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PubMed1986

Compensation neurosis.

The concept of compensation neurosis developed in the wake of the nineteenth century Industrial Revolution and subsequent enactment of workmen's compensation laws. The nosologic designation of traumatic neurosis was not consensually accepted until after World War II; the compensation label was epithetically applied as a simplistic explanation of puzzling postaccident disability. In diagnostic evaluation of postaccident symptoms not attributable to tissue damage; these factors are relevant: secondary gain and loss; alteration in family dynamics; iatrogenic influences, particularly from industrial medical departments; liberalization of workmen's compensation laws; the symbolic significance of money in our culture; the climate of creeping socialism. One consequence stemming from the conceptualization of a compensation neurosis is implicit adherence to the anachronistic mind-body dichotomy.

Family↗

PubMed1990

Disability, direct cost, and payment issues in injuries involving woodworking and wood-related construction.

Treatment cost and payment patterns and disability for work, home, and recreation activities were examined for 495 consecutive persons seen as primary care patients over one year in Northern Vermont with injuries associated with woodworking, wood related construction, and home repair activities and materials. These primary care patients were from a larger sample of 601 persons with such injuries who received either primary or tertiary care. Mean total charges were $530 and $342 respectively for work and nonwork related injuries, with highest costs for back and arm injuries, and injuries involving powered equipment and elevations. At six months post injury, patients averaged 11.6 days of disability for work, 10.3 days for home activities, and 13.1 days for recreation. Overwhelmingly, this disability was experienced by nonhospitalized patients. Median charges and disability days were far lower, reflecting the fact that the majority of injuries were minor and only 6% resulted in hospitalization. Only 29% of hospital charges for injuries at work were paid by workmen's compensation, and a third either were unpaid or were paid by the injured party. Self-employed contractors and carpenters, in particular, lacked coverage by workmen's compensation.

Accidents, Occupational↗

PubMed1994

[Absence from work and illness behavior in patients with chronic pain].

Factors relating to working status, i.e. whether the subject is still at work or on workmen's compensation, have been studied in chronic pain patients. Sociodemographic and pain variables were not correlated with absence from work, nor was diagnosis. However, beliefs and attitudes concerning pain differed between patients still working and those on workmen's compensation. In chronic pain patients medical attention should focus not only on description of symptoms but also on the "illness behaviour" dimension.

Absenteeism↗

PubMed1986

Treatment of the painful neuroma by neuroma resection and muscle implantation.

The successful treatment of the painful neuroma remains an elusive surgical goal. This report evaluates one approach to the management of this problem which entails neuroma excision and placement of the proximal end of the nerve away from denervated skin, away from tension, and into a well-vascularized environment: muscle. Seventy-eight neuromas in 60 patients with a mean follow-up of 31 months (range 18 to 43 months) were evaluated. Sixty-seven percent of these patients involved Workmen's Compensation and 57 percent had had at least one previous operation to treat their pain. The results demonstrated good to excellent results in 82 percent of the treated nerves in the entire group. Factors that were predictive of a poorer outcome were (1) digital neuroma (p less than 0.0005), (2) Workmen's Compensation (p less than 0.01), and (3) three or more previous operations for pain (p less than 0.01). Transposition of nerves into small superficial muscles or muscles with significant excursion resulted in treatment failures. The etiology and histopathology of treatment failures are reviewed. Treatment of radial sensory neuromas by transposition of the radial sensory nerve into the brachioradialis muscle when any associated injury to the lateral antebrachial cutaneous nerve was also treated, gave good to excellent relief of pain, and improved hand function in 88 percent of the patients.

Adult↗

PubMed1991

[Occupational health care as a basis of occupational medicine monitoring in small companies. Common occupational medicine/ergonomic approach to prevention].

Set out from various specific angles, the concept concerning a modern common industrial medicine/safety/ergonomics approach can be fitted into the present legal framework. Adapted according to specific needs, this approach can equally be applied in all areas--health promotion, prevention, cure, rehabilitation. Those involved in the current debate about industrial health policies start out from the premise that industrial medicine could contribute strongly in this respect. While the workmen's compensation scheme, together with the industrial medical profession, is to a considerable extent involved in the subject as a whole on the basis of the industrial safety Act, its competencies are however limited, being in actual fact confined to the field of health maintenance in the occupational context. The examinations they effect in this framework cannot be based on a holistic medical orientation, because our constitution has expressly excluded the private sphere of the individual (self-management domain). Hence, there are very little chances of success for any attempt of changing current health care practice solely via the workmen's compensation administrations. It currently is, rather, the health and pension insurance schemes who hold the potential for influence. The common approach of industrial medicine, safety and ergonomics outlined may be of considerable use also in view of their goals, and holds sufficient justification for their intervening favourably in the ongoing debate about quality and quantity of industrial medical service provision with the ministries in charge.

Ergonomics↗

PubMed1981

Mortality among workers receiving compensation for asbestosis in Ontario.

Mortality among 172 workers who received workmen's compensation for asbestosis in Ontario was investigated and the causes of death were compared with those for the general male population in that province. The workers were found to have increased rates of death, relative to the general populations, for nonmalignant respiratory diseases, lung cancer and pleural and peritoneal mesothelioma. In comparison with the general population, the proportion of workers that survived was 69% of that expected 5 years after they were awarded compensation and 53% at 10 years.

Adult↗

PubMed2005

Work-related hand injuries in Ontario: an historical perspective.

Worker's compensation legislation was enacted in Ontario almost 90 years ago. Workers injured on the job gave up their right to sue employers and received no-fault compensation from an independent, employer-funded body called the Workmen's Compensation Board. Three academic health sciences centers in Ontario that are recognized for their commitment to patient care, research, and education compose part of the Specialty Program network with the Ontario Workplace Safety and Insurance Board (WSIB). Statistical data from the WSIB database for workers with hand injuries from 1996 to 2003 show an increase in fractures from fall injuries in the group of women older than 60 that may be related to osteoporosis, a common condition in this group.

Accidents, Occupational↗

PubMed1975

The compensation experience of patients with chronic beryllium disease.

The experience of patients with chronic beryllium disease seeking workmen's compensation indicates that the system does not meet its intentions of providing for relief of workers for job-related illness. In the instance of beryllium disease there is undue delay in adjudication of the compensation. This delay has its origin in part from litigation over the diagnosis and disability on the part of private insurers and in part on failure of the IAB to press for findings. Moreover, the process of litigation and delay may produce significant psychological distress. For others the compensation for a chronic disability is inadequate. Whether compensation acts as a system of relief depends on whether the patient has a working husband or wife. Among the women here with beryllium disease, the system worked only to the extent that they could rely on their husbands. Compensation benefits should be provided in accord with rises in the cost of living index. Compensation boards should press for prompt settlement of claims.

Adolescent↗

PubMed2004

Workers' compensation: a historical review and description of a legal and social insurance system.

The workers' compensation system is a no-fault legal and social insurance system established to address compensation issues that involve work-related injuries and illnesses. The system was developed in response to dissatisfaction with common law litigation on the parts of injured workers and employers. The history of the development of workers' compensation is reviewed, and a general description of the system is offered, including discussion of state law and insurance structures, benefits and costs, administrative boards/commissions, and the federal systems for workers' compensation and related programs. The recent history of the workers' compensation system is provided, the recommendations of the National Commission on State Workmen's Compensation Laws in 1972 are reviewed, and the problems and state-initiated changes in worker's compensation that occurred during the 1990s are discussed.

Humans↗

PubMed1955

Permanent disability evaluation.

Physicians' reports for the purpose of permanent disability rating differ in character and in scope from usual clinical reports. Complete and precise reporting of permanent disability factors by physicians aids the Industrial Accident commission in making proper awards for permanently disabled workmen. The use of a CMA-approved method of reporting permanent disability factors reduces misunderstanding and needless delay in adjustment of cases.

Accidents, Occupational↗

PubMed1985

Unraveling the effects of compensation, litigation, and employment on treatment response in chronic pain.

Although it has often been suggested that chronic pain patients who are receiving workmen's compensation or who have litigation pending are less likely to benefit from treatment, the results of outcome studies of this question conducted by various pain clinics have been inconsistent. We hypothesized that poorer outcome in such patients may be related to the fact that they are less likely to be working and that the inconsistent results in the literature may therefore be explained by variability among studies in the percentages of patients who are receiving compensation (or who have litigation pending) who are also working. We examined the relationships among compensation, litigation, employment, and short- and long-term treatment response in a series of 454 chronic pain patients. Compensation benefits and employment status both predicted poorer short-term outcome in univariate analyses; however, when employment and compensation were jointly used to predict outcome in multiple regression analyses, only employment was significant. In additional analyses, only employment significantly predicted long-term outcome, whereas compensation and litigation did not. Our results suggest that it would be valuable to redirect attention away from the deleterious effects of the 'compensation neurosis' and toward the roles of activity and employment in the treatment and rehabilitation of chronic pain patients.

Adult↗

PubMedDate not supplied

Manual materials handling: the cause of over-exertion injury and illness in industry.

It is reported from various sources that overexertion due to lifting, pushing, pulling, and carrying objects accounts for about 27 percent of all compensable industrial injury and illness in the United States. Resulting strain/sprain injuries account for over 50 percent of workmen's compensation clams in many industries. Almont two-thirds of these involve back pain, with reported compensation and medical payments totaling well over one billion dollars annually in the U.S. An estimated 300,000 plus workers will be affected each year, 5 to 10 percent of whom will have a permanent disability and often will be unemployable. This paper attempts to describe four basic approaches used to study this occupational health problem. In so doing, a concerted effort is made to identifiy the gaps in knowledge which need to be more fully researched. The approaches utilized to understand and control the hazards of manual materials handling are: 1) epidemiological studies of job and worker attributes to identify those that individually and in combination cause musculoskeletal incidents, 2) psychophysical studies to ascertain the volitional tolerance of workers to the stress mitigated by manual materials-handling activities, 3) biomechanical studies of the musculoskeletal system during common exertions required in manual materials-handling activities, and 4) physiological studies of the strain imposed on the cardiovascular system during repeated load-handling activities. The state of knowledge from each of these approaches is summarized briefly, and a case is made that much research is still needed to substantiate the necessary controls to lessen the economic burden and human suffering associated with manual materials-handling acts in industry.

Adolescent↗

PubMed1979

Failed lumbar disc surgery and repeat surgery following industrial injuries.

One hundred and seventy-nine of the compensation patients in this study who had one low-back operation had to have repeat back surgery. One hundred and three Workmen's Compensation Board patients who were reoperated on by a number of surgeons in the Toronto area were independently reviewed with one to two years of follow-up. Many had residual back pain, limited lumbar movement, presisting nerve-root deficits, and psychological disturbances. Forty per cent of the second operations were successful. Subsequent operations yielded progressively poorer results and made more patients worse than better. Operations were frequently undertaken without clear indications or evidence of correctable organic lesions. The results of repeat operations were better when the preceding operation had given more than six months' relief, when sciatica overshadowed back pain, and when a definite recurrent disc herniation was found. Scarring and neurolysis, previous infection, repair of a pseudarthrosis, and adverse psychological factors precluded a good result. Careful patient selection based on total evaluation of the disability including psychological assessment, accurate localization of the lesion by detailed investigation, and, most important, a logical sequence of decisions based on clear, objective criteria are prerequisites for this complex and demanding surgery. Caution and restraint are required when contemplating repeat back surgery.

Accidents, Occupational↗

PubMed2000

Late postoperative results in 1000 work related lumbar spine conditions.

BACKGROUND: Poor results after lumbar spinal surgery have been recorded in compensation cases throughout the world medical literature. It seems that psychosocial factors play an important role in the delay in returning to gainful employment but that chronic postoperative lumbar and lower extremity pain is blamed for this state of affairs. The present series of late outcomes is based on actual physical examination by independent neurosurgical and orthopedic experts appointed by the Workman's Compensation Board, providing an impartial opinion as to the discrepancy between objective findings and failure to reintegrate into the work force. METHODS: One thousand workmen's compensation patients who had undergone lumbar spinal surgery were divided into two groups, one of 600 patients with single operations, evaluated on average 51 months after surgery, and the second of 400 with multiple operations, evaluated on average 38 months postoperatively. RESULTS: Seventy-one percent of the single operation group had not returned to work more than 4 years after the operation, and 95% of the multiple operations group. In none of these cases was there a neurological deficit that precluded gainful employment, the failure to return to work being blamed on chronic postoperative pain. CONCLUSIONS: Although motivational (that is, psychosocial) factors undoubtedly play a role in failure to return to work, the role of chronic pain cannot be ignored. Increased attention must be devoted to ascertaining the etiology of this pain and ways to prevent it.

Accidents, Occupational↗

PubMed2000

Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis.

The results of 32 total knee arthroplasties performed for osteoarthritis in 32 patients who were 40 years of age or younger are reviewed. At a mean followup of 7.9 years (minimum, 5 years), the Knee Society knee scores increased from an average of 47 to 88 points, and the function scores increased from 45 to 70 points. Overall, Knee Society knee scores were considered good or excellent in 82% of patients (26 knees) and fair or poor in 18% (six knees). Postoperative function scores were good or excellent in only 40% (13 knees). The average postoperative flexion arc was 110 degrees. If patients involved in worker's compensation cases are excluded from analysis, the results improved substantially, with range of motion averaging 113 degrees, and Knee Society knee scores and function scores averaging 92 points and 77 points, respectively. Excluding the five patients involved in workmen's compensation cases, knee scores were good or excellent in 91% of patients (25 knees) and function scores were good or excellent in 50% of patients (14 knees). Three revisions were performed for aseptic failure; one additional patient has radiographic evidence of tibial loosening, representing an aseptic failure rate of 12.5% at 8 years. Although slightly higher than observed in older patients, this failure rate still may be considered acceptable for this population of patients with severely affected knees who are not considered candidates for nonarthroplasty surgery. Despite a slightly higher tendency for aseptic failures in this group of patients, cemented total knee arthroplasty may provide some patients younger than 40 years of age with severe debilitating and recalcitrant osteoarthrosis, an important option with reasonable mid- and long-term results.

Adult↗

PubMedDate not supplied

Treatment of herniated lumbar disk syndrome with chymopapain.

One hundred twenty-four patients with herniated lumbar disks received intradiskal injections of chymopapain before the Food and Drug Administration's withdrawal of the drug. One year after injection, 90 patients (72.6%) experienced major improvement, 21 (16.9%) had slight improvement, and 13 (10.5%) had no improvement. Of those patients who had no previous back surgery and who were not compensation cases, 77 patients (81%) had marked improvement, 13 (13.7%) had slight improvement, and five (5.3%) had no improvement. Three- to six-year follow-ups were obtained by questionnaire. Of the 114 patients responding, overall 83 patients (72.8%) had marked improvement, and 75 (83.3%) of those with no previous surgery and who were not workmen's compensation cases had major improvement. Since all patients met objective criteria for diskectomy, favorable results from chemonucleolysis spared most the trauma of surgery and its attendant convalescence. These results indicate that chemonucleolysis can and should be considered an advantageous alternative to surgery in appropriately selected patients.

Adolescent↗

PubMed2000

Management of symptomatic lumbar pseudarthrosis with anteroposterior fusion. A functional and radiographic outcome study.

STUDY DESIGN: An independent retrospective review of 37 patients undergoing 39 anteroposterior lumbar fusions for lumbar pseudarthrosis repair between 1984 and 1990. OBJECTIVES: To evaluate radiographically and functionally the results of the combined anteroposterior fusion for the management of symptomatic lumbar pseudarthrosis, and to assess risk factors for functional failure after the procedure. SUMMARY OF BACKGROUND DATA: Most reported techniques of pseudarthrosis repair involve posterior fusion with no instrumentation, posterior fusion with instrumentation, or anterior fusion alone. The results of lumbar pseudarthrosis repair are poor. Fusion rates range from 30% to 70%, with only a 30% to 50% rate of functional success. METHODS: Thirty-nine procedures were assessed in 37 patients. The outcomes were assessed radiographically (solid fusion vs. pseudarthrosis) and functionally (success vs. failure). Radiographs were assessed at follow-up examination for consolidation of fusion anteriorly and posteriorly. Functional outcome was graded by using multiple instruments, including data from chart review and the follow-up outcome questionnaire. A functional failure score that took into account 10 items was developed. RESULTS: In this patient population (37 patients, 59% with a smoking history, 71% with compensation or legal claims), there was a 10% pseudarthrosis rate. Pseudarthrosis was defined when one or more levels were involved and when it occurred anteriorly and posteriorly. In 12 patients (35%), the outcome was rated as functional failure. The presence of one or more abnormal neurologic findings and significant narcotic use before surgery significantly increased the chance of a patient's outcome being functional failure. Workmen's Compensation or legal status before surgery also increased the chance of functional failure, though this correlation was not statistically significant. CONCLUSIONS: A combined anterior and posterior approach for the management of symptomatic lumbar pseudarthrosis is a viable alternative to posterior fusion alone. In fact, this procedure affords a higher fusion rate based on radiographic assessment. Functional failure rates may be decreased by using caution for those patients using narcotics regularly before surgery or in those with unexplained preoperative neurologic abnormal findings.

Adult↗

PubMed1983

A computer data bank system for otolaryngologic and audiologic data.

A data bank system has been in routine clinical operation for more than two years in our department. It is used to record histories, physical findings, and audiometric data; to produce reports that are sent with short covering letters to referring physicians, and to establish a data bank for research. Although originally created for noise-induced hearing loss claimants referred by the Workmen's Compensation Board, the system was designed, from the start, to be applicable to a wide range of clinical conditions. This report describes the conceptual approach to the data bank and certain practical details involved. The system is quick and effective to use, and it can be run on a relatively small microcomputer.

Audiology↗