Disability Risk in Work-Related Musculoskeletal Injury

描述：工人的绝大多数成本和损失的生产力 补偿是由于与工作有关的肌肉骨骼损伤。在受伤的人中 有这种情况的工人，只有一小部分(5%-10%)会发生 长期残疾，占成本和损失的大部分(80%-85%) 工作。在缺乏准确的方法来识别处于风险中的工人 对于长期残疾，二级预防工作不能有很好的针对性。 这是一项在华盛顿州进行的为期5年的基于人口的前瞻性研究 背部受伤和腕管综合征(CTS)的工人。主要目的是 就是为长期残疾开发一个准确的风险预测模型 在5个关键风险维度中：与就业相关的因素；生物医学保健 相关因素；社会人口因素；行政/法律因素；以及 心理社会因素。为了实现这一目标，对以下人员进行了基线采访 约3000名符合条件的工人将在2-6周内进行 (工人补偿)申领津贴。持续的残疾衡量标准 结果(损失时间补偿)将从计算机化的 数据库为一年。其他重要结果将由 一年后(职能状态、工作状态)及以后的跟踪访谈 计算机化记录(工作状态、工资状态)。多变量生存分析 将使用风险维度内和跨风险维度来开发主要风险 模型，包括根据受伤严重程度进行调整。产品的可靠性 还将确定从病历确定严重程度(具体 目标2)。这项研究的第三个目标是开发一个简短的风险评估。 治疗腰背部和CTS损伤的器械，将有助于 医生在第一次治疗受伤的工人时。这些活动的主要焦点是 工具将基于那些可以修改的风险因素，并且 可以进行早期干预，以防止残疾。统计 这一目标的分析将侧重于特定的敏感性和特异性 风险因素的组合。这些风险评估工具将是试点 在参加职业卫生保健质量的医生中进行测试 改进工程。这个项目的第四个目标是确定再受伤 最初的腰背损伤队列2中的再损伤发生率和预测因素 在最初受伤的几年后。华盛顿独特的学习环境 国家，包括进行基于人口的抽样的能力，及时 获得对受伤工人的调查、医疗、索赔和工作状况的联系 数据库，以及来自商界和劳工界的支持，将 为这项研究的成功作出了重大贡献。

DESCRIPTION: The vast majority of cost and lost productivity in workers' compensation is due to work related --musculoskeletal injuries. Among injured workers with these conditions, a small proportion (5-10 percent) develops long-term disability and account for most (80-85 percent) of the cost and lost work. In the absence of an accurate method to identify workers at risk for long-term disability, secondary prevention efforts cannot be well targeted. This is a 5-year, population-based, prospective study among Washington State workers with back injuries and carpal tunnel syndrome (CTS). The principal aim is to develop an accurate predictive model of risk for long-term disability among 5 key risk dimensions: employment related factors; biomedical healthcare related factors; socio-demographic factors; administrative/legal factors; and psychosocial factors. To accomplish this aim, a baseline interview among approximately 3000 eligible workers will be conducted within 2-6 weeks of (workers compensation) claim allowance. A continuous measure of disability outcome (lost time compensation) will be determined from a computerized database at one year. Additional important outcomes will be determined by a follow-up interview at one year (functional status, work status) and from computerized records (work status, wage status). Multivariate survival analysis within and across risk dimensions will be used to develop the principal risk models, including adjustment for injury severity. The reliability of determining severity from medical records will be determined as well (Specific Aim 2). A third aim of this study is to develop a brief risk assessment instrument for both low back and CTS injuries which would be useful to physicians when first treating injured workers. The main focus of these instruments would be on those risk factors which may be modifiable and which may be amenable to early intervention to prevent disability. Statistical analysis for this aim will focus on sensitivity and specificity of specific combinations of risk factors. These risk assessment instruments will be pilot tested among physicians participating in an occupational health care quality improvement project. The fourth aim of this project is to determine reinjury rate and predictors of reinjury among the original low back injury cohort 2 years after the initial injury. The unique study environment in Washington state, including the ability to conduct population-based sampling, timely access to survey injured workers, linkage of medical, claims and work status databases, and support from the business and labor communities, will substantially contribute to the success of this study.