Low back disability among self-employed dentists, veterinarians, physicians and physical therapists in the Netherlands

Abstract

This study was carried out among self-employed dentists, veterinarians, physicians and physical therapists insured against the financial consequences of disability by the insurance company Movir in Nieuwegein, the Netherlands. Disability for an individual was defined as a condition in which someone, due to illness or accident, regardless of the cause, is unable to pursue his/her profession, according to medical assessment. It concerned both short-term and long-term periods of sickness absence. The study consists of two parts: a) A retrospective investigation into the magnitude of the problem of low back disability from 1977 through 1989. b) A test of an early intervention program, introduced in 1990, involving a control group of low back disability claimants of 1987 and 1988 combined. Low back pain was the main cause of disability in 1,119 claims, submitted by 839 claimants. In 795 cases, this involved the first low back disability claim during the whole insurance period. The incidence of low back disability increased by 211 percent, from 3.48 per 1,000 persons at risk in 1977 to 7.35 in 1989. The costs of compensation for low back disability increased from 5.7 percent of the total compensation paid in 1977 to 13 percent in 1989. Nearly a quarter of the claims, all of which lasted longer than six months, accounted for 90 percent of the compensation costs of low back disability. The present study showed that in the case of veterinarians over 34 years of age and dentists over 44 years of age, specific low back pain, nonspecific low back pain in combination with a deferred period of 14 days or more, low back problems before acceptance, and the presence of psychosocial problems at the start of the disability were significantly associated with the duration of low back disability. This means that these "factors" predicted a longer duration. Based on the retrospective data, a predictive model of long-term low back disability was developed, which could be used for secondary prevention among the population studied. At termination of a first claim of low back disability, a deferred period of 30 days or more, and low back surgery at the first claim or before acceptance predicted a longer working period until a recurrence, while low back problems before acceptance had an inverse effect. The retrospective study demonstrated the effect of insurance factors on the incidence and the duration of low back disability, and on the recurrence rate. The higher the insured daily compensation, the higher the risk of claiming low back disability. A deferred period of 14 days or more decreased the risk of claiming low back disability.(ABSTRACT TRUNCATED AT 400 WORDS)