Articles: low-back-pain.
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Case Reports
Resolving disputes under the Americans with Disabilities Act. A case example of an employee with a back impairment.
To illustrate the importance of proactive medical professional participation in Americans with Disabilities Act reasonable accommodation cases, this article describes the use of alternative dispute resolution techniques to resolve a case involving a blue collar employee with a work-related lower back injury. The problems in accommodating employees with back and spine injuries are being experienced by many employers. To date, the largest number of discrimination claims filed with the Equal Employment Opportunity Commission under the Americans with Disabilities Act involve individuals with back and spine impairments. This article identifies eight decision-points in the Americans with Disabilities Act accommodation process that are relevant to employers, persons with disabilities, medical professionals, union representatives, and legal counsel.
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An expert committee of the German Chapter of the IASP has published five recommendations for the prevention and early treatment of low back pain. These refer to an early activation of the patient facilitated by scheduled pain medication and an interdisciplinary treatment including physiotherapy and psychotherapy if risk factors for chronicity are detected.
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Outcome studies of lumbar disc surgery document a success rate ranging between 49% and 90%, according to the evaluation criteria used. The aim of the present study was to investigate the prognostic value of pain history and of sociodemographic, psychodiagnostic and medical factors for the long-term outcome after lumbar disc surgery. ⋯ Anamnestic information on the pain history and psychological factors have prognostic value for the outcome after lumbar disc surgery. If there is no absolute medical indication for disc surgery, we suggest reconsidering the treatment planned for patients with the risk factors specified.
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To determine ways in which emergency physicians approach the diagnosis and treatment of the common presenting complaint of low back pain, responses of emergency physicians to a questionnaire dealing with three hypothetical patients with different types of low back pain were taken from a stratified national random sample of eight medical specialties. For severe acute (with and without sciatica) or chronic low back pain, physicians were asked which tests and consultants they would use in pursuit of the diagnosis, and which treatments and specialty referrals they would recommend in each of the three scenarios. For diagnosis in the acute cases (pain less than 1 week), up to 22% of emergency physicians recommended computed tomography (CT scan) and 36% recommended magnetic resonance imaging (MRI). ⋯ Referrals to surgical specialists (orthopedist or neurosurgeon) were highest (81%) for acute sciatica, compared with 52% for chronic low back pain, and 41% for acute nonsciatic low back pain. In conclusion, given that most cases of acute low back pain resolve with minimal intervention, diagnostic imaging, laboratory testing, and early specialist consultation favored by many emergency physicians would add little except expense to understanding its etiology. For treatment, emergency physician recommendations for bedrest were longer than necessary and, for physical therapy, of no proven benefit.(ABSTRACT TRUNCATED AT 250 WORDS)
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The efficacy of a physical therapy outpatient program with multiple interventions to treat low back pain in subjects receiving workers' compensation was examined. The primary purpose of the study was to describe the level of disability, physical impairment, and rate of return to work for compensated patients. ⋯ Compliance, chronicity, and leg symptoms are all factors that can affect the outcome of physical therapy. The positive outcomes for subjects who complied with therapy suggest that a physical therapy program with multiple interventions may decrease disability and impairment.