[Psychological interventions in the field of neurotraumatology during the acute care].

Neurotrauma means head or spine injury caused by an external force. Neurotraumatology care requires coordinated teamwork on the part of specialists, including psychological care as part of the multidisciplinary treatment team. Psychological interventions in the field of neurotraumatology aim to address the psychological consequences and challenges associated with head or spine injury. These interventions play a vital role in crisis intervention, promoting recovery, enhancing quality of life, and supporting individuals and their families in coping with the psychological impact of neurotrauma. Serious physical injuries always cause severe psychological consequences, both in short and long term. A critical accident is a sudden, unexpected, often directly life-threatening event that exceeds the individual's ability to respond and can create a potential crisis response, including suicidal risk, as well as the development of psychological disorders, in most cases acute stress disorder, adjustment disorder and post-traumatic stress disorder. Psychological interventions in neurotraumatology are often provided by a multidisciplinary team that may include psychologists, psychiatrists, social workers, and other healthcare professionals. These interventions are tailored to the unique needs and circumstances of each individual, with the goal of reducing psychological symptomps, promoting psychological well-being, adjustment, and overall recovery following neurotrauma. It is essential that not only patients who have experienced severe physical trauma, but also their family members have access to expert psychological support. This study summarizes psychological interventions during the treatment of neurotaruma patients at the intensive care unit.

Kinesiophobia and Its Association With Health-Related Quality of Life Across Injury Locations.

OBJECTIVE: To compare baseline kinesiophobia levels and their association with health-related quality of life across injury locations. DESIGN: Retrospective cross-sectional study. SETTING: Single, large outpatient physical therapy clinic within an academic medical center. PARTICIPANTS: Patients (N=1233) who underwent an initial evaluation for a diagnosis related to musculoskeletal pain and completed the 11-item version of the Tampa Scale for Kinesiophobia (TSK-11) and the Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8) questionnaires within 7 days of their first visit were eligible for inclusion. Three hundred eighty patients were excluded because of missing data or because they were younger than 18 years. A total of 853 patients (mean age, 43.55y; range, 18-94y) were included. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Comparison of baseline kinesiophobia levels and their association with health-related quality of life across injury locations in an outpatient physical therapy setting. RESULTS: Separate analysis of variance models compared TSK-11 scores based on involved body region, and Pearson correlation coefficients were used to examine the association between TSK-11 scores and the SF-8 subscales at each body region. TSK-11 scores did not differ by body region (range, 23.9-26.1). Weak to moderate negative correlations existed between kinesiophobia and the SF-8 subscales. CONCLUSIONS: Kinesiophobia levels appear elevated and negatively associated with health-related quality of life at initial physical therapy evaluation regardless of injury location. These findings suggest that physical therapists in outpatient orthopedic settings should implement routine kinesiophobia assessment and provide stratified care based on kinesiophobia levels across musculoskeletal conditions.

Don't look at my wheelchair! The plasticity of longlasting prejudice.

CONTEXT: Scientific research has consistently shown that prejudicial behaviour may contribute to discrimination and disparities in social groups. However, little is known about whether and how implicit assumptions and direct contact modulate the interaction and quality of professional interventions in education and health contexts. OBJECTIVES: This study was designed to examine implicit and explicit attitudes towards wheelchair users. METHODS: We investigated implicit and explicit attitudes towards wheelchair users in three different groups: patients with traumatic spinal cord injury (SCI); health professionals with intense contact with wheelchair users, and healthy participants without personal contact with wheelchair users. To assess the short-term plasticity of prejudices, we used a valid intervention that aims to change implicit attitudes through brief direct contact with a patient who uses a wheelchair in an ecologically valid real-life interaction. RESULTS: We found that: (i) wheelchair users with SCI held positive explicit but negative implicit attitudes towards their novel in-group; (ii) the amount of experience with wheelchair users affected implicit attitudes among health professionals, and (iii) interacting with a patient with SCI who contradicts prejudices modulated implicit negative bias towards wheelchair users in healthy participants. CONCLUSIONS: The use of a wheelchair immediately and profoundly affects how a person is perceived. However, our findings highlight the dynamic nature of perceptions of social identity, which are not only sensitive to personal beliefs, but also highly permeable to intergroup interactions. Having direct contact with people with disabilities might foster positive attitudes in multidisciplinary health care teams. Such interventions could be integrated into medical education programmes to successfully prevent or reduce hidden biases in a new generation of health professionals and to increase the general acceptance of disability in patients.

Sufficiency of a two factor model for posttraumatic stress disorder symptoms in spinal injury.

The above study has many of strengths, including an important topic, excellent sample size, well-articulated design and questionnaire, thorough factor analysis with goodness-of-fit tests, a clear explanation of the rationale for the findings, as well as their current applications in the medical field. Despite these strengths, the fit of the findings to the five-factor model of Elhai and Palmieri (2011) would appear to be lower than the fit to a two-factor model, a model that explains the data well. Therefore, we recommend that practitioners refrain from adopting and implementing the five-factor model for PTSD treatment in traumatic spinal injury victims due to insufficient support at this time.

The trajectory of physical and mental health from injury to 5 years after multiple trauma: a prospective, longitudinal cohort study.

OBJECTIVES: To describe the trajectory of physical and mental health from injury to 5 years postinjury for patients with multiple trauma, and to examine predictors of recovery of physical and mental health. DESIGN: A prospective, longitudinal cohort study with data from injury (baseline), the return home (t1), and 1 (t2), 2 (t3), and 5 (t4) years. SETTING: Hospital and community setting. PARTICIPANTS: Patients (N=105; mean age ± SD, 35.3±14.0y; age range, 18-67y; 83% men) with multiple trauma and a New Injury Severity Score (NISS) ≥16 treated at a regional trauma referral center. Mean NISS ± SD was 34.6±12.6, and mean Glasgow Coma Scale (GCS) score ± SD was 12.2±3.9. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Medical Outcomes Study 36-Item Short-Form Health Survey physical component summary (PCS) and mental component summary (MCS), injury severity parameters, and World Health Organization Disability Assessment Schedule II (WHODAS II) for activities and participation. RESULTS: The proportion with poor physical health (<40 points on the PCS) stabilized at 56% at t4 from 81% at t1. The proportion with poor mental health (<40 points on the MCS) stabilized at 31% at t4 from 43% at t1. Generalized estimating equations showed that predictors of PCS were time points of measurement (Wald, 85.50; P<.001), GCS (B=-.48, P=.004), time in hospital/rehabilitation (B=-.22, P=.001), and the rank-transformed WHODAS II subscales Getting around (B=.16, P<.001) and Participation in society (B=.06, P=.015). Predictors of MCS were time points of measurement (Wald 13.46, P=.004), sex (men/women) (B=-4.24, P=.003), education (low/high) (B=3.43, P=.019), and WHODAS II cognitive function (B=.18, P<.001) and Participation in society (B=.18, P≤.001). CONCLUSIONS: Physical and mental health over the 5 years improved with time, but was still significantly below population means. The physical and mental health status stabilized, but the recovery trajectories differed for physical and mental health. Predictors of health were personal and injury-related factors and function in a biopsychosocial perspective.

Meal provision in a UK National Spinal Injury Centre: a qualitative audit of service users and stakeholders.

STUDY DESIGN: A single centre survey. OBJECTIVES: The objective of this study is to (1) assess patients' food intake and (2) measure satisfaction with current food provision, as judged by patients and by stakeholders (medical and nursing staff, managers and catering staff). METHODS: Standardised questionnaires were used to record food intake over a 24-h period, and to evaluate the quality, ordering, delivery and overall acceptability of food provided. RESULTS: The food intake of 67 patients with spinal cord injury (SCI) was recorded (64% response rate) and 166 evaluations (50% response rate) were returned. Twenty-nine patients (48%) consumed three full meals a day, 17 (26%) received oral nutritional supplements, 22 (34%) received vitamin/mineral supplements, and 23 (35%) required assistance to eat. Some patients and stakeholders expressed satisfaction with the current food provision: taste good: 25 versus 17% (for patients and stakeholders, respectively); appropriate texture: 22 versus 21%; appropriate temperature: 55 versus 72% (P = 0.002); well presented: 43 versus 28%; good choice: 49 versus 59%; received meal ordered: 65 versus 37% (P < 0.001); meal served on time: 71 versus 58%; and no interruption during mealtimes: 62 versus 46%. Principal component analyses of item scores identified three main factors (food quality, food presentation and food delivery (logistics). CONCLUSION: The present study identified some areas where there appeared to have been improvement in SCI hospital catering, but with much still to be achieved. Hospital-catering systems should be tailored to meet the demands of the different patient groups to optimise nutritional intake. Periodic quality control is essential to meet recommendations and patients' expectations.

Perceptions of a clinical psychology support group for spinal injury.

BACKGROUND: A service evaluation was performed exploring nurses' perceptions of a clinical psychology facilitated peer support group in a spinal injury rehabilitation setting. AIMS: To determine whether staff found the meetings useful while, more broadly, to highlight the need to support and supervise nursing staff in psychological care appropriately. METHOD: A questionnaire was developed and distributed to the 30 members of staff who worked on the ward. Seventeen questionnaires were returned (57%). Data was analysed using thematic analysis. RESULTS: The meetings were viewed as a place to discuss issues, and a safe protected space to share stresses. Staff felt the meetings aided team cohesion and helped them share ideas and draw up clinical strategies. Meetings aided stress management and confidence building. Staff considered the meetings to increase their psychological awareness and understanding. CONCLUSION: Staff involved in the acute care and rehabilitation of spinal injured patients are consistently exposed to highly demanding and stressful clinical environments. Support meetings where staff can discuss patient and ward issues are invaluable. Other clinical nursing areas would benefit from similar support systems.

Cervical spine clearance in obtunded blunt trauma patients: a prospective study.

BACKGROUND: : An acceptable algorithm for clearance of the cervical spine (C-spine) in the obtunded trauma patient remains controversial. Undetected C-spine injuries of an unstable nature can have devastating consequences. This has led to reluctance toward C-spine clearance in these patients. OBJECTIVE: : To objectify the accuracy of computed tomography (CT) scanning compared with dynamic radiographs within a well established C-spine clearance protocol in obtunded trauma patients at a level I trauma center. METHODS: : This was a prospective study of consecutive blunt trauma patients (18 years or older) admitted to a single institution between December 2004 and April 2008. To be eligible for study inclusion, patients must have undergone both a CT scan and dynamic plain radiographs of their C-spine as a part of their clearance process. RESULTS: : Among 402 patients, there was one injury missed on CT but detected by dynamic radiographs. This resulted in a percentage of missed injury of 0.25%. Subsequent independent review of the CT scan revealed that in fact pathologic changes were present on the scan indicative of the injury. CONCLUSIONS: : Our results indicate that CT of the C-spine is highly sensitive in detecting the vast majority (99.75%) of clinically significant C-spine injuries. We recommend that CT be used as the sole modality to radiographically clear the C-spine in obtunded trauma patients and do not support the use of flexion-extension radiographs as an ancillary diagnostic method.

[Using music in work therapy complex in able-bodied patients with spinal injury].

The authors analyzed results of using music in work therapy rehabilitation complex in able-bodied patients with spinal injury. Efficiency of the therapy was demonstrated. Findings are that the patients demonstrate positive change in views, interests, desires, attitude to the personal condition and surroundings, tendency to overcome the disease, to realize compensatory resources of the body, more motivation to work--that serves as a good basis for further work rehabilitation of the patients.

Do PROMIS Physical Function, Pain Interference, and Depression Correlate to the Oswestry Disability Index and Neck Disability Index in Spine Trauma Patients?

STUDY DESIGN: Correlational study. OBJECTIVE: In spine trauma patients, we aimed to assess the correlation of patient-reported outcome measurement information system (PROMIS) physical function (PF), pain interference (PI), and Depression scores with Oswestry Disability Index (ODI) and Neck Disability Index (NDI) ODI/NDI scores. SUMMARY OF BACKGROUND DATA: The ODI and NDI were intended as patient-reported outcome measures (PROMs) to evaluate clinical outcomes in patients seeking spine care. To date, the PROMIS has not been studied in the spine trauma population. METHODS: Between January 1, 2015 and December 13, 2017, patients presenting to a single, level 1 trauma center spine clinic with known spine trauma were identified. A total of 56 patients (52 operative, 4 nonoperative) representing 181 encounters were identified. PROMIS PF, PI, and Depression, as well as the ODI or NDI, were administered to patients. Spearman rho (ρ) were calculated between PROMs. RESULTS: A strong correlation exists between PROMIS PI and the ODI (ρ = 0.79, P < 0.001), while a strong-moderate correlation exists between PROMIS PF and the ODI (ρ = -0.61, P < 0.001). A moderate correlation exists between PROMIS Depression and the ODI (ρ = 0.54, P < 0.001). Strong correlations exist between PROMIS PI and the NDI (ρ = 0.71, P < 0.001) and PROMIS Depression and the NDI (ρ = 0.73, P < 0.001). A poor correlation exists between PROMIS PF and the NDI (ρ = -0.28, P = 0.005). CONCLUSION: PROMIS PF, PI, and Depression domains significantly correlate with the ODI and NDI; however, only PROMIS PI strongly correlates with both the NDI and ODI. This suggests that PROMIS PI can be used to capture similar information to that of the ODI or NDI but that PROMIS PF and Depression may offer additional clinical information. LEVEL OF EVIDENCE: 2.

Spinal Injuries in Suicidal Jumpers.

STUDY DESIGN: This was a retrospective case series at a single institution. OBJECTIVE: The study was performed to investigate the characteristics of spinal injuries in survivors of suicidal jumping. SUMMARY OF BACKGROUND DATA: Spinal fracture/dislocation is associated with high-energy trauma such as that induced by motor vehicle accidents. Survivors of suicidal jumping sometimes sustain spinal injuries. However, the characteristics of such spinal injuries are unclear. METHODS: We identified 87 survivors of suicidal jumping who sustained spinal injuries from 2007 to 2016 in our institution. We compared the demographic data, radiological findings, neurological status, associated injuries, treatments, and mental health conditions between these 87 survivors and 204 non-suicidal patients with spinal injury. RESULTS: Suicidal jumpers were predominantly female (67%) and 10 years younger than non-suicidal patients. Mental health problems, mainly schizophrenia and depression, were diagnosed in 77% of suicidal jumpers. Neurological damage from spinal trauma was generally less severe in suicidal jumpers than in non-suicidal patients. Most spinal injuries in suicidal jumpers were located in the thoracic or lumbar spine region (85%). Among comorbid injuries, extremity injuries were highly associated with spine injury in suicidal jumpers. Nearly 70% of suicidal jumpers exhibited extremity injury in contrast to 33% of non-suicidal patients. Approximately, 25% of suicidal jumpers underwent surgical treatment. Surgical treatment was similarly performed on suicidal jumpers and non-suicidal patients regardless of the discrepancy in neurological damage between these two groups. CONCLUSION: Spinal injuries in suicidal jumpers differed from spinal injuries in non-suicidal patients with regard to sex, age, mental health condition, injury location, neurologic damage, and associated injuries. Most survivors of suicidal jumping were young female patients with mental health problems. They tended to have thoracic and lumbar spine trauma rather than cervical trauma with less severe neurological deficits and a higher incidence of accompanying limb injury. LEVEL OF EVIDENCE: 3.

Impaired quality of life after bicycle trauma.

INTRODUCTION: Bicycle crashes often affect individuals in working age, and can impair quality of life (QoL) as a consequence. The aim of this study was to investigate QoL in bicycle trauma patients and to identify those at risk of impaired QoL. PATIENTS AND METHODS: 173 bicycle trauma patients who attended a level I trauma centre from 2010 to 2012 received Hadorn's QoL questionnaire six months after their crash. Medical data was collected from the patient's records. Univariate ordinal logistic regression was used to investigate the association between QoL and other factors. RESULTS: 148 patients returned the questionnaire (85.5%). The majority had only mild or minor injuries (85.1%; n=126). However, 72.1% (n=106) still suffered from pain or other physical symptoms more than six months after their bicycle crash. Patients with a Glasgow Coma Scale (GCS) ≤13 or an Injury Severity Score (ISS) >15 experienced impaired emotions/outlook on life (p-values 0.003 and 0.045, respectively). Physical suffering was reported by patients with a GCS ≤13 and in those with injuries to the cervical spine (p-values 0.02 and 0.025, respectively). Patients with an ISS >15 or facial fractures experienced limitations in daily activities (p-values 0.031 and 0.025, respectively). CONCLUSIONS: More than 70% of bicycle trauma patients suffered physically more than six months after their crash, even though only 15% were severely injured. Risk factors for an impaired QoL were cervical spine injuries or facial fractures, a GCS ≤13 and an ISS >15.

Sensitivity and specificity of reliable digit span in malingered pain-related disability.

The reliable digit span (RDS) performance of chronic pain patients with unambiguous spinal injuries and no evidence of exaggeration or response bias (n = 53) was compared to that of chronic pain patients meeting criteria for definite malingered neurocognitive dysfunction (n = 35), and a group of nonmalingering moderate-severe traumatic brain injury (TBI) patients (n = 69). The results demonstrated that scores of 7 or lower were associated with high specificity (> .90) and sensitivity (up to .60) even when moderate to severe TBI are included. Multiple studies have demonstrated that RDS scores of 7 or lower rarely occur in TBI and pain patients who are not intentionally performing poorly on cognitive testing. This study supports the use of the RDS in detecting response bias in neuropsychological patients complaining of pain as well as in the assessment of pain-related cognitive impairment in patients whose primary complaint is pain.

The dominant role of psychosocial risk factors in the development of chronic low back pain disability.

STUDY DESIGN: An inception cohort design was used in which 421 patients were evaluated systematically with a standard battery of psychosocial assessment tests (Structured Interview for DSM-III-R Diagnosis, Minnesota Multiphasic Personality Inventory, and Million Visual Pain Analog Scale) within 6 weeks of acute back pain onset. OBJECTIVES: The present study evaluated the predictive power of a comprehensive assessment of psychosocial and personality factors in identifying acute low back pain patients who subsequently develop chronic pain disability problems (as measured by job-work status at 1-year follow-up evaluation). SUMMARY OF BACKGROUND DATA: There has been a relative paucity of prospective research in the United States comprehensively evaluating potential psychosocial risk factors that are associated with those injured workers who subsequently fail to return to work and productivity after 1 year because of low back pain disability. Such research has been quite limited because of the time and cost involved in conducting prospective studies. METHODS: All study patients were symptomatic with lumbar pain syndrome for no more than 6 weeks. These acute patients were tracked every 3 months, culminating in a structured telephone interview being conducted 1 year after the initial evaluation to document return-to-work status. RESULTS: Logistic regression analyses, conducted to differentiate between patients who were back at work after 1 year versus patients who were not because of the original back injury, revealed the importance of three psychosocial measures: self-reported pain and disability, scores on Scale 3 of the Minnesota Multiphasic Personality Inventory, and workers' compensation and personal injury insurance status. The model generated correctly classified 90.7% of the cases. Results revealed that major psychopathology, such as depression and substance abuse, did not precede or cause the development chronic pain disability. CONCLUSIONS: These results show the presence of a robust "psychosocial disability factor" that is associated with those injured workers who are likely to develop chronic low back pain disability problems. Based on these data, a statistical algorithm has been generated that can identify those acute patients who will require early intervention to prevent the development of chronic disability. The second major result is that preinjury or concomitant psychopathology does not appear to predispose patients to chronic pain disability, although high rates of psychopathology have been shown in chronic low back pain. Future research should be directed at emotional vulnerability and psychosocial events in the period after the injury that may lead to chronicity.

The rise and fall of Erichsen's disease (railroad spine).

The railroad represented one of the major technologic achievements of the 19th century. Sadly, railroad collisions, which resulted in major injuries and loss of life, began to tarnish the image of this popular mode of transportation. Public alarm about rail travel intensified in 1866, when noted British surgeon John Eric Erichsen described a peculiar progressive spinal disorder, similar to spinal concussion, that was a sequela to railroad accident or injury. The history of this disorder, which came to be known as "railroad spine" or "Erichsen's disease", represents a little known yet important chapter in the evolution of the modern comprehension of functional illness that can complicate or even replace an initial substrate of organic disease.

Psychosocial job factors, physical workload, and incidence of work-related spinal injury: a 5-year prospective study of urban transit operators.

STUDY DESIGN: Five-year prospective cohort study of 1449 transit operators. OBJECTIVES: To investigate psychosocial job factors as predictors of work-related spinal injuries, controlling for current and past physical workload. SUMMARY OF BACKGROUND DATA: The association between psychosocial job factors and spinal disorders may be confounded by physical workload. A 1991 prospective study of Boeing workers found psychosocial but not physical factors to be associated with spinal injuries. However, data on physical workload were limited. Recent cross-sectional studies of transit drivers showed both physical and psychosocial factors to be independently associated with back and neck pain. This study was designed to test these findings prospectively. METHODS: Spinal injuries were ascertained from workers' compensation records, employment history from company records, and psychosocial factors from questionnaires. Logistic regression models adjusted for age, gender, height, weight, vehicle type, and current and past physical workload. RESULTS: During follow-up, 320 drivers reported a first spinal injury. Spinal injury was predicted by psychological job demands (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.33-1.95); job dissatisfaction (OR, 1.56; 95% CI, 1.09-2.23); and the frequency of job problems (OR, 1.52; 95% CI, 1.02-2.26). Marginally significant associations were found for low supervisor support (OR, 1.30; 95% CI, 0.99-1.72) and female gender (OR, 1.49; 95% CI, 0.95-2.32). Compared with full-time work, part-time work was associated with a 2.7-fold reduced risk for spinal injury (OR, 0.37; 95% CI, 0.15-0.93). Cable car crews performing the heaviest physical labor had a threefold increased risk of spinal injury compared with bus drivers (OR, 3.04; 95% CI, 1.85-5.00). CONCLUSIONS: Physical workload and psychosocial job factors both independently predict spinal injury in transit vehicle operators.

Effect of age on outcomes of tertiary rehabilitation for chronic disabling spinal disorders.

STUDY DESIGN: A prospective cohort study evaluating age as a factor in treatment outcomes for chronic disabling work-related spinal disorders undergoing tertiary rehabilitation. OBJECTIVE: To assess the association between age and objective psychosocioeconomic treatment outcomes for work-related spinal disorders undergoing functional restoration. SUMMARY OF BACKGROUND DATA: As early as the 1950s, a link between age and low back symptoms has been identified in the literature. Several studies have demonstrated that the occurrence of low back pain is positively correlated with age up to about 50-60 years, after which prevalence declines. It has been argued that this pattern is stronger for more severe, chronic back pain cases. Little research attention has been given to age as a factor in treatment outcomes for work-related spinal disorders. METHODS: A cohort of 1052 chronically disabled (none working full-time when starting the rehabilitation program) spinal disorder (CDSD) patients were placed into five groups based on age: Group 1, <25 years (22 +/- 2 years, n = 59); Group 2, 25-34 years (30 +/- 3 years, n = 301); Group 3, 35-44 years (39 +/- 3 years, n = 381); Group 4, 45-54 (49 +/- 3 years, n = 237); and Group 5, > or =55 years (59 +/- 4 years, n = 74). All patients completed a functional restoration program combining quantitatively directed exercise progression with a multimodal disability management approach using psychological and case management techniques. Before the start of the program, and again on completion of the program, all patients received a psychosocial evaluation and were also assessed on a variety of physical motion, strength, aerobic, and functional factors, and a cumulative score was calculated, which aggregates and averages these physical measures. A structured clinical interview examining socioeconomic outcomes (work return, health utilization, recurrent injury, and resolution of financial disputes) was conducted at 1 year after program completion, and at least partial information was obtained from this interview on all consecutive patients in the study. RESULTS: The length of pretreatment disability increased with age (P < 0.001), as well as pretreatment surgery rates (P < 0.002). A Mantel-Haenzel chi2 test for linear trend across age groups revealed that the percentage of patients who returned to work declined progressively from 100% in Group 1 to 69% in Group 5 (P < 0.001). The same linear trend was revealed for the percentage of patients retaining work at the end of 1 year (98-62%, P < 0.001). Older workers returned to the same job and/or the same employer (P < 0.005). Younger workers found different jobs with new employers (48-11%, P < 0.0001). Analysis of variance for the disability questionnaire revealed that after treatment subjective disability progressively increased (while improvements decreased) from Group 1 to Group 5 (P < 0.01). The cumulative physical score variable, even normalized for age, was progressively lower from Group 1 to Group 5, both at pretreatment (P < 0.03) and post-treatment (P < 0.02). CONCLUSIONS: The present study represents the first large-scale examination of the association between age and treatment outcomes for a work-related CDSD population. Age is significantly and linearly related to pretreatment duration of disability and frequency of pretreatment surgeries. After rehabilitation treatment there is a linear decrement in both work return and work retention, so that younger patients are far more likely to return and hold work after functional restoration. Older workers who go back to work are much more likely to return to the same employer and do the same job, or to become self-employed. Calculation of odds ratios revealed that patients >55 years are 5.68 times more likely to return to the same job and employer, relative to those <25 years; those >55 years were also approximately three times more likely than those <25 years to return to the same employer, compared with those <25 years. Younger workers are far more likely to take a different job and/or seek a new employer. Older patients are also somewhat more likely to seek a new health provider to deal with perceived residual pain/disability. This trend coincides with their higher post-treatment subjective disability levels, and their lower cumulative physical scores both prerehabilitation and postrehabilitation. However, age does not affect additional surgery rates, subsequent injuries, or delays in settling financial disputes.

Are occupational drivers at an increased risk for developing musculoskeletal disorders?

STUDY DESIGN: This study analyzed the role of exposure to driving and other covariates in reports of back, neck, and shoulder pain and resultant disability. Cohorts in Sweden and the United States were compared. OBJECTIVES: To establish the effect of mechanical and psychosocial factors in reporting back, neck, and shoulder pain and work loss. SUMMARY OF BACKGROUND DATA: There are numerous reports of a positive relationship between back pain and driving. However, exposure data are minimal. The influence of job satisfaction has not been assessed. METHODS: The physical factors affecting reports of back, neck, and shoulder pain were investigated in a two-country cohort study of bus and truck drivers and sedentary workers. Vibration exposure was obtained by directly measuring the vibration imposed on the driver during a typical work day. Lifting exposure was attained by questionnaire. Cumulative exposure was computed based on work history. Musculoskeletal health information was based on a modified nordic questionnaire, and other questionnaires recorded the physical and psychosocial aspects of the work environment. RESULTS: Of the sample, 50% reported low back pain, with no difference between countries. The highest risk factors (odds ratios) for back and neck pain were long-term vibration exposure, heavy lifting, and frequent lifting. A combination of long-term vibration exposure and frequent lifting carried the highest risk of low back pain. Work loss from low back pain was influenced by perceived job stress. CONCLUSIONS: Vibration (resulting from driving) and lifting cause back, neck, and shoulder pain, whereas inability to work seems affected by stress at work.