Comparison of Trends in the Incidence of Traumatic Spinal Cord Injury in Daily Life, Automobile Accidents, and Industrial Accidents: A National Multi-Insurance Study in Korea.

BACKGROUND: To examine the incidence of traumatic spinal cord injury (TSCI) from all etiologies, we measured and compared the incidence of TSCI from three national or quasi-national databases in South Korea, namely, the National Health Insurance Service (NHIS), automobile insurance (AUI), and Industrial Accident Compensation Insurance (IACI). METHODS: We reviewed patients with TSCI reported in the NHIS database between 2009 and 2018, and in the AUI and IACI databases between 2014 and 2018. TSCI patients were defined as those first admitted to the hospital with a diagnosis of TSCI according to the International Classification of Diseases (10th revision) criteria. Age-adjusted incidence was calculated using direct standardization using the 2005 South Korean population or the 2000 US population as the standard population. The annual percentage changes (APC) of TSCI incidence were calculated. The Cochrane-Armitage trend test was performed according to the injured body region. RESULTS: In the NHIS database, age-adjusted TSCI incidence using the Korean standard population increased significantly from 2009 to 2018 (from 33.73 per million in 2009 to 38.14 per million in 2018, APC = 1.2%, P = 0.014). Contrarily, age-adjusted incidence in the AUI database significantly decreased from 13.88 per million in 2014 to 11.57 per million in 2018 (APC = - 5.1%, P = 0.009). In the IACI database, the age-adjusted incidence showed no significant difference, while crude incidence showed a significant increase (from 22.02 per million in 2014 to 28.92 per million in 2018, APC = 6.1%, P = 0.038). According to the age group, all the three databases showed high incidences of TSCI in those in their 60s and 70s or older. Among those in their 70s or older, the incidence of TSCI increased dramatically in the NHIS and IACI databases, while no significant trend was found in AUI database. In 2018, the number of TSCI patients was the highest among those over 70 years of age in the NHIS, whereas among those in their 50s were the highest in both AUI and IACI. The proportion of patients with cervical spinal cord injury was the most common in all these databases. CONCLUSIONS: The differences in trends in the incidence of TSCI may be due to the different etiologies and different characteristics of subjects depending on insurance type. These results imply the need for tailored medical strategies for the different injury mechanisms represented by three national insurance services in South Korea.

Frequency and Cost of Claims by Injury Type From the Korea Workers' Compensation Insurance Between 2016 and 2019.

OBJECTIVE: This study aimed to examine the frequency of worker injuries by affected body part(s) and the associated costs. Methods : We performed a secondary analysis of national workers' compensation claims data from the Korean workers' compensation insurance. The main outcome measures were frequency and cost of claims by injury type. Results : Multiple injuries were ranked as the highest injury type in the number of annual claims and percentage of the total cost/total medical cost. Hand/wrist/finger was the most common single-injury type. The frequency of injury type and the cost amount payable as a percentage of the total cost were the highest for multiple injuries, hand/wrist/finger injuries, and knee/lower leg injuries. Conclusions : Regarding frequency and costs, hand/wrist/finger injuries were highest in cost, by single-injury type. Therefore, these injuries should be recognized as intervention targets.

Efficacy of a Lower Back Intensive Rehabilitation Program in Occupational Injury Patients and Characteristics of Care: A Retrospective Cohort Study.

BACKGROUND The Lower Back Intensive Rehabilitation Program (LBIRP) was developed by hospitals affiliated with the Korea Workers' Compensation and Welfare Service to support patients with lower back pain caused by occupational injuries. We studied the characteristics of patients who participated in this program to assess its efficacy and suggest areas for program quality improvement. MATERIAL AND METHODS This large-scale retrospective cohort study analyzed the electronic medical records and occupational injury insurance data of patients with lower back damage due to occupational injuries who participated in the LBIRP in hospitals affiliated with the Korea Workers Compensation and Welfare Service between April 2017 and 2020. RESULTS Multidimensional analysis showed that pain, isometric strength of the hip, central muscular endurance, neuromuscular control ability, and self-questionnaire scores were significantly different among groups. Further, significant differences were observed in most multidimensional analysis items according to the cause of disease, program period, and severity of disease. There were no significant differences between the groups. CONCLUSIONS Based on the findings of this study, efforts must be continued to improve and standardize the LBIRP. It is expected that future studies with continuous patient follow-up comparing treatment effects among affiliated hospitals will help to expand the LBIRP for rehabilitation in private hospitals.

Satisfying medical and rehabilitation needs positively influences returning to work after a work-related injury: an analysis of national panel data from 2018 to 2019.

BACKGROUND: This study examined how meeting the medical needs of injured workers after initial treatment may affect their return to work, using data from the Panel Study of Workers' Compensation Insurance. METHODS: This study was designed as a longitudinal study, which used data from the second-year, follow-up survey conducted in the secondary cohort of the Panel Study of Workers' Compensation Insurance. The odds ratio (OR) and 95% confidence interval were estimated through binomial and multinomial logistic regression analyses to examine the effects of unmet medical needs on workers' return to original work and return to work overall (including reemployment). RESULTS: The returned to original work OR of workers whose rehabilitation needs were met was 1.35 (1.12-1.63) while the return to work OR was 1.20 (1.03-1.41). The returned to original work OR of workers whose medical needs were met was 1.64 (1.18-2.27) while the return to work OR was 1.39 (1.07-1.80). In terms of disability rating, the return to work ORs of workers with mild disabilities whose medical/rehabilitation needs were not met and those of workers without disabilities were 1.71 (1.17-2.49) and 1.97 (1.27-3.08), respectively. In the case of regular/temporary workers, the returned-to-work ORs of workers whose medical/rehabilitation needs were not met were 1.54 (1.12-2.13) and 1.27 (1.03-1.56), respectively. CONCLUSIONS: For workers who sustained work-related injuries, providing medical accessibility and meeting rehabilitation needs were found to be important predictors of return to work after initial treatment.

Assessment of Dysarthria Using One-Word Speech Recognition with Hidden Markov Models.

BACKGROUND: The gold standard in dysarthria assessment involves subjective analysis by a speech-language pathologist (SLP). We aimed to investigate the feasibility of dysarthria assessment using automatic speech recognition. METHODS: We developed an automatic speech recognition based software to assess dysarthria severity using hidden Markov models (HMMs). Word-specific HMMs were trained using the utterances from one hundred healthy individuals. Twenty-eight patients with dysarthria caused by neurological disorders, including stroke, traumatic brain injury, and Parkinson's disease were participated and their utterances were recorded. The utterances of 37 words from the Assessment of Phonology and Articulation for Children test were recorded in a quiet control booth in both groups. Patients were asked to repeat the recordings for evaluating the test-retest reliability. Patients' utterances were evaluated by two experienced SLPs, and the consonant production accuracy was calculated as a measure of dysarthria severity. The trained HMMs were also employed to evaluate the patients' utterances by calculating the averaged log likelihood (aLL) as the fitness of the spoken word to the word-specific HMM. RESULTS: The consonant production accuracy reported by the SLPs strongly correlated (r = 0.808) with the aLL, and the aLL showed excellent test-retest reliability (intraclass correlation coefficient, 0.964). CONCLUSION: This leads to the conclusion that dysarthria assessment using a one-word speech recognition system based on word-specific HMMs is feasible in neurological disorders.