Early Predictors of Re-Injury, Clinically Significant Weight Gain, and Lumbar Spine Surgery Following Occupational Back Injury: A Prospective Study of Workers in Washington State
Keeney, Benjamin Jon
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Back injuries are the costliest and most prevalent disabling occupational injuries in the United States. Little is known about early predictors for outcomes following occupational back injury. This dissertation identifies early predictors and prevalence for three outcomes following occupational back injury: occupational back re-injury within 1 year, clinically significant weight gain (7%) by 1 year, and undergoing lumbar spine surgery within 3 years. The Washington Workers' Compensation Disability Risk Identification Study Cohort provided a large, population-based sample with variables obtained early after injury in eight domains: sociodemographic, employment-related, pain and function, clinical status, health care, administrative/legal, health behavior, and psychological. Telephone interviews were conducted with workers 3 weeks and 1 year after submission of a time-loss claim for the injury. Computerized claims and medical records provided additional measures. Potential predictors were identified (P ≤ 0.10) in bivariate analyses. Those variables were then included in multivariate logistic regression models predicting the outcomes following the index injury. 1123, 1263, and 1885 workers were included in the re-injury, weight gain, and surgery analyses, respectively. 26% of workers self-reported a back re-injury, 14% self-reported weights that represented a clinically significant increase, and 9% underwent surgery. Early predictors of re-injury included male gender, constant whole body vibration at work, a history of previous similar injury, 4 or more previous workers' compensation claims of any type, possession of health insurance, and high fear-avoidance scores; baseline obesity was associated with reduced odds. Female gender was a baseline predictor of weight gain; time-loss compensation at 1 year was highly associated with weight gain. Baseline predictors of surgery included higher Roland Disability Questionnaire scores, greater injury severity, and first seeing a surgeon for the injury; reduced odds were observed for those under age 35, women, Hispanics, and those whose first health care provider for the injury was a chiropractor. Baseline variables across multiple domains predicted the outcomes of interest in all analyses. Increased knowledge of early predictors of re-injury, weight gain, and lumbar spine surgery may help lead to effective interventions that lower the risk of negative outcomes following occupational back injury.
- Health services 
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