Workplace Injury Compensation and Mental Health and Self-Harm Outcomes: A Systematic Review

Workers' compensation systems aim to financially support injured workers. However, seeking compensation often leads to poorer physical and mental health outcomes. This review examines previous studies to investigate the relationship between workers' compensation and mental health and self-harm outcomes. A three-tiered search strategy across five databases identified studies that examined workers' compensation claims as an exposure or risk factor, with outcomes related to mental health, self-harm and suicidality. Nine full-text studies were included; however, heterogeneity limited generalizability. Most studies supported an association between pursuing compensation and poorer mental health and self-harm outcomes. Some studies attributed this to specific aspects of the system such as justice perception and navigation of the claims system. Findings suggest an association between workers' compensation and mental health or self-harm outcomes. Inconclusive findings highlight the need for further research. Understanding the psychiatric impacts of pursuing compensation is crucial to help formulate a more accessible compensation system.

Neurocognitive and Symptom Validity Testing for Post-COVID-19 Condition in a Workers Compensation Context

OBJECTIVE

Efficacy of a neurocognitive screening evaluation (NCSE) in assessing symptoms and disability associated with post-COVID-19 condition (PCC) and facilitating employee recovery and return to work was evaluated.

METHODS

An NCSE was administered to 64 employees off work because of neurocognitive complaints attributed to post-COVID-19 condition. Neurocognitive and symptom validity data were analyzed along with recovery and return-to-work timelines.

RESULTS

A large percentage of the employees gave invalid responses and noncredible effort on psychological and cognitive tests (48%). The NCSEs with invalid profiles suggested more severe cognitive and psychiatric symptoms than valid profiles. Both valid and invalid groups had significant reductions in illness duration and lost workdays after the NCSE.

CONCLUSIONS

Post-COVID-19 condition resulted in reports of mild to moderate cognitive and psychiatric symptoms with extensive mean work leave of 11 months before mental health assessment. Regardless of symptom validity, after the NCSE, the employees were released to work at an average of 3 weeks.

Audit of surgeon billing in workers compensation-insured elective spinal surgery in New South Wales, Australia from 2010 to 2018

BACKGROUND

Medical billing practices have received increasing scrutiny in Australia and worldwide. In 2015, the Australian Government initiated a comprehensive review of the Medicare Benefits Schedule (MBS), including spinal surgery. This study provides a snapshot of five spinal surgeon billing patterns and associated costs in the workers compensation system in New South Wales prior to these changes.

METHODS

This retrospective cohort study used workers compensation billing data from the State Insurance Regulatory Authority to capture elective spinal surgeries in New South Wales from 2010 to 2018. The main outcome measures were: proportion of items billed within recommended limits (up to 150% of the listed Australian Medical Association (AMA) fee); surgical billing patterns including repeat billing of items during a single episode of surgery; use of paediatric or scoliosis items; use of surgical items from outside the spinal surgery schedule; co-billing of items not permitted as per the AMA Fees List item descriptions and associated costs.

RESULTS

There were 12 622 spinal surgeries in 9520 patients. While only 2.2% of items were billed above the recommended limits, 38% of surgeries included at least one of the five billing patterns. The average cost increase was AU$4700 per surgery, 47% greater than surgeries which did not include the specified billing patterns, for a total additional cost of AU$22.9 M over the 9-year study period.

CONCLUSION

Five spinal surgery billing patterns accounted for an additional AU$22.9 million in direct surgical costs from 2010 to 2018.

Post-Offer Employment Testing and Its Impact on Health Care Costs for Employers

OBJECTIVE

To quantify the cost benefits associated with Post-Offer Employment Testing (POET).

METHODS

Cross-sectional analysis of 5 million individuals/480 million medical, prescription, absence, short- and long-term disability, property and casualty and workers' compensation claims. Individuals who received POET were statistically matched by company, position, age, and gender to candidates who did not.

RESULTS

Significant injury reduction rates and integrated benefits cost savings were found in the cohort screened by POET.

CONCLUSION

POET is an effective tool for the employer to manage health, disability, motor vehicle crash, at-work injury costs, and reduce turnover.

Emerging Issues from COVID-19 in the Australian Workplace

This article addresses a range of workplace issues, with a focus on workers' compensation and return to work, and employment law and related medical issues after the outbreak and spread of COVID-19 in Australia since 2020. It will briefly address some changes to the insurance industry generally and then consider the sometimes complex issues arising from workers' compensation claims, which have changed behaviours in claims and injury management. It concludes the theme emerging from decided cases to date that employers, insurers, and rehabilitation providers must adopt a reasonable approach to the consultation and implementation of workplace changes affecting injured workers subject to return-to-work programs.

The Influence of Stigma Perceptions on Employees' Claims Experiences for Psychological Injuries: Re-Examination of a Cross-Sectional Survey among Australian Police and Emergency Service Personnel

While a large body of research assessed the contribution of mental health stigma on disclosure, treatment seeking, and recovery, limited research exists seeking to identify the relative contribution of stigma beliefs on workers' compensation claims for psychological injury. Survey data of ambulance, fire and rescue, police, and state emergency service personnel (N = 1855, aged 45-54 years, 66.4% male) was re-examined to assesses the unique and combined associations of self-, personal, and workplace stigma with workers' compensation claims experiences and recovery. Participants responded to self-report stigma items (predictor variables), perceived stress, fairness, and support perceptions of going through the claims process and its impact on recovery (outcome variables). Multiple regression analyses revealed that the combined stigma dimensions predicted about one fifth of the variance of claims and recovery perceptions. Organisational commitment beliefs and the self-stigma dimension of experiences with others were the two most important, albeit weak, unique predictors across outcomes. Given the small but consistent influences of organisational commitment beliefs and the self-stigma dimension of experiences with others, it seems warranted to apply workplace interventions that are looking to establish positive workplace contact and a supportive organisational culture to alleviate negative effects attributable to mental health stigma.

Return to Work After Autologous Chondrocyte Implantation of the Knee in Patients with Workers Compensation Insurance

OBJECTIVE

This retrospective analysis aimed to evaluate patient and defect characteristics on return to work after autologous chondrocyte implantation (ACI) for all patients with workers compensation insurance in our clinic.

METHODS

Retrospective analysis of medical records of patients with workers compensation treated with ACI in our clinic over 10 years (August 2004 to November 2014). Data were collected on demographics, lesion size and location, number of defects, duration of symptoms, and outcomes.

RESULTS

A total of 28 patients with 30 ACI procedures were included in this analysis. Patients had a mean age of 40.0 years, were mostly male, and tended to be overweight (mean body mass index = 31.5 kg/m²). Most patients were employed in occupations with high physical demand (85.7%) compared with lower physical demand jobs (14.3%). The mean number of lesions per knee = 1.73. Overall, the mean total surface area of the defect was large (12.6 cm²), with large mean individual lesion size of 7.39 cm². All 28 patients returned to work in some capacity, with a total of 22 (79%) returning to full work, and 6 (21%) returning to modified work. There were no significant differences in the comparison of patients who returned to full versus modified work, in mean age, body mass index, high versus low physical demand occupation, or lesion characteristics (size, chronicity, or location).

CONCLUSIONS

Our results demonstrate that in a challenging workers compensation cohort, in patients with multiple large defects, treatment with ACI allows a high percentage of patients to return to their normal vigorous work activities within 9 months to 1 year following cartilage restoration. This study is a level IV retrospective case series.

Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers' Compensation Population

Introduction

Patients with a worker compensation claim are associated with a greater probability of continued symptoms and activity intolerance. This study aims to determine predictors of improved patient-reported outcomes in the workers’ compensation population.

Methods

Patients with workers’ compensation claims undergoing arthroscopic rotator cuff repair between 2010 and 2015 were included. Age, gender, dominant hand, occupation, and number of tendons involved were analyzed. At a minimum of two years, patients were contacted to complete American Shoulder and Elbow Surgeons (ASES) Survey, Simple Shoulder Test (SST), and return-to-work status (RTW). Preoperative characteristics and scores were then compared.

Results

Seventy patients were available for follow-up at an average of 5.4 years (range: 2.1-8.8 years). Average age was 55 years (range: 37-72); 55 (78.6%) were males, 23 (32.9%) were laborers; and 59 (84.2%) patients returned to work. The sole predictor for RTW was surgery on the non-dominant arm (96.5% versus 75.6%; p = 0.021). Laborers showed decreased RTW (p = 0.03). Patients who completed RTW had excellent outcomes with higher ASES (87 versus 50; p value < 0.001) and SST scores (10.4 versus 4.6; p < 0.001). Patients with three tendon tears had inferior ASES (p = 0.026) and SST (p = 0.023) scores than those with less.

Conclusion

Most workers’ compensation patients have excellent outcomes from rotator cuff repair. Patients with three tendon tear repairs demonstrated the worst functional outcomes. Laborers showed decreased ability to RTW with nearly one-third unable.

Workers' Compensation, Return to Work, Behavioural Health and COVID-19 in Australia

The COVID-19 pandemic has highlighted a range of challenges for the participants in Australian workers' compensation schemes. Although there are some jurisdictional differences in legislation operating at sub-national levels, this article addresses some common themes that have emerged since the outbreak of the pandemic in Australia in early 2020. One of the major concerns which has emerged is the issue of proving the causal link between COVID-19 and work. In some jurisdictions, legislation has specifically addressed these causation concerns. While the number of workers' compensation claims overall is low, there are specific industries which have been heavily affected by the pandemic which may result in a spike in claims in areas such as aged care and the medical and allied professions. We speculate that a number of legal and practical concerns will emerge that may in time contribute to some new jurisprudence in the workers' compensation arena.

Determining the influence of the Workers Compensation Board of Manitoba's opioid policy on prescription opioid use amongst WCB recipients

Background

Opioid medications are commonly used by Workers Compensation Board (WCB) claimants following workplace injuries. The purpose of this study is to describe the impact of an opioid management policy on opioid prescriptions amongst a WCB‐covered population compared to changes in the use of these medications in the general population of a Canadian province.

Methods

We linked WCB claims data from 2006 to 2016 (13,155 claims, 11,905 individuals) to Manitoba provincial health records and compared opioid use amongst this group to 478,606 individuals aged 18–65. Linear regression was performed to examine the change over time in number of individuals being prescribed opioids for various durations and dosages of 50 or more, and 120 or more morphine equivalents (ME)/day for both the WCB and Manitoba population.

Results

WCB claimants totaled 2.5% of Manitoba residents aged 18–65 who were prescribed opioids for non‐cancer pain. After the introduction of the opioid use policy for the WCB population in November 2011, the number of people prescribed opioids declined 49.4% in the WCB group, while increasing 10.8% in the province as a whole. The number of individuals using 50 ME/day or more declined 43.1% in the WCB group and increased 5.8% in the province.

Conclusions

Opioid management programs organized by a compensation board can lead to a substantial reduction in the prescription of opioid medications to a WCB client population, including individuals who were prescribed higher doses of these medications when compared with general trends in the community.

Analysis of Thoroughbred horse farm workers' compensation insurance claims in Kentucky: Injury frequency, cost, lost time, and associated occupational factors

BACKGROUND

Thoroughbred horse farm workers self-report a high frequency of work-related injuries and pain. However, an analysis of Thoroughbred horse farm workers' compensation injury claims is absent from the literature, yet may benefit worker safety.

METHODS

We analyzed workers' compensation insurance firm data containing 2276 claims filed between 2008 and 2015. Injury frequency, cost, and lost time per cause, nature, and body part injured were examined qualitatively and via univariate tests. Factors associated with high cost and high duration lost time claims were modeled via multivariable logistic regression.

RESULTS

The average Thoroughbred worker claim cost $4,198 and accrued 10 days lost time, involving strikes (57% of total claims), sprains/strains (34%), and wrist/hand injuries (18%). Injuries primarily occurred on mornings (54%), weekdays (79%), and during the transition from breeding to sales (23%). Jobs with a high level of horse contact had significantly higher cost ($6,487) and higher duration lost time (16.8 days) claims, with significantly higher cost claims on the weekends ($6,471) and from the oldest workers ($7466), vs reference groups. Logistic models indicate significantly increased odds of a high-cost injury among high horse contact jobs (OR = 1.87; 95% C.I. = 1.53-2.29) and older age tertiles (1.38; 1.08-1.75; 1.70, 1.32-2.18). The odds of a high duration lost time injury are significantly increased among high horse contact jobs (1.91; 1.53-2.39) and males (1.50, 1.13-1.98), with significantly reduced odds among the most tenured workers (0.74; 0.56-0.99).

CONCLUSIONS

Our findings elucidate factors to reduce injury frequency, cost, and lost time among Thoroughbred horse farm workers.

Outcomes of expedited rotator cuff surgery in injured workers: Impact of pathology on readiness for return to work

OBJECTIVES

The objectives of this study were to (1) examine the overall recovery and satisfaction following an expedited rotator cuff (RC) decompression or repair at 3-6 months and (2) explore group differences (repair vs. decompression) in demographics, clinical, disability, and psychosocial factors.

METHODS

This was a prospective longitudinal study of injured workers whose surgery was expedited. The outcome measures were Quick disabilities of the arm, shoulder, and hand ( QuickDASH), the Hospital Anxiety and Depression Scale (HADS), the readiness for return to work (RRTW) scale, and satisfaction with surgery and overall recovery.

RESULTS

Of 118 patients participated in the study, 106 patients, age: 51 (9), 71 males (67%) completed the study. Sixty-four (60%) patients underwent a RC repair and 42 (40%) had RC decompression. Patients improved on average in QuickDASH ( p = 0.004), anxiety ( p = 0.003), and depression scores ( p = 0.004). The majority of patients (75%) were satisfied with surgery. In the decompression group, the pre-contemplation (PC) stage of the RRTW which documents the absence of desire or planning for return to work in the non-working sample ( r = 0.81, p = 0.008) and the uncertain maintenance (UM) stage of the RRTW which explores the worker's struggle to stay at work in the working sample correlated with physical disability as measured by the QuickDASH scores ( r = 0.62, p = 0.0001). In the repair group, the above domains correlated with the depression HADS scores (PC: r = 0.64, p = 0.001 and UM: r = 0.57, p < 0.0001).

CONCLUSION

Expedited RC surgery improved physical disability and mental well-being and was associated with a relatively high satisfaction at a maximum of 6 months. The poorer report of readiness for return to work was associated with higher physical disability in the decompression group and higher report of depression in the repair group. These differential associations may emphasize the importance of physical versus psychological management in patients with different levels of pathology.

A mixed-methods analysis of logging injuries in Montana and Idaho

BACKGROUND

Despite advances in mechanization, logging continues to be one of the most dangerous occupations in the United States. Logging in the Intermountain West region (Montana and Idaho) is especially hazardous due to steep terrain, extreme weather, and remote work locations.

METHODS

We implemented a mixed-methods approach combining analyses of workers' compensation claims and focus groups to identify factors associated with injuries and fatalities in the logging industry.

RESULTS

Inexperienced workers (>6 months experience) accounted for over 25% of claims. Sprain/strain injuries were the most common, accounting for 36% of claims, while fatalities had the highest median claim cost ($274 411). Focus groups identified job tasks involving felling trees, skidding, and truck driving as having highest risk.

CONCLUSIONS

Injury prevention efforts should focus on training related to safe work methods (especially for inexperienced workers), the development of a safety culture and safety leadership, as well as implementation of engineering controls.

Faking Bad in Workers Compensation Psychological Assessments: Elevation Rates of Negative Distortion Scales on the Personality Assessment Inventory in an Australian Sample

The workers compensation system provides a clear external incentive for deliberate feigning of physical or mental illness to some individuals. Although it has been asserted that all pre-liability workers compensation psychological assessments should involve assessment of deliberate feigning, the lack of an agreed standard for assessing this response style creates a substantial challenge in practice. Over the last two decades, substantial attention has been given to measures of psychopathology that also include validated negative distortion indices. The Personality Assessment Inventory) has been validated in both the clinical and forensic population, and is reportedly used by many Australian psychologists. This study explores rates of elevation of negative distortion scales on the PAI as a potential indicator of deliberate feigning in a large Australian workers compensation sample.

Pain acceptance potentially mediates the relationship between pain catastrophizing and post-surgery outcomes among compensated lumbar fusion patients

Purpose

Chronic low back pain is highly prevalent and often treatment recalcitrant condition, particularly among workers’ compensation patients. There is a need to identify psychological factors that may predispose such patients to pain chronicity. The primary aim of this study was to examine whether pain acceptance potentially mediated the relationship between pain catastrophizing and post-surgical outcomes in a sample of compensated lumbar fusion patients.

Patients and methods

Patients insured with the Workers Compensation Fund of Utah and who were at least 2 years post-lumbar fusion surgery completed an outcome survey. These data were obtained from a prior retrospective-cohort study that administered measures of pain catastrophizing, pain acceptance, mental and physical health, and disability.

Results

Of the 101 patients who completed the outcome survey, 75.2% were male with a mean age of 42.42 years and predominantly identified as White (97.0%). The majority of the participants had a posterior lumbar interbody fusion surgery. Pain acceptance, including activity engagement and pain willingness, was significantly correlated with better physical health and mental health, and lower disability rates. Pain catastrophizing was inversely correlated with measures of pain acceptance (activity engagement r=−0.67, p<0.01, pain willingness r=−0.73, p<0.01) as well as the outcome measures: mental health, physical health, and disability. Pain acceptance significantly mediated the relationship between pain catastrophizing and both mental and physical health and also the relationship between pain catastrophizing and disability.

Conclusion

This study demonstrated that the relationship between pain catastrophizing and negative patient outcomes was potentially mediated by pain acceptance. Understanding this mediating relationship offers insight into how pain acceptance may play a protective role in patients’ pain and disability and has potential implications for pain treatments.

Reducing Occupational Risk to Ambulatory Caregivers

In recent years, safe patient handling in the health care industry has been addressed by various stakeholders, but much work remains to reduce health care worker injuries, and improve safety and care quality for patients. Recently, safe patient handling in ambulatory care settings has gained attention. As health care delivery evolves, demands on ambulatory care will increase and more dependent patients will visit ambulatory care clinics. Typically, ambulatory care clinics are not equipped with appropriate safe patient handling equipment. Examination tables, standard in ambulatory care clinics, currently have fixed height and are not easily accessible. This study investigated the benefits of introducing new height-adjustable examination tables to an ambulatory care setting. The results of this study indicate that by using height-adjustable examination tables, work-related musculoskeletal disorder (WMSD) risk for caregivers can be significantly reduced.

Does time off work after injury vary by jurisdiction? A comparative study of eight Australian workers' compensation systems

OBJECTIVES

To determine whether the jurisdiction in which a work-related injury compensation claim is made is an independent predictor of duration of time off work following work injury, and if so, the magnitude of the effect.

SETTING

Eight Australian state and territory workers' compensation systems, providing coverage for more than 90% of the Australian labour force. Administrative claims data from these systems were provided by government regulatory authorities for the study.

PARTICIPANTS

95 976 Australian workers with workers' compensation claims accepted in 2010 and with at least 2 weeks of compensated time off work.

PRIMARY OUTCOME MEASURE

Duration of time lost from work in weeks, censored at 104 weeks.

RESULTS

After controlling for demographic, worker, injury and employer factors in a Cox regression model, significant differences in duration of time loss between state and territory of claim were observed. Compared with New South Wales, workers in Victoria, South Australia and Comcare had significantly longer durations of time off work and were more likely to be receiving income benefits at 104 weeks postinjury, while workers in Tasmania and Queensland had significantly shorter durations of time off work.

CONCLUSIONS

The jurisdiction in which an injured worker makes a compensation claim has a significant and independent impact on duration of time loss. Further research is necessary to identify specific compensation system policies and practices that promote timely and appropriate return to work and reduce duration of time off work.

Immigrant dairy workers' perceptions of health and safety on the farm in America's Heartland

BACKGROUND

Dairy farming is dangerous. Yearly, farms grow fewer and larger by employing immigrant workers, who have limited industrial agriculture experience and safety and health training.

METHODS

We examined results of five focus groups with 37 Hispanic, immigrant dairy workers. Analysis followed a grounded theory approach and employed ATLAS.ti.

RESULTS

Reported injury experience affirmed the hazardous nature of dairy. Some workers received appropriate worker compensation benefits, whereas others were instructed to deny work-relatedness. Some employers covered medical injury costs out-of-pocket, whereas others did not. Cows were a major injury source. Pressure to work and weather were noted as injury risk factors. Worker compensation was poorly understood, and immigration status and fear of deportation influenced injury and hazard reporting.

CONCLUSION

Injury management practices range from benevolent to threatening. Workers compensation is poorly understood and undocumented status is an occupational hazard. We underscore the need for further research and immigration policy change.

Proportion of opioid use due to compensated workers' compensation claims in Manitoba, Canada

Background

This study identifies the percentage of opioids prescribed for compensated workplace conditions in Manitoba, Canada and whether Workers Compensation Board (WCB) status is associated with higher prescription opioid doses.

Methods

Opioid prescriptions for WCB recipients were linked with databases housed at the Manitoba Center for Health Policy. Duration of continuous opioid prescription and morphine equivalents (ME) per day (ME/D) were calculated for individuals age 18–65.

Results

Over the period from 1998 to 2010, 3.8% of the total opioid dosage of medication prescribed in the study population were prescribed to WCB recipients. WCB recipients accounted for 2.1% of the individuals prescribed opioids. In adjusted analyses WCB recipients were more likely to be prescribed over 120 ME/D (OR 2.06 95% CI, 1.58–2.69).

Conclusions

WCB recipients account for a small, but significant amount of the total opioid prescribed in Manitoba. Manitoba's WCB population is a group at increased risk of being prescribed over 120 ME/day. Am. J. Ind. Med. 58:33–39, 2015. © 2014 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

Impact of differential injury reporting on the estimation of the total number of work-related amputations

BACKGROUND

A capture-recapture analysis was performed to estimate the total number of work-related amputations. We examined the impact of misclassification due to differential injury reporting on the estimate of total number of work-related amputations.

METHODS

Bureau of Labor Statistics' Survey of Occupational Injuries and Illnesses (SOII) samples and workers' compensation records (WC) were used to estimate the total number of work-related amputations. Some of the amputation cases in one data source matched with injuries other than amputations in the other data source. We performed sensitivity analyses reassigning such cases as matched amputations.

RESULTS

Depending on how we treated the cases matched with other injuries, the total number of work-related amputations ranged from 276 to 442 cases, yielding dramatically different capture rates (35-87%).

CONCLUSION

Due to differential classification, estimates of work-related amputations would be biased. Our findings highlight the importance of accurately reporting and classifying work-related injuries and illnesses.

Contingent workers: Workers' compensation data analysis strategies and limitations

The growth of the contingent workforce presents many challenges in the occupational safety and health arena. State and federal laws impose obligations and rights on employees and employers, but contingent work raises issues regarding responsibilities to maintain a safe workplace and difficulties in collecting and reporting data on injuries and illnesses. Contingent work may involve uncertainty about the length of employment, control over the labor process, degree of regulatory, or statutory protections, and access to benefits under workers' compensation. The paper highlights differences in regulatory protections and benefits among various types of contingent workers and how these different arrangements affect safety incentives. It discusses challenges caused by contingent work for accurate data reporting in existing injury and illness surveillance and benefit programs, differences between categories of contingent work in their coverage in various data sources, and opportunities for overcoming obstacles to effectively using workers' compensation data.

Conference report: community health centers and vulnerable workers

A one-day conference in Washington brought together leaders of community health centers and worker advocates to discuss collaboration. They agreed that health centers could help protect vulnerable workers. They agreed on use of electronic medical records; access to workers compensation; Medical-Legal Partnerships; better understanding of work settings in their communities; and educating clinicians on work and jobs.

Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To determine the effect of early (receipt ≤30 d postonset) magnetic resonance imaging (MRI) on disability and medical cost outcomes in patients with acute, disabling, work-related low back pain (LBP) with and without radiculopathy.

SUMMARY OF BACKGROUND DATA

Evidence-based guidelines suggest that, except for "red flags," MRI is indicated to evaluate patients with persistent radicular pain, after 1 month of conservative management, who are candidates for surgery or epidural steroid injections. Prior research has suggested an independent iatrogenic effect of nonindicated early MRI, but it had limited clinical information and/or patient populations.

METHODS

A nationally representative sample of workers with acute, disabling, occupational LBP was randomly selected, oversampling those with radiculopathy diagnoses (N = 1000). Clinical information from medical reports was used to exclude cases for which early MRI might have been indicated, or MRI occurred more than 30 days postonset (final cohort = 555). Clinical information was also used to categorize cases into "nonspecific LBP" and "radiculopathy" groups and further divided into "early-MRI" and "no-MRI" subgroups. The Cox proportional hazards model examined the association of early MRI with duration of the first episode of disability. Multivariate linear regression models examined the association with medical costs. All models adjusted for demographic and medical severity measures.

RESULTS

In our sample, 37% of the nonspecific LBP and 79.9% of the radiculopathy cases received early MRI. The early-MRI groups had similar outcomes regardless of radiculopathy status: much lower rates of going off disability and, on average, $12,948 to $13,816 higher medical costs than the no-MRI groups. Even in a subgroup with relatively minimal disability impact (≤30 d of total lost time post-MRI), medical costs were, on average, $7643 to $8584 higher in the early-MRI groups.

CONCLUSION

Early MRI without indication has a strong iatrogenic effect in acute LBP, regardless of radiculopathy status. Providers and patients should be made aware that when early MRI is not indicated, it provides no benefits, and worse outcomes are likely.

LEVEL OF EVIDENCE

3.

Prevention guidance for isocyanate-induced asthma using occupational surveillance data

Data from Washington State's work-related asthma surveillance system were used to characterize isocyanate-induced asthma cases occurring from 1999 through 2010. Injured worker interviews and medical records were used to describe the industry, job title, work process, workers' compensation cost, and exposure trends associated with 27 cases of isocyanate-induced asthma. The majority (81%) of cases were classified within the surveillance system as new-onset asthma while 19% were classified as work-aggravated asthma. The workers' compensation cost for isocyanate-induced asthma cases was $1.7 million; this was 14% of the total claims cost for all claims in the asthma surveillance system. The majority of cases (48%) occurred from paint processes, followed by foam application or foam manufacturing (22%). Nine of the asthma cases associated with spray application occurred during application to large or awkward-shaped objects. Six workers who did not directly handle isocyanates (indirect exposure) developed new-onset asthma. Two cases suggest that skin contact and processes secondary to the isocyanate spray application, such as cleanup, contributed to immune sensitization. Surveillance data provide insight for the prevention of isocyanate-induced respiratory disease. Key observations are made regarding the development of work-related asthma in association with a) paint application on large objects difficult to ventilate, b) indirect exposure to isocyanates, c) exposure during secondary or cleanup processes, and d) reports of dermal exposure.