ISSLS prize winner: early predictors of chronic work disability: a prospective, population-based study of workers with back injuries.
METHODS
Prospective population-based cohort study.


OBJECTIVE
To identify early predictors of chronic work disability after work-related back injury.


BACKGROUND
Identification of early predictors of prolonged disability after back injury could increase understanding concerning the development of chronic, disabling pain, and aid in secondary prevention. Few studies have examined predictors across multiple domains in a large, population-based sample.


METHODS
Workers (N = 1885) were interviewed 3 weeks (average) after submitting a lost work-time claim for a back injury. Sociodemographic, employment-related, pain and function, clinical, health care, administrative/legal, health behavior, and psychological domain variables were assessed via worker interviews, medical records, and administrative databases. Logistic regression analyses identified early predictors of work disability compensation 1 year after claim submission.


RESULTS
Significant baseline predictors of 1-year work disability in the final multidomain model were injury severity (rated from medical records), specialty of the first health care provider seen for the injury (obtained from administrative data), and worker-reported physical disability (Roland-Morris disability questionnaire), number of pain sites, "very hectic" job, no offer of a job accommodation (e.g., light duty), and previous injury involving a month or more off work. The model showed excellent ability to discriminate between workers who were/were not disabled at 1 year (area under the receiver operating characteristic curve = 0.88, 95% CI = 0.86-0.90).


CONCLUSIONS
Among workers with new lost work-time back injury claims, risk factors for chronic disability include radiculopathy, substantial functional disability, and to a lesser extent, more widespread pain and previous injury with extended time off work. The roles of employers and health care providers also seem important, supporting the need to incorporate factors external to the worker in models of the development of chronic disability and in disability prevention efforts.
Turner
Judith A
JA
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA. jturner@u.washington.edu
Franklin
Gary
G
Fulton-Kehoe
Deborah
D
Sheppard
Lianne
L
Stover
Bert
B
Wu
Rae
R
Gluck
Jeremy V
JV
Wickizer
Thomas M
TM
D000328:Adult; D001363:Awards and Prizes; D019567:Back Injuries / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002908:Chronic Disease; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D011153:Population; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult