Low Back Work Research Articles

A survey of lifting and lowering tasks

An assessment of 1063 lifting and lowering tasks was conducted, and the individual task parameters were analyzed. The survey was conducted as part of an epidemiological study of the relationship between low-back workers’ compensation claims and the physical demands of lifting and lowering tasks. The primary objective of the study was to provide summary statistics of the parameter values of a large sample of actual lifting and lowering tasks. The 10, 25, 50, 75, and 90 percentile values of the parameters of the lifting tasks, defined in accordance with the NIOSH lifting equation, are presented. A secondary objective of the study was to compare the results to a previous survey of lifting and lowering tasks. The results showed fairly strong agreement with the previous survey with the exception of load and frequency. The median load from the current survey was approximately one half the value found previously whereas the median frequency was approximately double. The potential reasons for these differences are explored. The results are also compared to several epidemiologic studies of repetitive lifting/lowering. Relevance to industry Prevention of work-related low-back disorders continues to be a critical component of workplace health and safety programs. The parameters of lifting and lowering tasks are summarized to provide benchmarks for practitioners as well as researchers investigating lifting and lowering tasks in the laboratory.

Clinical practices in the management of new-onset, uncomplicated, low back workers' compensation disability claims.

Recent consensus guidelines delineate what appears to be the most successful and cost-effective management of low back pain (LBP), and some recent studies have suggested that better outcomes occur with the least aggressive forms of medical intervention. The purpose of this study was to describe how practitioners manage new-onset, uncomplicated low back workers' compensation (WC) disability cases. A sample of cases was randomly selected from a large insurance carrier's national data source. An effort was made to select only uncomplicated cases, which would be expected to have relatively minimal need for medical intervention. There was an apparent overuse of diagnostic and treatment modalities. Diagnostic imaging was overutilized, not only in terms of the number of studies done (65% had plain films, 22% had magnetic resonance imaging scans) but also in the time frame in which they were performed (38% had plain films on the first clinic visit). Ninety percent received at least one medication, and 38% received more than one prescription for opioid analgesics. Expensive non-steroidal anti-inflammatory drugs were prescribed more often than acetaminophen (61% versus 6%, respectively). Sixty-two percent received physical therapy that often included modalities with as yet unproven efficacy. Overutilization of either diagnostic or treatment procedures increases the likelihood of iatrogenic complications, is not cost-effective, and may adversely impact clinical and occupational outcomes.

Healthcare utilization and referral patterns in the initial management of new-onset, uncomplicated, low back workers' compensation disability claims.

Most episodes of low back pain are considered non-specific in nature, with the vast majority resolving within 2 weeks and almost all resolving within 6 weeks regardless of the medical intervention. Recently published clinical guidelines have clearly delineated a limited set of circumstances that would indicate the need for specialist referral. The purpose of this study was to describe the healthcare utilization and physician referral patterns for new-onset, uncomplicated, low back workers' compensation disability cases randomly selected from a large insurance carrier data source. The provision of care in urgent care centers and emergency departments for both initial and main sources of care occurred more frequently than was probably indicated. For this selected group of uncomplicated low back pain cases, specialist care was provided more commonly than would be expected or indicated (36% of the sample was seen by a surgeon, while only 2% received surgery). In addition, referral to specialists (other than occupational medicine specialists) was often made sooner than would be expected or indicated, with a median of 13 days for such referrals. Such overutilization of resources can reasonably be expected to increase overall medical costs.