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PubMed1998

Claim rates of compensable back injuries by age, gender, occupation, and industry. Do they relate to return-to-work experience?

STUDY DESIGN: A retrospective cohort study of Michigan workers' compensation cases involving back injuries in 1986 and 1987 with incidence and outcome data. OBJECTIVE: To determine claim rates by age, gender, and industry or occupation for compensable back injuries and to investigate the relation between occupation and return to work. SUMMARY OF BACKGROUND DATA: The cohort of 24,094 Michigan workers' compensation cases from 1986 and 1987 in which claimants were compensated for back injuries was reviewed. Compensation eligibility requires more than 7 days' disability after injury. METHODS: Claim rates for back injuries by age, gender, and industry or occupation using employment data interpolated from 1980 and 1990 Census 1% Public Use Microdata Samples. Cox proportional hazards analysis was performed for return to work in the first 8 weeks after injury, with occupation coded at the three-digit level. RESULTS: All-age claim rates for Michigan compensable back injuries by occupation ranged between 0.03% and 1.7% annually (0.39% for all cases) and were generally higher in women in white collar occupations and in men in blue collar occupations. The claim rate peaked in men in the 25-34 year range, with the highest rates in manual labor occupations. The peak claim rates by age were less marked in women, tending to occur broadly throughout the 25-44-year range. Similar all-age values were recorded by industry. The male-to-female risk ratio over all occupations does not vary by age and is approximately 1.4:1. As the classification of occupation became more detailed, large differences in risk were documented within major occupation groups. The highest risk in this study was approximately 6% annually for 25-44 year old men in driver-sales (beverage truck drivers and delivery workers). Only 7 of 40 occupation categories showed a significant relative hazard for return to work in the first 8 weeks after injury, and these were blue collar occupations with earlier return than the reference sales category. For Michigan compensable back injuries, a rough estimate of the true annual incidence of new claims is 94% of the reported claim rate. CONCLUSIONS: The relative risk of compensable back injury is generally higher for females in white collar occupations, higher for males in blue collar occupations and approximately equal in service occupations. Although the risk of back injury is related to occupation, the same occupational factors do not operate as a barrier to return to work.

Adolescent↗

PubMedDate not supplied

The use of total quality improvement techniques to determine risk factors for back injuries in hospital workers.

OBJECTIVE: To identify the risk factors for back injuries among hospital employees using quality-management techniques. METHODS: Data from employee-health records were collected from 1993 to 1995 on a total of 100 back injuries. The data were reviewed retrospectively for risk factors using quality-management techniques. RESULTS: We identified two major categories of risk factors: administrative and environmental. The five most common causes of back injuries were as follows: inadequate or lack of proper training in body mechanics, not enough help in lifting, the load being lifted was too heavy, poor condition of the floor surface (slippery or uneven), and the patient was unable to help. The Workers' Compensation costs for the 100 back injuries was in excess of $600,000. CONCLUSION: Based on these findings, several preventive strategies are identified.

Adult↗

PubMed1987

Design and evaluation of a back injury prevention program within a geriatric hospital.

Two phases of a back injury prevention program were studied using 2035 accident reports filed between 1979 and 1984. Phase 1, Personnel Program, was designed to decrease the duration of wage-loss claims by increasing the effectiveness of the existing procedures used to process these claims. This program significantly lowered the proportion of high-hour claims (P less than .05) and significantly reversed a trend of increasing accident rates (P less than .05). Phase 2, Back Program, was designed to lower the incidence of back injuries through a feedback-oriented educational program. The Back Program itself could not demonstrate a significant reduction in back injuries primarily due to the powerful and confounding effect of the Personnel Program. The combination of the Personnel Program and the Back Program significantly lowered back injuries for nurses when compared with a similar group of injuries that occurred at geriatric hospitals (P less than .001). The large effect of the Personnel Program and the small effect of the Back Program have design implications for any injury prevention program.

Aged↗

PubMed1977

Low back injury in sport.

Low back injuries are shown to present a serious hazard to sportsmen and women, and may lead to long-term disability in relation to their sport. Training methods, particularly weight training, led to many of the injuries and it is recommended that personnel involved in training become more aware of these dangers. Spondylolysis was found in 18% of cases and it is suggested that the full investigation of low back pain in a sportsman is incomplete until this lesion has been excluded.

Adolescent↗

PubMed1995

The epidemiology of back injuries in nurses at a large Canadian tertiary care hospital: implications for prevention.

Two years of prospective data on 416 back injuries were gathered at a 1100-bed acute and tertiary care hospital to assist target prevention efforts. The rate of injury among 1645 nurses was found to be highest for those working on orthopaedic, medicine, neurology, spinal and surgery wards, indicating priorities for prevention. In fact, 51% of the orthopaedic nurses sustained at least one back injury during the two-year period. Gender did not significantly affect the risk of back injury; however, injuries were slightly more common in nurses with less seniority and younger nurses were found to be at significantly increased risk of back injury. Almost 63% of the back injuries which occurred in nurses working 8 h shifts on the high-risk wards occurred during the first two hours of the shift. Lifting and transferring patients with assistance were the two most common mechanisms for back injury (22.6% and 23.3%, respectively). In total, injured nurses attributed 52.3% of their injuries to inadequate training; inadequate staffing was given as the primary reason for 13.8% of the injuries. The results suggest that training in the indications for and use of mechanical devices for lifting/transferring patients requires intensification, and a 'warm-up' period should also be considered in the face of injuries occurring early in the shift if work activities cannot be evenly planned.

Adult↗

PubMed1989

[Back injuries and the work site].

Payments through obligatory accident insurance for back injuries as a result of an accident in the legal sense are common. In contrast, the acceptance of back injuries as an occupational illness is associated with such strict legal prerequisites that, considering the early appearance and frequency of degenerative back diseases in the general population, the condition whereby a back injury must have been caused exclusively or predominantly, i.e. at least three quarters, by the occupational activity is satisfied only in rare cases. Epidemiological studies show that back conditions occur more frequently in certain types of exposed occupation. The high degree of causality required by the legislature is, however, not demonstrated so that back injuries could therefore be recognized as occupational illnesses only in rare cases. Because of this, prevention at the place of work is all the more important.

Accidents, Occupational↗

PubMed1991

A case-control study of risk factors for industrial low back injury: implications for primary and secondary prevention programs.

Data were collected on 228 consecutive back injuries in Boston's General Mail Facility and 228 non-injured controls drawn randomly from each case's work unit, matching on craft (clerk, mailhandler, maintenance), shift, and general supervisor. Data were collected on age, gender, duration of employment, 3 year history of injury claims, overtime work in the past 2 weeks, job change in the past 60 days, and machine vs. manual job. Risk factors for back injury were examined simultaneously in a conditional logistic regression for matched pairs. Risk factors included history of back injury claim (OR = 16.5, p less than 0.0001), younger age (OR = 3.0, p = 0.0001), shorter duration of employment (OR = 2.6, p = 0.0007), recent job change (OR = 2.5, p = 0.06), and history of non-back injury claim (OR = 2.0, p = 0.08). Among heavy lifters (vs. clerks) overtime and being female increased the risk of injury. In this setting, higher risk workers who may benefit from preventive education programs can be identified.

Accidents, Occupational↗

PubMed1993

A case-control study of risk factors for industrial low back injury. The utility of preplacement screening in defining high-risk groups.

Using a cohort of 8183 postal workers, this study assesses the efficacy of preplacement medical examinations in defining the risk of occupational low back injuries. From this cohort, 154 subjects with occupational low back injuries between 1983 and 1988 and 942 control subjects who did not have low back injuries were identified. A multivariate logistic regression shows that a history of prior disability, odds ratio 2.90 (95% confidence interval 1.88-4.48), and a heavy lifting job, odds ratio 1.91 (1.32-276) are associated with occupational low back injuries. However, a history of previous back injury on screening examination is not associated with subsequent occupational injury. The association between a history of disability and occupational low back injury has not been previously noted and warrants further research.

Adult↗

PubMed1990

Australian workers with back injury: a statistical overview.

This paper reviews international and Australian data concerning the occurrence of back injuries amongst the labour force. Analyses of Australian Bureau of Statistics data for the period 1977 to 1986 revealed substantial differences between Australian states in their rates of back injury claims for work injuries, with a decline in rates over the ten years surveyed. Analyses of WorkCare data from the State of Victoria in Australia revealed that claimants with back injury claims of greater than 12 months standing were very costly. A total of 8,633 claimants accounted for 68.7% of all payments for back injury ($362 million out of a total of $527 million) when these claimants represented only 10.7% of all back injury claimants for the period September 1985 to May 1989. Substantial variations were found in claim rates across occupations and age levels. An almost linear (r = 0.98) association was found between age and proportion of long term claimants at each age level. It is suggested that these data could be used to identify 'at risk' groupings with a view to the implementation of preventive measures.

Adolescent↗

PubMedDate not supplied

Short-term efficacy of back injury intervention project for patient care providers at one hospital.

A one-year Back Injury Prevention Program was initiated at a 440-bed acute care hospital in 1996 in response to concerns over high incidence and severity of back injuries among nursing staff and others. The program included an ergonomic evaluation of patient handling, pilot testing and purchase of new equipment, a train-the-trainer program, and training of 374 nurses and other patient handling staff (approximately one-half of the nursing staff). An impact evaluation, measured by comparing self-reported knowledge, work practices, and back pain among a subset of trainees and controls revealed an increase in knowledge of risk factors, a marginal increase in the use of mechanical devices to transfer patients, and a significant decrease in repositioning of patients in bed among trained versus control subjects (p = .017). Over the course of the program, the number of back injuries was 30% below the average of the prior 3 years, with the number of reported injuries in the final quarter (immediately following the training program) approximately one-seventh of the three prior quarters. It is concluded that back injury training may increase knowledge of risk factors and controls and may impact behaviors over which individuals have control (e.g., how often they move patients). However, training effectiveness is limited when engineering controls such as patient transfer devices are unavailable.

Back Injuries↗

PubMed1987

Personal and job-related factors as determinants of incidence of back injuries among nursing personnel.

The purpose of this multicenter prospective cohort study was to assess personal and job-related factors as determinants of incidence of reported back injuries among nurses. The study population included 5,649 nurses who were surveyed by questionnaire and then observed for a 12-month study period. An annual injury rate of 4.9% was observed. Four factors were found to be significant (P less than .01) predictors of back injury. All four factors--service area, lifting, job category, and previously reported back injury--maintain significance when a forward stepping model of logistic regression is applied. The adjusted odds ratios observed are 4.26 for service areas where lifting occurs most as compared with areas where lifting occurs least; 2.19 for daily lifters v light, occasional, and nonlifters; 1.77 for nursing aides v registered nurses and supervisory personnel; and 1.73 for individuals who have previously reported back injury v those who have not reported previous injury. These findings strongly suggest that job-related rather than personal characteristics are the major predictors of back injury in nurses.

Accidents, Occupational↗

PubMed1996

Nursing staff back injuries: prevalence and cost in long term care facilities.

This report describes the period prevalence and cost of back injuries to nursing staff of long term care facilities in comparison to nurses employed industry wide and to other occupations industry wide. The period prevalence of back injuries to nursing staff in long term care facilities was highest for nurse aides, followed by LPNs and then RNs. Nurses (combined) had a period prevalence of back injuries nearly 1.5 times higher than all employees of long term care facilities and 6 times higher than all occupations combined industry wide. Within long term care facilities, nurses sustaining back injuries were younger and had been employed for a shorter period of time than the average for all nurses employed in long term care facilities. Back injuries accounted for more than half of the indemnity and medical costs for all injuries incurred in nursing homes and industry wide. The findings highlight the need for better prevention and rehabilitation

Adult↗

PubMed1986

Neck and low back injuries in wrestling.

Drs. Wroble and Albright review the neck and low back injuries of the University of Iowa wrestling teams over the last 8 years with respect to diagnosis, mechanism of injury, time lost from wrestling, and recurrence. They describe examination of the low back and treatment of low back injuries. Examination of the neck is reviewed in detail and common neck injuries are discussed. Emergency management of acute neck injuries is outlined. Various aspects of prevention of neck injuries are presented.

Adult↗

PubMed1989

The effects of compensation on recovery from low-back injury.

The influence of compensation on recovery from low-back pain was assessed in a retrospective controlled cohort study. One hundred fifty compensable and 150 noncompensable back injury patients were invited for review between 1 and 5 years from presentation. A 91.3% follow-up was achieved, and there was no difference in the median age, follow-up, and initial injury score between the two groups. The incidence of reported pain, disability, psychological disturbance, unemployment, and length of time off work was greater in the compensation group (P less than 0.001). Settlement of the claim did not result in any reduction in morbidity, even up to 5 years later. These results demonstrate that the payment of compensation delays recovery from low-back injury.

Adult↗

PubMed1997

Knee flexion to extension peak torque ratios and low-back injuries in highly active individuals.

The purpose of this study was to investigate for possible relationships between knee flexion to extension peak torque ratios (F1/Ext(rat)) and low-back injuries in highly active males and females. Forty-eight male (age 25.9 +/- 4.5 years) and 41 female (age 27.3 +/- 2.6 years) competitive rowers, and 20 male (age 26.6 +/- 6.0 years) professional ballet dancers volunteered for the study. Each subject performed a test of lumbar and knee flexor flexibility, isokinetic dynamometry and completed a self-administered questionnaire. Flexibility was assessed by using the sit-and-reach test. Knee flexion to extension peak torques were bilaterally monitored at the angular velocities of 1.04 and 4.19 rad x s(-1). The questionnaire was designed to obtain information regarding the number of days off action (e.g., training, competition, and rehearsals), due to low-back injuries, for the 12-month period prior to testing. Results revealed significant negative correlation coefficients between knee F1/Ext(rat), obtained at 1.04 rad x s(-1), and days off physical activity for oarsmen (r = - 0.69; p < 0.01), oarswomen (r = -0.62; p < 0.01) and male dancers (r = -0.57; p < 0.05). No such correlations were found for either knee F1/ Ext(rat) obtained at the angular velocity of 4.19 rad x s(-1) or between the sit-and-reach test results and low-back injuries. A sub-group of 22 female rowers was re-tested after a 6-8 month period, during which a special hamstring strength training programme was introduced. The main conclusions were: a) the lower the F1/Ext(rat) the greater the degree of low-back injury, b) at least in female rowers, 6-8 months of hamstring strength training can contribute to a reduction of the incidence of low-back injury, and c) isokinetic assessment of quadriceps and hamstrings obtained at lower compared to higher angular velocities is more prognostic of low back injury.

Adult↗

PubMed1994

Epidemiology of back injury in university hospital nurses from review of workers' compensation records and a case-control survey.

Reviewing Workers' Compensation records for back injury from a large university hospital for a 2-year period, we found a yearly incidence of lost work time back injury among nurses of 2.0% per year, exceeded only by physical plant staff, who had a rate of 3.5%. Nurses' aides had an injury rate 3.3-fold higher than registered nurses and licensed practical nurses and higher than any other occupational group. We compared 100 cases of nurses with back injury in the previous 2 years with 197 noninjured control subjects using a mailed 40-item questionnaire. Multivariate logistic modelling showed that prior nonback injury and performing combined lifting activities were statistically significant risk factors for back injury, and being overweight approached significance, after adjusting for the effects of age, gender, and each of the evaluated risk factors.

Accidents, Occupational↗

PubMed1991

Low-back injuries in a heavy industry. I. Worker and workplace factors.

The costs and circumstances of low-back strains, low-back impact injuries, and non-low-back injuries among field employees of an offshore petroleum drilling company, 1979-1985, were compared. The objectives were to identify worker and workplace factors associated with low-back injuries, to identify factors differentially associated with lost-time injuries, and to formulate recommendations for the control of low-back injuries. Low-back-impact injuries resulted largely from falls. Efforts to prevent falls would have a potential to reduce other serious consequences as well as back injuries. Workers performing the heaviest physical labor were at highest risk of low-back strains. Based on activities precipitating the injury, modifications of work site, equipment, and procedures to help reduce low-back strains are recommended. Only job was a predictor of whether a low-back strain was likely to be associated with lost time. Even this association was lacking for low-back impact injuries. Cost control by preventing the small proportion of high cost injuries may not be feasible. Rather, subsets of low-back injuries defined, for example, by work site or activity can suggest options for intervention.

Accidental Falls↗

PubMed1990

Results of a multicenter trial using an intensive active exercise program for the treatment of acute soft tissue and back injuries.

Dissatisfaction with current nonsurgical treatment of acute soft tissue and back injuries initiated a search for more effective treatment. A multicenter trial, involving 12 clinics, treated 1,072 patients. Treatment consisted of intensive, time-limited exercises emphasizing mobility, muscle strengthening, work conditioning, sequence training, and appropriate education sessions. Return to full-time work was proof that the patient had recovered fully. Time off work and compensation costs were parameters used to evaluate results. A detailed study of 703 patients treated at five clinics, operational for more than 12 months, showed superior results when compared with the comparison group of 2,172 matched control subjects. The treatment group returned to work earlier and realized substantial cost savings. This treatment program has proved to be superior to the miscellaneous variety of treatment modalities used for acute soft tissue and back injuries provided to the comparison group.

Back Injuries↗