Ja. Tacci et al., Clinical practices in the management of new-onset, uncomplicated, low backworkers' compensation disability claims, J OCCUP ENV, 41(5), 1999, pp. 397-404
Citations number
37
Categorie Soggetti
Envirnomentale Medicine & Public Health
Journal title
JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
Recent consensus guidelines delineate what appears to the the most successf
ul and cost-effective management of low back pain (LBP) and some recent stu
dies have suggested that better outcomes occur with the least aggressive fo
rms of medical intervention. The purpose of this study was to describe how
practitioners manage new-onset, uncomplicated low baa workers' compensation
(WC) disability cases. A sample of cases was randomly selected from a larg
e insurance carrier's national data source. An effort was made to select on
ly 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 perf
ormed (38% had plain films on the first clinic visit). Ninety percent recei
ved at least one medication, and 38% received more than one prescription fo
r opioid analgesics. Expensive non-steroidal anti-inflammatory drugs were p
rescribed more often than acetaminophen (61% versus 6%, respectively). Sixt
y-two percent received physical therapy that often included modalities with
as yet unproven efficacy. Overutilization of either diagnostic or treatmen
t procedures increases the likelihood of iatrogenic complications, is not c
ost-effective, and may adversely impact clinical and occupational outcomes.