Relationship between early prescription dispensing patterns and work disability in a cohort of low back pain workers’ compensation claimants: a historical cohort study

ObjectivesTo examine and compare whether dispensing of prescription opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs) within 8 weeks after a work-related low back pain (LBP) injury is associated with work disability.MethodsA historical cohort study of 55 571 workers’ compensation claimants with LBP claims in British Columbia from 1998 to 2009 was conducted using linked compensation, dispensing and healthcare data. Four exposures were constructed to estimate the effect on receipt of benefits and days on benefits 1 year after injury: drug class(es) dispensed, days' supply, strength of opioids dispensed and average daily morphine-equivalent dose.ResultsCompared with claimants receiving NSAIDs and/or SMRs, the incidence rate ratio (IRR) of days on benefits was 1.09 (95% CI 1.04 to 1.14) for claimants dispensed opioids only and 1.26 (95% CI 1.22 to 1.30) for claimants dispensed opioids with NSAIDs and/or SMRs. Compared with weak opioids only, the IRR for claimants dispensed strong opioids only or strong and weak opioids combined was 1.21 (95% CI 1.12 to 1.30) and 1.29 (95% CI 1.20 to 1.39), respectively. The incident rate of days on benefits associated with each 7-day increase in days supplied of opioids, NSAIDs and SMRs was 10%, 4% and 3%, respectively. Similar results were seen for receipt of benefits, though effect sizes were larger.ConclusionsFindings suggest provision of early opioids leads to prolonged work disability compared with NSAIDs and SMRs, though longer supplies of all drug classes are also associated with work disability. Residual confounding likely partially explains the findings. Research is needed that accounts for prescriber, system and workplace factors.

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953 The relationship between early prescription dispensing patterns and work disability in a cohort of low back pain workers’ compensation claimants

10.1136/oemed-2018-icohabstracts.1588 ◽

2018 ◽

Author(s):

Nancy Carnide ◽

Sheilah Hogg-Johnson ◽

Mieke Koehoorn ◽

Andrea Furlan ◽

Pierre Côté

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Work Disability ◽

Workers Compensation ◽

Low Back ◽

The Relationship

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'Reassurance and healthcare seeking in people with persistent musculoskeletal low back pain consulting orthopaedic spine practitioners: A prospective cohort study'

European Journal of Pain ◽

10.1002/ejp.1765 ◽

2021 ◽

Author(s):

Kathrin Braeuninger‐Weimer ◽

Hanna Rooslien ◽

Naffis Anjarwalla ◽

Tamar Pincus

Keyword(s):

Cohort Study ◽

Low Back Pain ◽

Back Pain ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Low Back ◽

Healthcare Seeking

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Persistent headache and low back pain after accidental dural puncture in the obstetric population: a prospective, observational, multicentre cohort study

Anaesthesia ◽

10.1111/anae.15491 ◽

2021 ◽

Author(s):

G. Niraj ◽

M. Mushambi ◽

P. Gauthama ◽

A. Patil ◽

A. Kelkar ◽

...

Keyword(s):

Cohort Study ◽

Low Back Pain ◽

Back Pain ◽

Dural Puncture ◽

Low Back ◽

Multicentre Cohort Study ◽

Accidental Dural Puncture ◽

Obstetric Population ◽

Persistent Headache ◽

Multicentre Cohort

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Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain: A 5- and 12-Month Follow-up Cohort Study

Physical Therapy ◽

10.2522/ptj.20130076 ◽

2013 ◽

Vol 93 (12) ◽

pp. 1603-1614 ◽

Cited By ~ 24

Author(s):

Karin Verkerk ◽

Pim A.J. Luijsterburg ◽

Martijn W. Heymans ◽

Inge Ronchetti ◽

Annelies L. Pool-Goudzwaard ◽

...

Keyword(s):

Cohort Study ◽

Low Back Pain ◽

Prognostic Factors ◽

Back Pain ◽

Short Form ◽

Low Back ◽

Multidisciplinary Therapy ◽

Patient Reported ◽

Specific Disability

Background Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain (CNSLBP). Objective The purpose of this study was to describe the course of disability and identify clinically important prognostic factors of low-back-pain–specific disability in patients with CNSLBP receiving multidisciplinary therapy. Design A prospective cohort study was conducted. Methods A total of 1,760 patients with CNSLBP who received multidisciplinary therapy were evaluated for their course of disability and prognostic factors at baseline and at 2-, 5-, and 12-month follow-ups. Recovery was defined as 30% reduction in low back pain–specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale (QBPDS) was ≤20 points at follow-up. Potential prognostic factors were identified using multivariable logistic regression analysis. Results Mean patient-reported disability scores on the QBPDS ranged from 51.7 (SD=15.6) at baseline to 31.7 (SD=15.2), 31.1 (SD=18.2), and 29.1 (SD=20.0) at 2, 5, and 12 months, respectively. The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey (SF-36) (Physical and Mental Component Summaries) at baseline. In addition, at 5-month follow-up, a shorter duration of complaints was a positive predictor, and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up. Limitations Missing values at 5- and 12-month follow-ups were 11.1% and 45.2%, respectively. Conclusion After multidisciplinary treatment, the course of disability in patients with CNSLBP continued to decline over a 12-month period. At 5- and 12-month follow-ups, prognostic factors were identified for a clinically relevant decrease in disability scores on the QBPDS.

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A Cohort Study and Conceptual Model for the Effect of Prior Incidents on Inereased Longevity and Recurrence of Low Back Pain (LBP)

Journal of Occupational and Environmental Medicine ◽

10.1097/00043764-199504000-00132 ◽

1995 ◽

Vol 37 (4) ◽

pp. 522

Author(s):

Edward S. Gibson

Keyword(s):

Cohort Study ◽

Low Back Pain ◽

Back Pain ◽

Conceptual Model ◽

Low Back

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Influence of weekday of admission and level of distress on length of hospital stay in patients with low back pain: a retrospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04529-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Emanuel Brunner ◽

André Meichtry ◽

Davy Vancampfort ◽

Reinhard Imoberdorf ◽

David Gisi ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Low Back Pain ◽

Back Pain ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Negative Binomial ◽

Length Of Hospital Stay ◽

Binomial Model ◽

Low Back

Abstract Background Low back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients’ multidimensional needs. Providing inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during weekends. Delays in therapeutic procedures may result in a prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates the influence of weekday of admission and distress on LoS of inpatients with LBP. Methods This retrospective cohort study was conducted between 1 February 2019 and 31 January 2020. In part 1, a negative binomial model was fitted to LoS with weekday of admission as a predictor. In part 2, the same model included weekday of admission, distress level, and their interaction as covariates. Planned contrast was used in part 1 to estimate the difference in log-expected LoS between group 1 (admissions Friday/Saturday) and the reference group (admissions Sunday-Thursday). In part 2, the same contrast was used to estimate the corresponding difference in (per-unit) distress trends. Results We identified 173 patients with LBP. The mean LoS was 7.8 days (SD = 5.59). Patients admitted on Friday (mean LoS = 10.3) and Saturday (LoS = 10.6) had longer stays, but not those admitted on Sunday (LoS = 7.1). Analysis of the weekday effect and planned contrast showed that admission on Friday or Saturday was associated with a significant increase in LoS (log ratio = 0.42, 95% CI = 0.21 to 0.63). A total of 101 patients (58%) returned questionnaires, and complete data on distress were available from 86 patients (49%). According to the negative binomial model for LoS and the planned contrast, the distress effect on LoS was significantly influenced (difference in slopes = 0.816, 95% CI = 0.03 to 1.60) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday). Conclusions Delays in interdisciplinary LBP management over the weekend may prolong LoS. This may particularly affect patients reporting high levels of distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients’ multidimensional needs reduces LoS in primary care hospitals.

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