Compensation Board Claims Research Articles

Workers’ compensation board claims and emergency department diagnostic management of non-specific low back pain

Background: Low back pain is a leading cause of disability worldwide and results in enormous healthcare and lost productivity costs. Guidelines exist to guide the management of low back pain, but guideline adherence varies.Objective: This study assessed whether initial presentation to the emergency department for non-specific low back pain with a Workers’ Compensation Board of Nova Scotia claim was associated with different diagnostic management from non-claimants.Methods: In this retrospective cohort study, we analyzed administrative data from four emergency departments in Nova Scotia on 18,337 adult patients who presented for non-specific low back pain between July 15, 2009 and May 1, 2019. All data were retrieved from the Nova Scotia Health Authority Emergency Department Information System.Results: Patients had a mean age of 43 years and 51.3% were female. Most patients were assigned a Canadian Triage Acuity Scale score of 3 (51.9%) and reported moderate (51.2%) to severe pain (41.5%). Occupational injuries consisted of 11.6% of visits. More than 37% of patients received one or more diagnostic test. Patients with occupational injuries were less likely to receive diagnostic tests (odds ratio [OR] = 0.52, 95% CI 0.47 to 0.58), imaging (OR = 0.60, 95% CI 0.54 to 0.67), and laboratory tests (OR = 0.35, 95% CI 0.29 to 0.43). These results remained consistent when controlling for covariates.Conclusion: Patients who presented to the emergency department for occupational non-specific low back pain were less likely to receive diagnostic tests compared to non-occupational non-specific low back pain patients.

Obstructive Sleep Apnea Severity and the Risk of Occupational Injury: A Prospective Observational Cohort.

To determine whether patients with obstructive sleep apnea (OSA) are at increased risk of occupational injury (OI) METHODS: Working patients (aged 18 to 65 who reported more than 10h of work per week) who were referred to the University of British Columbia Sleep Laboratory for suspected OSA for polysomnogram (PSG) were recruited from 2003 to 2011. Patients completed an extensive survey the night of their PSG. Validated OI was obtained by linking patient data to Workers Compensation Board Claims Data. 1109 workers were studied; mean age was 47.1years, median AHI was 15.0/h, median BMI was 30kg/m2, 70.2% were male and 29% of patients worked in physical or manual related occupations. 78 patients (7.03%) suffered 140 OI in the 5years after PSG. In a multivariate logistic regression model, OSA severity [defined as a log(AHI + 1)] was a significant predictor of OI (p = 0.04) after controlling for age, sex, BMI, and physical or manual related occupations. Patients with moderate and severe OSA had approximately two times the odds of an OI compared to patients without OSA (OR 1.99, 95% CI 0.96-4.44 and 2.00, 95% CI 0.96-4.49 for moderate and severe OSA groups, respectively). In this prospective study, OSA severity was independently associated with an increased risk of OI.

Not all non-rheumatoid patients are satisfied with thumb metacarpophalangeal joint arthrodesis

Arthrodesis of the thumb metacarpophalangeal (MP) joint exhibits good results in rheumatoid patients but is controversial in post-traumatic conditions. This study evaluated the subjective outcome after thumb MP joint arthrodesis in chronic injuries and non-rheumatoid degenerative disorders. Forty-six patients were evaluated retrospectively with a mean follow-up of 4.1 years (range 1.5–6.5). Both the Quick DASH score (mean 18.6; range 0–72.7) and Visual Analogue Scales (satisfaction, pain, stiffness, and impairment of ADL; mean 3.2, 3.0, 3.0, and 2.5; range 0–9.6, 0–9.1, 0–9.8, and 0–9.6, respectively) showed wide variations. Twelve patients regretted the operation and 37 experienced difficulties with one or more specific activities. Multiple regression analyses indicated that elderly patients with painless instability are the best candidates for thumb MP joint arthrodesis. In young patients with excessively painful thumb MP joints and involvement in Workers' Compensation Board claims, but without advanced degenerative changes, this study recommends avoiding arthrodesis and considering alternative treatment modalities. The importance of adequate preoperative information about the realistic expectations after arthrodesis of the thumb MP joint is emphasised.

Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomized control trial

Background context The process through which new scientific developments are incorporated into clinical practice is referred to as "knowledge transfer" and is currently the subject of great interest in many areas of clinical medicine. Family physicians managing patients with acute low back pain have been shown to have a poor overall rate of concordance with clinical practice guideline–recommended treatments. New methods need to be developed to help physicians bridge the guideline implementation gap. Purpose To determine the efficacy of a knowledge transfer method that communicates clinical practice guidelines to family physicians and their patients using patient-specific, physician-to-physician communications. Study design A prospective randomized controlled study. Patient sample 428 patients with acute mechanical low back pain and accepted Workers' Compensation Board claims were studied. Outcome measures Concordance with specific clinical practice guideline-derived history taking items, physical examination procedures and treatment recommendations was determined. Methods Patients with acute mechanical back pain of less than 4 weeks duration and accepted Workers' Compensation Board claims were randomly assigned to one of three groups. In Group 1 (control group) neither the patients nor their family physicians received any information concerning the guidelines. In Group 2, family physicians alone or as well as their patients (Group 3) received a summary of clinical practice guidelines at approximately 2 weeks postinjury. In addition, both Groups 2 and 3 received reminders summarizing the recommended guidelines for patients at three specific stages of their clinical course. All guideline correspondence was addressed to a specific family physician or patient, signed by the study physician-investigators, and specified the patient by name. Results Family physicians in the control and intervention groups demonstrated a high degree of concordance with the guideline-recommended history taking and physical examination procedures, but were generally highly discordant with guideline-recommended treatments. Significant improvement in guideline-concordant treatments was seen only with diminished recommendations of prolonged bed rest and passive therapies and an increase in recommended aerobic exercise. Concordance with guideline recommendations relating to the use of spinal manipulative therapy was poor in all study groups. Conclusions A knowledge transfer method that involved patient-specific, physician-to-physician communication to family physicians or their patients at three stages of the patient's clinical course was largely unsuccessful in improving concordance with guideline treatment recommendations.

Occupational injuries and illnesses in the plywood manufacturing industry group 1997–2002: a descriptive study of workers compensation board claims

A comprehensive Workers Compensation Board of Alberta claims database for the plywood manufacturing industry group describing the 831 injury claims occurring from 1997 to 2002 was analyzed. The results of the study are reported with respect to: (1) claims trends in nature of injury, type of accident or exposure, source of injury, and body part injured, (2) the effect of work experience and worker age on the above classifications, (3) the impact of observed claims trends in terms of cost and duration of claim, (4) the relationship of Alberta figures to overall incidence rates of non-fatal injuries/illnesses generally, and the characteristics of those injuries/illnesses specifically, reported by the Bureau of Labor Statistics. The majority of successful claims were experienced by males 35–44 years of age with 2–5 years of work experience. Musculoskeletal injuries were the most common nature of injury (52%) and the upper extremity was the most frequently injured region of the body (41.8%). The majority of claims were classified as medical aid (64.8%) and did not result in time loss. Comparison of the incidence rates of specific injury/illness characteristic categories observed in Alberta versus those reported by the Bureau of Labor Statistics indicate that the survey of occupational injuries and illness is not an accurate indication of the characteristics of accepted compensation claims in the plywood industry group of Alberta, Canada. Relevance to industry The description of injury trends within the plywood manufacturing industry stands to positively impact the effectiveness of prevention and rehabilitation programs addressing workplace injuries and illnesses. In addition, comparison of incidence rates observed in Alberta to those estimated by the Survey of Occupational Injuries and Illnesses provides insight into the differences between the respective statistical sources.

Occupational injuries and illnesses in the sawmill industry of Alberta

A comprehensive Workers Compensation Board of Alberta claims database for the sawmill industry describing 3779 claims was analyzed for the years 1997–2002. A total of 48,025 days were lost due to claim and total claims cost were $ 8,640,886.06. The objectives of this descriptive study were to: identify claims trends in terms of nature of injury, type of accident or exposure, source of injury, and body part injured; determine the effect of work experience and worker age on the above classifications; assess the impact of observed claims trends in terms of cost and duration of claim; and compare incidence rates of nonfatal injuries resulting in workers compensation board claims in Alberta, Canada to those reported by the Bureau of Labor Statistics in the United States. The majority of injuries resulting in claims were experienced by males 24–35 years of age with 1–6 months of work experience. Musculoskeletal injuries were the most common nature of injury (46.7%). The upper extremity was the most frequently injured region of the body (45.5%). The majority of claims (54.5%) were defined as lost time claims and 46% as medical aid only. Comparison of the incidence rates of specific injury/illness characteristic categories indicate that incidence rates reported by the BLS based on the survey of occupational injuries and illness are not representative of incidence rates observed in Alberta, Canada. Relevance to industry The description of injury trends within the sawmill industry stands to positively impact the effectiveness of prevention and rehabilitation programs addressing workplace injuries/illnesses. In addition, comparison of incidence rates observed in Alberta to those estimated by the Survey of Occupational Injuries and Illnesses provides a useful insight into the differences between the respective statistical sources.

Displaced intra-articular calcaneal fractures: variables predicting late subtalar fusion.

The goal of the current study was to analyze the prospective clinical outcome of patients who failed closed or open treatment of a displaced intra-articular calcaneal fracture. This cohort of patients required a secondary subtalar fusion by distraction bone-block arthrodesis. Review of prospective, randomized trial database. Four level I trauma centers. Between April 1, 1991 and December 31, 1997, 424 patients with 471 displaced intra-articular calcaneal fractures were involved in a large, multicenter, randomized trial. Forty-four patients who required subtalar fusion following initial treatment of a displaced intra-articular calcaneal fracture were compared to the population of patients who did not require subtalar fusion. The variables compared between the two groups included Böhler angles, two computed tomography classification systems, and clinical scores including SF-36, visual analogue score, and oral analogue score. Subtalar distraction bone-block arthrodesis with tricortical bone graft was used in all 45 feet. The following were examined: x-ray fracture classification, specifically Böhler angles and Essex-Lopresti classification; computed tomography classification, specifically Sanders and Crosby; clinical scores, specifically validated visual analogue score, general health survey scores, oral analogue score, and other factors (i.e., patient demographics including age, sex, profession, smoking history, and Worker's Compensation Board involvement. Initial treatment of the 44 patients in our study was nonoperative in 37 (84%) patients and operative (open reduction and internal fixation) in 7 (16%) (1 patient had bilateral heel fractures). Patients requiring fusion differed demographically from those patients not requiring fusion. Mean age was 39 years in both the fusion and nonfusion group. The fusion group had 97% males, whereas the nonfusion group had 89% males. Sixty-four percent of the fusion patients were Worker's Compensation Board claims, whereas 35% of the nonfusion group were Worker's Compensation Board claims. Of those that required fusion, 77% were heavy laborers. On average, the fusion group had a Böhler angle 15 degrees less than the nonfusion group. Forty-six percent of the fusion patients were Sanders-type IV initial fractures. Logistic regression analysis revealed that the primary predictors of requiring fusion were Worker's Compensation Board status (odds ratio = 3.03, 95% confidence interval = 1.41-6.57), Sanders-type IV (odds ratio = 5.48, 95% confidence interval = 1.57-19.18), Böhler angle <0 degrees (odds ratio = 10.64-95% confidence interval = 1.33-85.17), and nonoperative initial treatment (odds ratio = 5.86-95% confidence interval = 2.33-14.67). These data suggest that the amount of initial injury involved with the calcaneal fracture is the primary prognostic determinant of long-term patient outcome. Böhler angle on presentation of <0 degrees was 10 times more likely to require a secondary subtalar fusion than a Böhler angle on presentation of >15 degrees. Sanders-type IV calcaneal fractures were 5.5 times more likely to be fused than a simple Sanders type II fracture. Worker's Compensation Board patients were three times more likely to be fused than non-Worker's Compensation Board patients. Nonoperative care was six times more likely to lead to a late fusion as compared to open reduction and internal fixation treatment. Late fusion provided relief from pain and improved function as evidenced by an improvement in visual analogue score postsurgery. This study demonstrates that there is a distinct patient group with a displaced intra-articular calcaneal fracture who are at high risk of subtalar fusion. These include male Worker's Compensation Board patients who participate in heavy labor work with a fracture pattern with Böhler angle less than 0 degrees. If their initial treatment was nonoperative, the likelihood of requiring late subtalar fusion was significantly increased. Initial open reductional open reduction and internal fixation of patients with displaced intra-articular calcaneal fracture minimized the likelihood that subtalar fusion would be required.

Nonneurologic hand pain versus carpal tunnel syndrome: do psychological measures differentiate?

To determine whether psychological measures would differentiate a group of patients with physician-diagnosed nonneurologic hand pain from patients with carpal tunnel syndrome (CTS). Many patients, who also displayed symptoms of psychological distress, were referred to an electrodiagnostic clinic with a diagnosis of possible CTS; they subsequently had normal nerve conduction studies. Sixty patients with hand pain were referred to either of two university clinics for electrophysiologic testing, were assigned to either the CTS or nonneurologic group, and were compared on a series of psychometric tests. The Beck Depression Inventory and McGill Pain Questionnaire showed that the physician-assigned nonneurologic patients have a greater degree of depression, use more affective adjectives, and choose more words on the McGill Pain Questionnaire than the physician-assigned CTS group. The nonneurologic group also scored higher on indices of self-reported disability on the Pain Disability Inventory in five of seven categories. Although the CTS group perceived more control over their pain, no differences were observed in the types of coping strategies used on the Coping Strategy Questionnaire. Finally, the nonneurologic group had more Workers' Compensation Board claims. Evidence of important psychological issues in some patients with hand pain suggests a need for greater awareness among treating physicians.

Violence in the workplace in British Columbia: A preliminary investigation

This article examines the problem of violence in the workplace within British Columbia between 1982 and 1992. using provincial Workers' Compensation Board claims during this period as a primary data base. The study examines employee claims for lime loss as a consequence of on-the-job violence. and identifies those occupations which appear to be at greatest risk. Perhaps surprisingly. health care workers appear to have a risk of violence at work that is similar to the risks faced by police officers. More specifically. it appears that during the past decade significant increases in workplace violence have occurred within the health care sector. and most specifically. within long term care institutions. More research is needed in order to understand more fully the nature of these changes within the health care sector. Five possibilities for responding to the problems of workplace violence are outlined and discussed: 1) changing the rules of the workplace so as to reduce the risk of injury, 2) changing the environmental design of the workplace so as to reduce the risk of injury. 3) rethinking the nature of specific institutions so as to improve the quality of life within those institutions, 4) improving education and training for workers who face the risk of on-the job violence. and 5) increasing the number of staff or re-assigning staff so as to diminish the possibility of violent interactions.

Accident patterns by time-of-day and day-of-week of injury occurrence

Mason, K., 1979. Accident patterns by time-of-day and day-of-week of injury occurrence. Journal of Occupational Accidents, 2: 159–176. Using Workers' Compensation Board's claims experience for the years 1971–1974 it is discovered that, with respect to hour of working day and day of working week of injury occurrence, there are definite patterns in the numbers of injuries reported, and that these patterns differ in unexpected ways for strain injuries and non strain injuries. In particular, it is observed that there are many more strain injuries reported as having occurred on Monday morning than would be expected from the patterns exhibited by the rest of the data. This excess of Monday morning strain claims is estimated to total between one and two percent of all claims. The phenomenon is analysed by industrial, occupational and individual factors.