Journal of occupational and environmental medicine
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J. Occup. Environ. Med. · Dec 2000
Clinical management and the duration of disability for work-related low back pain.
Clinical practice guidelines recommend a conservative approach to management of acute low back pain (LBP). The present study sought to determine whether health care utilization and the physician's initial management of work-related LBP were associated with disability duration. Clinical management information was obtained for 98 randomly selected, workers' compensation claimants with acute, uncomplicated, disabling work-related LBP. ⋯ Effects of early diagnostic imaging (first 30 days of care) on length of disability were observed (P = 0.001). Patients whose treatment course did not involve extended opioid use and early diagnostic testing were 3.78 times more likely (95% confidence interval, 1.6 to 8.9) to have gone off disability status by the end of the study. The nature of the association between these initial clinical management aspects and LBP disability duration merits further exploration.
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J. Occup. Environ. Med. · Apr 2000
Evidence-based design: the ACOEM Practice Guidelines Dissemination Project.
A steering committee and investigators from the American College of Occupational and Environmental Medicine (ACOEM) designed and carried out the ACOEM Practice Guidelines Dissemination Project to encourage adoption of the ACOEM Occupational Medicine Practice Guidelines. The project also involved research on guideline acceptance as well as potential improvements and additions to the guidelines. ⋯ This article summarizes that information and the needs assessment done prior to case-based guidelines training. Other articles in this issue report on guideline adoption and use and the results of the market research on the ACOEM guidelines.
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J. Occup. Environ. Med. · Mar 2000
ReviewACOEM position statement. Spirometry in the occupational setting. American College of Occupational and Environmental Medicine.
This position statement reviews several aspects of spirometric testing in the workplace, where spirometry is employed in the primary, secondary, and tertiary prevention of occupational lung disease. Primary prevention includes pre-placement and fitness-for-duty examinations as well as research and monitoring of health status in groups of exposed workers; secondary prevention includes periodic medical screening of individual workers for early effects of exposure to known occupational hazards; and tertiary prevention includes clinical evaluation and impairment/disability assessment. For all of these purposes, valid spirometry measurements are critical, requiring: documented spirometer accuracy and precision, a rigorous and standardized testing technique, standardized measurement of pulmonary function values from the spirogram, adequate initial and refresher training of spirometry technicians, and, ideally, quality assessment of samples of spirograms. ⋯ Throughout this position statement, ACOEM makes detailed recommendations to ensure that each of these areas of test performance and interpretation follow current recommendations/standards in the pulmonary and regulatory fields. Submitted by the Occupational and Environmental Lung Disorder Committee on November 16,1999. Approved by the ACOEM Board of Directors on January 4,2000.
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J. Occup. Environ. Med. · Jan 2000
Why most workers with occupational repetitive trauma do not file for workers' compensation.
Despite the availability of no fault insurance for wage replacement and medical care costs, the majority of workers diagnosed with an occupational disease do not apply for workers' compensation. The objective of the study was to determine the reasons why workers diagnosed with work-related musculoskeletal disease did not apply for workers' compensation benefits. A cross-sectional study of 1598 individuals diagnosed with neck, upper extremity, and low back work-related musculoskeletal disease from April to June 1996 was performed. ⋯ The strongest predictors of who would file were those factors associated with the severity of the condition. Other factors were increasing length of employment, lower annual income, and worker dissatisfaction with coworkers. Our study population consisted mainly of unionized autoworkers, and our findings may not be generalizable to the total workforce.