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The Injured Back - A complex workplace concern

The Injured Back - A complex workplace concern. Lorain County Safety Council CEO Breakfast LCCC James Anthony, MD Medical Director Mercy Occupational Health Center Lorain, Ohio. Overview of Problem. On average, rates of workplace injuries have declined

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The Injured Back - A complex workplace concern

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  1. The Injured Back - A complex workplace concern Lorain County Safety Council CEO Breakfast LCCC James Anthony, MD Medical Director Mercy Occupational Health Center Lorain, Ohio

  2. Overview of Problem • On average, rates of workplace injuries have declined • Depending on your point of view, there are varying theories as to why work injury rates have declined • Certain injury types and causes lead to far more days away from work than others • Preventive measures can be focused based on this information • Back pain is one of the most problematic among all musculoskeletal complaints

  3. What Employers Know Medical only claim (7 or fewer days off) $717 average cost Lost time claim (8 or more days off) $44,000 average cost

  4. 100% Resolution of claim vs. time 75% Percent resolution 50% 25% 0% 0 6 12 18 24 36 Time, in months

  5. At Mercy OHC – Injuries • Top 12 Injuries by percentage of total injuries for 2000 (account for 55%) Lumbar Sprain/Strain 10.9% Open Wound of the Finger 8.5% Shoulder Sprain/Strain 6.2% Eye abrasion/foreign body 6.0% Wrist Sprain/Strain 4.0% Ankle Sprain/Strain 3.6% Thoracic Sprain/Strain 3.2% Finger Contusion 2.9% Knee Sprain/Strain 2.8% Open Wound of Hand 2.7% Knee Contusion 2.3% Neck Sprain/Strain 1.9%

  6. At Mercy OHC – Injuries • Top 12 Injuries by percentage of total injuries for 2011 (account for 52.7%) Lumbar Sprain/Strain 9.8% dec. Open Wound of the Finger 8.5% Shoulder Sprain/Strain 5.8% Knee Sprain/Strain 4.3% inc. Eye abrasion/foreign body 4.0% dec. Neck Sprain/Strain 4.0% inc. Wrist Sprain/Strain 3.8% Ankle Sprain/Strain 3.1% Thoracic Sprain/Strain 2.8% Knee Contusion 2.4% Open Wound of Hand 2.1% Finger Contusion 2.1% dec.

  7. At Mercy OHC – Injuries • Top 12 Injuries by percentage of total injuries for 2000 through 2011 (account for 57.8%) Lumbar Sprain/Strain 11.7% Open Wound of the Finger 9.7% Shoulder Sprain/Strain 6.7% Eye abrasion/foreign body 5.7% Knee Sprain/Strain 3.8% Ankle Sprain/Strain 3.6% Thoracic Sprain/Strain 3.5% Wrist Sprain/Strain 3.3% Neck Sprain/Strain 3.2% Open Wound of Hand 2.5% Knee Contusion 2.1% Finger Contusion 2.0%

  8. Challenges of Back Injury Care • Affects up to 50% of adults each year • Most episodes are self-limiting • About 20% are more than 2 weeks (Those are the ones everyone remembers) • Most common cause of long-term disability • Red Flags need further investigation

  9. Challenges of Back Injury Care • Risk Factors for mechanical low back pain • Cigarette Smoking • Repetitive lifting • Job Satisfaction • Pregnancy • Imaging • Generally thought to be overutilized • MRI is testing of choice for person with “red flags” • MRI images don’t predict development or duration of back pain but are correlated with increased surgery rates

  10. Challenges of Back Injury Care • Quicker recovery and less disability with back injuries will occur if: • Injured worker (IW) stays active • IW returns to work and normal life quickly • IW does not smoke • IW likes their job • IW has no other psychological stress • IW does not have a disputed compensation claim • IW does not have a history of chronic pain in other areas

  11. Challenges of Back Injury Care • Bad results with long-term pain and disability are more common when: • IW has multiple and prolonged medical/surgical treatments designed to “fix” them • IW smokes • IW loses muscle support by prolonged resting • IW has “issues” with their employer • IW has psychological distress or chronic pain in other areas

  12. Challenges of Back Injury Care • Here is how we start every case where a back injury is involved: • I’ll read it to you……………………………………….

  13. Challenges of Back Injury Care • Virtually impossible to “objectify” the findings from any examination or diagnostic study to “explain” exactly what is happening in back injuries • The mechanism of injury (MOI) can be anywhere from an awkward movement (especially with any lift) to a slip and violent fall landing on the back • Symptoms vary so widely among patients and do not correlate AT ALL with diagnostic tests except in specific cases

  14. Challenges of Back Injury Care • About 50% of individuals WITHOUT any back pain will have “abnormal” MRIs. This percentage is higher as we age. • Individuals with virtually normal MRI scans can have legitimate pain and even disability • Preexisting low back arthritis is no “defense” against a work injury claim as long as the history and findings are consistent with an acute injury • Back pain started after an actual injury does not magically change after 12 weeks to being from arthritis just because some arthritis is found on an MRI

  15. Challenges of Back Injury Care • USPSTF indicates there is no evidence for or against using the following measures to prevent back pain: • Risk Factor Modification (stop smoking etc.) • Back School • Back Supports • Back Supports might even increase risk of back pain but can be of very limited use during acute flair-ups

  16. Prevent Back Injuries • Be proactive and not reactive • Prescreening for musculoskeletal adequacy post-offer along with any other screening you require such as a physical or drug test • Serves the purpose of screening out a few potential employees that are clearly unable to perform the required duties of their job • Initiates education about lifting and body mechanics from a neutral source and reinforces the importance the employer places on workplace safety • Relatively inexpensive addition to a post-offer physical examination

  17. Prevent Back Injuries • Be proactive and not reactive • Have a physical therapist or occupational health nurse visit your plant periodically to review ways to prevent musculoskeletal injuries with your employees or supervisors • Preventive stretching and simple exercises can often be helpful if presented in a positive and fun atmosphere • Allow employees enough time to do a simple warm-up routine before starting production

  18. Prevent Back Injuries • Be proactive and not reactive • Try to give employees adequate break times during the day to minimize fatigue near the end of shifts • Many injuries occur near the end of shifts when workers are most tired • Make sure adequate fluids are available in hot work areas and during the warmer summer months • It is proven that rested workers are more productive and make up for rest time with fewer injuries and better products

  19. Prevent Back Injuries with Ergonomics • Limit chance of overexertion • Train employees to use correct lifting techniques • Have mechanical lifting aids available for use when needed • Train employees to ask for help if something is too heavy • Check the areas where lifting is necessary and minimize any need to “lift and twist” • Train supervisors to encourage teamwork with respect to lifting such that asking for help is acceptable behavior • Design tasks such that there is minimal need to overreach or bend when lifting

  20. Important Considerations • Occupational back pain is one of the most prevalent and least understood of the illnesses and injuries covered by workers’ compensation • Occupational back pain is a prime target for disability management

  21. Results from one back injury study.. • The worker’s satisfaction with their employers’ responses to their claims is the most important single influence on maintaining employment subsequent to the onset of back pain, and roughly comparable to the severity of back pain

  22. Study Results • Although satisfaction with healthcare is influential, it is a much less important influence on patterns of employment than is a worker’s perception of the actions of his employer • Findings suggest unrealized opportunities for reducing the costs of occupational back pain by developing improved strategies for managing the relationships between employers and workers who file back claims

  23. Report From the Stay-at-work & Return-to-work Committee • Our contention – that a considerable amount of work disability can be prevented or reduced by finding new ways of handling important non-medical factors that are fueling its growth

  24. Report From the Stay-at-work & Return-to-work Committee • Acknowledge the powerful contribution that motivation makes to outcomes and make changes to improve incentive alignment • Support appropriate patient advocacy by getting treating doctors out of a loyalties bind. Focus on functional abilities and not return to work dates • Increase availability of on-the-job recovery and transitional work programs – STATE OF OHIO CITED AS A “BEST PRACTICE” in this area

  25. QUESTIONS & ANSWERS • The Injured Back – A complex workplace concern Lorain County Safety Council CEO Breakfast LCCC James Anthony, MD Medical director Mercy Occupational Health Center Lorain, Ohio

  26. Mercy Occupational Health Center Thank you for your kind attention and information!

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