Risk Factors For Chronic Disability Research Articles

Risk factors for chronic disability in a cohort of patients with acute whiplash associated disorders seeking physiotherapy treatment for persisting symptoms

Objectives(1) To identify risk factors for chronic disability in people with acute whiplash associated disorders (WAD). (2) To estimate the impact of the numbers of risk factors present. DesignProspective cohort study. Data were collected, on average, 32 days after injury (SD=10.9) and 12 months later. Baseline measures of pain, disability, neck movement, psychological and behavioural factors were independent variables and chronic disability at 12 months was the dependent variable in a multivariable logistic regression analysis. SettingNational Health Service physiotherapy departments. ParticipantsParticipants (n=599) with symptoms 3 weeks after injury, self-referred to physiotherapy as part of a randomised controlled trial. 430 (72%) participants provided complete data for this analysis. Main outcome measuresChronic disability based on Neck Disability Index scores. Results136 (30%) participants developed chronic disability. High baseline disability (OR 3.3, 95%CI 1.97 to 5.55), longer predicted recovery time (OR 2.4, 95%CI 1.45 to 3.87), psychological distress (OR 1.9, 95%CI 1.05 to 3.51), passive coping (OR 1.8, 95%CI 1.07 to 2.97) and greater number of symptoms (OR 1.7, 95%CI 1.07 to 2.78) were associated with chronic disability. One risk factor resulted in 3.5 times the risk (95%CI 1.04 to 11.45) of chronic disability but this risk increased to 16 times (95%CI 5.36 to 49.27) in those with four or five risk factors. ConclusionBaseline disability had the strongest association with chronic disability but psychological and behavioural factors were also important. Treatment strategies should reflect this which may require a change to current physiotherapy approaches for acute WAD. The number of risk factors present should be considered when evaluating potential for poor outcome.

ISSLS Prize Winner: Early Predictors of Chronic Work Disability

Prospective population-based cohort study. To identify early predictors of chronic work disability after work-related back injury. Identification of early predictors of prolonged disability after back injury could increase understanding concerning the development of chronic, disabling pain, and aid in secondary prevention. Few studies have examined predictors across multiple domains in a large, population-based sample. Workers (N = 1885) were interviewed 3 weeks (average) after submitting a lost work-time claim for a back injury. Sociodemographic, employment-related, pain and function, clinical, health care, administrative/legal, health behavior, and psychological domain variables were assessed via worker interviews, medical records, and administrative databases. Logistic regression analyses identified early predictors of work disability compensation 1 year after claim submission. Significant baseline predictors of 1-year work disability in the final multidomain model were injury severity (rated from medical records), specialty of the first health care provider seen for the injury (obtained from administrative data), and worker-reported physical disability (Roland-Morris disability questionnaire), number of pain sites, "very hectic" job, no offer of a job accommodation (e.g., light duty), and previous injury involving a month or more off work. The model showed excellent ability to discriminate between workers who were/were not disabled at 1 year (area under the receiver operating characteristic curve = 0.88, 95% CI = 0.86-0.90). Among workers with new lost work-time back injury claims, risk factors for chronic disability include radiculopathy, substantial functional disability, and to a lesser extent, more widespread pain and previous injury with extended time off work. The roles of employers and health care providers also seem important, supporting the need to incorporate factors external to the worker in models of the development of chronic disability and in disability prevention efforts.

Sounding Board. The illness as the focus of geriatric medicine.

Understanding the difference between illness and disease is a prerequisite to the care of patients affected by incurable disorders. Educated palliation in the absence of substantive information regarding this discrepancy is the art of medicine. Because elderly patients often present with several chronic diseases, many of which are irreversible, cure-oriented physicians caring for the elderly are especially vulnerable to frequent disappointments. Multiple influences, such as psychological, social, environmental, and iatrogenous factors, may also substantially limit the possibilities for "total cure." More important, even though many chronic conditions are incurable, the discomfort or disability they produce may be substantially modified. If this concept is not realized and addressed, patients (many of them elderly) with irreversible chronic diseases may receive less than optimal care from physicians seeking cures. Studies need to be directed at defining and quantifying specific interactions between illness and disease and discovering risk factors for chronic disability in the elderly. The degree to which we as physicians can assist the chronically ill may reflect our understanding of human discomfort and our sensitivity to personal distress. If we maintain a purely disease-specific focus, we may have difficulty thinking about strategies to serve the patient. Defining pathologic entities may be less complicated than intervening in the illness of the patient, but the latter constitutes healing.