It was a beautiful morning. The Upper Sacramento River in California's Siskiyou Mountains stretched out before me as I strung up my fly rod for a long-awaited day of fly-fishing. An hour (and a few fish) later, I took a misstep as I was wading waist-deep across the river and instantaneously felt the pain in my lower back. By the time I got back to my car, I could barely walk. And, I still had to face a four-hour drive home.
The experience reminded me of some of the interesting findings from the July IBI Research Insights. A survey of 100,000 employees shows that nearly 20 percent suffer back/neck conditions, and those conditions are the third leading cause of absence and the fourth leading cause of total lost time from absence and presenteeism.
When I got back to my office, I came upon fascinating research a colleague sent me recently on acute low-back pain and predictors of functionality and return to work (RTW) for occupational injuries. The study includes 568 patients between 2000 and 2002 seeking treatment for low back pain within 14 days of pain onset. The research seeks to identify the factors influencing (and predicting) functional outcomes and RTW from information available upon a first clinical visit.
The graph's bars show how each factor influences the likelihood of returning to work within 30 days of pain onset (values greater than one indicate the extent to which employees are more likely to RTW within 30 days, while values less than 1 indicate the extent to which they are less likely). Data measuring work factors, patient rating, and demographics were drawn from a patient questionnaire. Data for the clinician exam were taken from a questionnaire the clinician completed at the first patient visit. No data on the type or timing of medical care are included in the study. Data are included for 291 of the 568 participants.
The results tell us several interesting things. First – and not shown on the graph – is that physical health risks (such as smoking, obesity, history of back pain and type of back injury) surprisingly are NOT statistically significant predictors of RTW in the first 30 days after pain onset. However, the following four factors had a vital role to play in RTW predictions:
Work Factors. Employees are more likely to RTW when they know modified work is available and when they have a longer tenure at their jobs. Delays in reporting to the employer are associated with cases less likely to RTW. These delays may be associated with more chronic cases where the employee can no longer self-manage.
Patient Rating. Patients that expect to RTW are more likely to do so than those who don't. Patients having greater physical demands from their jobs and experiencing more pain tend to be less likely to RTW within 30 days.
Demographics. Among the demo-graphic variables included in the study, only age is significant. Older workers are less likely to RTW than younger workers.
Clinician Exam. If the clinician doesn't know if the employer has a modified job available and expects longer disability durations, patients tend to be less likely to RTW. "Medical factors" are far less important than "patient factors" in the prediction of disability. According to the study's authors, "This study provides further support that subjective interpretations and appraisals of patients are more powerful predictors of post back injury recovery than are physical examination variables."
Although this study deals only with occupational disabilities, the potential in extending the findings to non-occupational conditions is inescapable. This extension would suggest that RTW and early patient contact are important for good outcomes, thereby challenging how employers typically construct approaches to medical care and their current tendency to separate medical and disability data. It also suggests potential gains in implementing non-occupational RTW plans. The study emphasizes the importance of the three-way relationship between the patient, the physician and the employer as a way to simultaneously address delivery of patient care and business-relevant outcomes.
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