. Advances that are covered in this article involve factors contributing to UE-CTD, lumbar spine-imaging techniques, and the high-risk variables that contribute to prolonged disability.

Back Pain↗