A chiropractic service arrangement for musculoskeletal complaints in industry: a pilot study.
Chiropractic services are commonly used by workers with musculoskeletal problems, especially low back and neck complaints. Research into the effectiveness and cost-effectiveness of this approach is, however, difficult to design without prior pilot studies. This study followed 32 workers with these complaints attending one such service and used five measures of outcome over a 6-month period. These measured pain (VAS), disability (FLP), quality of life (SF-36), perceived benefit and satisfaction with care. Additionally, sickness costs to the companies were recorded over two years encompassing the study period. Treatment utilization was also monitored. Over half the population were chronic sufferers. The effect sizes were large for pain and for seven out of eight dimensions of the SF-36 questionnaire at 6-month follow-up, although not for disability (FLP). High levels of satisfaction and perceived improvement were reported and sickness costs to the companies fell. However, the sample size in this pilot study was small and did not include controls. We would, therefore, recommend a full cost-effectiveness study incorporating a randomized trial in this area. (+info)
The impact of welfare reform on parents' ability to care for their children's health.
OBJECTIVES: Most of the national policy debate regarding welfare assumed that if middle-income mothers could balance work while caring for their children's health and development, mothers leaving welfare for work should be able to do so as well. Yet, previous research has not examined the conditions faced by mothers leaving welfare for work. METHODS: Using data from the National Longitudinal Survey of Youth, this study examined the availability of benefits that working parents commonly use to meet the health and developmental needs of their children; paid sick leave, vacation leave, and flexible hours. RESULTS: In comparison with mothers who had never received welfare, mothers who had been on Aid to Families with Dependent Children were more likely to be caring for at least 1 child with a chronic condition (37% vs 21%, respectively). Yet, they were more likely to lack sick leave for the entire time they worked (36% vs 20%) and less likely to receive other paid leave or flexibility. CONCLUSIONS: If current welfare recipients face similar conditions when they return to work, many will face working conditions that make it difficult or impossible to succeed in the labor force at the same time as meeting their children's health and developmental needs. (+info)
Prognosis of accidental low back pain at work.
Accidental low back pain at the workplace was classified into two groups; 177 cases of the organic type and 176 cases of the non-specific type. Concerning the recuperation period, the length of leave, and the amount of compensation for recuperation, medical cost and leave of absence, a comparison was made between two groups. Regarding age, sex, and the type of work, no difference was found between the organic and the non-specific groups. However, the non-specific group showed lower values than the organic one for the duration of recuperation and leave and the amount of compensation for medical cost and leave of absence. Multiple regression analysis showed that the difference in the type of low back pain had more influence on the duration and cost than that in sex and age. The prognosis of non-specific low back pain is better than that of organic one in terms of cost and duration. (+info)
Back pain prevalence in US industry and estimates of lost workdays.
OBJECTIVES: Back pain is the most common reason for filing workers' compensation claims and often causes lost workdays. Data from the 1988 National Health Interview Survey were analyzed to identify high-risk industries and to estimate the prevalence of work-related back pain and number of workdays lost. METHODS: Analyses included 30074 respondents who worked during the 12 months before the interview. A case patient was defined as a respondent who had back pain every day for a week or more during that period. RESULTS: The prevalence of lost-workday back pain was 4.6%, and individuals with work-related cases lost 101.8 million workdays owing to back pain. Male and female case patients lost about the same number of workdays. Industries in high-risk categories were also identified for future research and intervention, including those seldom studied. CONCLUSIONS: This study provides statistically reliable national estimates of the prevalence of back pain among workers and the enormous effect of this condition on American industry in terms of lost workdays. (+info)
Are risk factors for atherothrombotic disease associated with back pain sickness absence? The Whitehall II Study.
STUDY OBJECTIVE: To explore the previously stated hypothesis that risk factors for atherothrombotic disease are associated with back pain. DESIGN: Prospective (mean of four years of follow up) and retrospective analyses using two main outcome measures: (a) short (< or = 7 days) and long (> 7 days) spells of sickness absence because of back pain reported separately in men and women; (b) consistency of effect across the resulting four duration of spell and sex cells. SETTING: 14 civil service departments in London. PARTICIPANTS: 3506 male and 1380 female white office-based civil servants, aged 35-55 years at baseline. MAIN RESULTS: In age adjusted models, low apo AI was associated with back pain across all four duration-sex cells and smoking was associated across three cells. Six factors were associated with back pain in two cells: low exercise and high BMI, waist-hip ratio, triglycerides, insulin and Lp(a). On full adjustment (for age, BMI, employment grade and back pain at baseline), each of these factors retained a statistically significant effect in at least one duration-sex cell. Triglycerides were associated with short and long spells of sickness absence because of back pain in men in fully adjusted models with rate ratios (95% confidence intervals) of 1.53 (1.1, 2.1) and 1.75 (1.0, 3.2) respectively. There was little or no evidence of association in age adjusted models with: fibrinogen, glucose tolerance, total cholesterol, apoB, hypertension, factor VII, von Willebrand factor, electrocardiographic evidence of coronary heart disease and reported angina. CONCLUSIONS: In this population of office workers, only modest support was found for an atherothrombotic component to back pain sickness absence. However, the young age of participants at baseline and the lack of distinction between different types of back pain are likely to bias the findings toward null. Further research is required to ascertain whether a population sub-group of atherothrombotic back pain can be identified. (+info)
Longitudinal, population-based study of self reported alcohol habits, high levels of sickness absence, and disability pensions.
STUDY OBJECTIVE: To analyse the relation between self reported hazardous drinking on the one hand and high sickness absence and/or disability pensions in both sexes on the other hand. DESIGN: The study is based on data from a health survey, Stockholm Health of the Population Study, conducted in 1984. The mailed questionnaire covered alcohol consumption. Three different measures of alcohol habits were used: usual alcohol consumption, consumption during the previous week, and answers to the four CAGE questions on problem drinking. Information from the health survey and data from a subsequent health examination were related to information from the National Swedish Social Insurance Board for the year 1984 and the years 1986 to 1991 concerning sick leave and disability pensioning. SETTING: Four primary health care districts in Stockholm County. PARTICIPANTS: The study group included persons who were aged 20 to 52 years in 1984, who answered the questionnaire (by mail or by telephone), and who participated in the health examination. The study group comprised 985 women and 870 men fulfilling the criteria for inclusion out of 6217 subjects aged 18 years and over randomly drawn. MAIN RESULTS: In both sexes, a consistent pattern of increased sickness absence was seen for high consumers and for those with indications of problem drinking. In most comparisons, a clearly increased relative risk, although not always statistically significant, for an average of at least 60 sick days per year or for a disability pension during follow up was found. In multivariate analysis, controlling for age, socioeconomic group, smoking habits, and self reported health, a small reduction in the relative risks was found, suggesting that these factors could explain only a small part of the relative risks. The risks for abstainers were higher than for low and moderate consumers. CONCLUSIONS: The effects of alcohol on subsequent high levels of sickness absence five to seven years after baseline as well as on the occurrence of disability pensions suggested that there is an effect on working incapacity independent of baseline health status, smoking, and socioeconomic group. (+info)
Relation between indicators for quality of occupational rehabilitation of employees with low back pain.
OBJECTIVES: To assess if the implementation of guidelines for occupational rehabilitation of patients with low back pain by means of process variables--a set of objective criteria for technical performance and continuity of care--led to a better outcome in clinical and return to work variables. METHODS: The study group consisted of 59 patients with at least 10 days of sick leave because of low back pain. Univariate analyses as well as multiple logistic regression and Cox's regression analyses were performed to assess the relation between quality of care and outcome. RESULTS: Process indicators for technical competence, continuity of care, and total performance were all significantly related to satisfaction of employees. Continuity of care and total performance were significantly related to working status at 3 months, and time to return to work. None of the process indicators was related to pain or disability after 3 months follow up. Satisfaction was not related to any of the other outcome variables. This indicates that if guidelines for occupational rehabilitation are met, outcome is better. CONCLUSION: Quality of the process of care was related to outcome. Interventions of occupational physicians need improvement in the areas of continuity of care and communication with treating physicians. The effectiveness of an improved intervention should be studied in a subsequent randomised clinical trial. (+info)
Follow up investigation of workers in synthetic fibre plants with humidifier disease and work related asthma.
OBJECTIVE: To investigate the clinical and sociomedical outcome in patients with various clinical manifestations of humidifier disease and work related asthma after removal from further exposure. METHODS: Follow up investigation (range 1-13 years) of respiratory symptoms, spirometry, airway responsiveness, sickness absence, and working situation in patients with (I) humidifier fever (n = 12), (II) obstructive type of humidifier lung (n = 8), (III) restrictive type of humidifier lung (n = 4), and (IV) work related asthma (n = 22). All patients were working at departments in synthetic fibre plants with microbiological exposure from contaminated humidification systems or exposure to small particles (< 1 micron) of oil mist. RESULTS: At follow up patients with work related asthma were less often symptom free (37%, 7/19) than patients with humidifier disease (I, II, III) (67%, 16/24). Mean forced expiratory volume in one second (FEV1) of patients with obstructive impairment had been increased significantly at follow up but still remained below the predicted value. Mean forced vital capacity (FVC) of patients with initially restrictive impairment had returned to normal values at follow up. Airway hyperresponsiveness at diagnosis persisted in patients with obstructive impairment (II + IV 14/17, but disappeared in patients with humidifier fever (3/3) and restrictive type of humidifier lung (2/2). In patients with obstructive impairment (II + IV), FVC and FEV1 at diagnosis were negatively associated with the duration between onset of symptoms and diagnosis and the number of years of exposure. Those with positive pre-employment history of respiratory disease had a lower FEV1 at diagnosis. Sickness absence due to respiratory symptoms decreased in all groups of patients after removal from further exposure, but this was most impressive in patients with the humidifier lung (II, III) and patients with work related asthma (IV). At follow up 83% of the patients were still at work at the same production site, whereas 11% received a disability pension because of respiratory disease. CONCLUSION: In patients with work related respiratory disease caused by exposure from contaminated humidification systems or oil mist, removal from further exposure resulted in clinical improvement, although, especially in those with obstructive impairment, signs persisted. Because of the possibility of transferring patients to exposure-free departments most patients could be kept at work. (+info)