THE INFLUENCE OF INDEMNIFICATION BY WORKERS COMPENSATION INSURANCE ONRECOVERY FROM ACUTE BACKACHE

Study Design. A prospective observational cohort was recruited from 20 8 randomly selected North Carolina practices. Objective. To compare th e course of compensation claimants with gainfully employed patients no t so insured from the time when they first sought care for acute back pain. Summary of Background Data. The human and financial cost attribu table to disabling chronic low back pain indemnified by workers' compe nsation programs continues to escalate. We explored the antecedents to this phenomenon. Method. Consecutive patients with acute low back pai n were interviewed by telephone within 1 week of first seeking care an d in follow-up calls after 2, 4, 8, 12, and 24 weeks to monitor functi onal and work status. Results. Of the 1633 patients enrolled, 505 were insured by workers' compensation. These were compared with 861 who ha d been employed on any job for pay within 3 months of the onset of the ir backache but whose care was not so underwritten. Those with compens able back pain were more likely to categorize their tasks as physicall y demanding and had taken more time off work in the month before the b aseline interview (P = 0.02). Recovery of the sense of wellness they e njoyed before this episode of back pain was delayed (Cox Model:Hazard Ratio = 0.822; P < 0.001; confidence interval: 0.733, 0.923), but reco very of function or return to work was not. This delay was independent of type of health care and perception of task demand and beyond that which could be ascribed to the quality of back pain. Conclusion. Each of these associations is a reproach to the fashion in which workers' c ompensation insurance for regional back pain serves the ethic that is its raison d'etre.