Prevention of long-term disability in back injuries: Screening and intervention

Objectives: To develop a brief worker-completed questionnaire for use soon after a work-related back injury to (a) asses risk of work disability one year after injury and (b) design and implement interventions to reduce disability. Methods: In this prospective cohort study, 1885 workers provided information regarding pain, functional status, psychosocial, clinical, and work characteristics 2-3 weeks after filing a claim for a new back injury. Work disability status was assessed one year after injury. Classification and regression tree analysis (CART) was used to identify the best predictive model of work disability status. Results: Pain interference with ability to work (>5, 0-10 scale), not currently working, and radiating leg pain comprised the best model which accurately classified 77% of the workers. Interventions: The questionnaire will be used to target interventions which may include new employer-based incentives related to work modifications, targeted progressive reactivation exercises, and patient education aimed at worker fear avoidance and low work expectations. Use of the screening questionnaire and interventions will be pilot tested within an occupational health quality improvement project.