Are components of a comprehensive medical assessment predictive of work disability after an episode of occupational low back trouble?
METHODS
One hundred fifty-nine subacute low back work-injured patients completed a full medical assessment at baseline. A full repeat examination was performed 3 months later, when return-to-work status was determined.


OBJECTIVE
To determine the prognostic value of a comprehensive medical assessment for the prediction of return-to-work status.


BACKGROUND
A systematic review of the work disability prediction literature of low back trouble prognosis revealed that no high-quality studies included a full medical history and physical examination in the design. The results of studies included in the systematic review were equivocal with respect to predictive usefulness of medical variables.


METHODS
Participants completed medical history questionnaires and then were clinically examined by one of six experienced examiners (three physicians and three physiotherapists). Return-to-work status was measured 3 months later, and predictive validity was evaluated using logistic regression modeling.


RESULTS
Medical variables (, medical history subscales, physical examination subscales, and lumbar range-of-motion tests) showed modest correct classification rates varying between 61.6% and 69.1% for participants.


CONCLUSIONS
Comprehensive medical assessments play a crucial role in the early identification of serious pathology after low back trouble. We were unable to identify, however, any medical evaluation variables that would account for significant proportions of variance in return to work. The weight of evidence obtained in this study suggests that injured workers' subjective interpretations and appraisals may be more powerful predictors of the course of postinjury recovery than exclusively medical assessments.
Hunt
David G
DG
Workers Compensation Board of British Columbia, Vancouver, British Columbia, Canada.
Zuberbier
Oonagh A
OA
Kozlowski
Allan J
AJ
Berkowitz
Jonathan
J
Schultz
Izabela Z
IZ
Milner
Ruth A
RA
Crook
Joan M
JM
Turk
Dennis C
DC
D019567:Back Injuries / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation; D001955:British Columbia; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000145:classification; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation; D008161:Lumbosacral Region; D008487:Medical History Taking; D009784:Occupational Diseases / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation; D017063:Outcome Assessment, Health Care; D010808:Physical Examination; D011237:Predictive Value of Tests; D011379:Prognosis; D016059:Range of Motion, Articular; D012050:Rehabilitation, Vocational; D015203:Reproducibility of Results; D012307:Risk Factors; D014938:Work Capacity Evaluation