Increased expenditures for other health conditions after an incident of low back pain.

STUDY DESIGN: We reviewed healthcare expenditures in a random sample of 655 patients from a managed health plan with new onset low back pain (LBP) in 1999. OBJECTIVE: To understand the affect of LBP on health care utilization for other health conditions. SUMMARY OF BACKGROUND DATA: Researchers often consider individual diseases in isolation rather than seeking a more comprehensive picture of comorbid conditions and their collective influence. Although underlying health conditions may exacerbate LBP, as has been discussed extensively, minimal attention has been given to the potential affect of LBP on other conditions. METHODS: We compared the healthcare expenses using 30-, 60-, and 90-day back care time windows before and after the initial LBP visit. Diagnostic (International Classification of Diseases, Ninth Revision) and treatment codes (Current Procedural Terminology [CPT]) were used to identify the expenditures for LBP and other conditions. RESULTS: Average monthly expenses per patient for other health conditions increased after LBP initiation when compared with the prior 1 to 3 months. This increase persisted even after the following conservative adjustments: (a) excluding all radiology expenses that occurred coincident with LBP; (b) excluding billings for non-LBP conditions that occurred on days of any LBP visit because these charges may have reflected mere convenience "shopping or servicing" behavior; (c) excluding patients with a baseline of low healthcare utilization before LBP initiation because convenience may have been especially important for this cohort. Patients with greater non-LBP expenses were likelier to have been prescribed psychiatric medications. CONCLUSION: LBP episodes were associated with increased expenditures for other health conditions. This suggests that the traditional estimates of LBP based primarily on LBP services underestimate the true cost of the condition. Further research may help to delineate the role of LBP, along with physical or mental comorbidities in boosting non-LBP costs.

Physiotherapy, steroid injections, or rest for lateral epicondylosis? What the evidence suggests.

OBJECTIVE: To identify effective lateral epicondylosis interventions and assess the quality of research over time. METHODS: Relevant MEDLINE and EMBASE searches respectively yielded 226 and 187 potential studies. Additional citations were extracted from bibliographies. Thirty controlled trials met inclusion criteria. The Cochrane Collaboration guidelines "quality score" served to rate studies. RESULTS: In the short term (<2 to 3 months) steroid injections and physiotherapy outperformed relative rest. Physiotherapy appears efficacious regardless of time frame. After 3 months, active physiotherapy outperforms injections, but does not appear significantly better than rest. Evidence was neutral or insufficient regarding ultrasound, splinting, or manipulation. Nonsignificant correlations between publication year and study quality score were found. CONCLUSIONS: Overall research quality has not improved with time. Steroid injections appear the most successful short-term intervention for pain relief. Active physiotherapy appears efficacious regardless of time frame.

Return to work for a company president with traumatic brain injury.

Return to work remains a central issue for many traumatic brain injury (TBI) patients. The present literature generally ignores the complex work issues involved for high-functioning individuals, in whose hands may lie the fate of many other workers. This case discusses return-to-work challenges facing a 64-year-old high-technology company founder and president. Following a bicycling accident, he sustained intracerebral hemorrhage with an initial Glasgow Coma Scale of score 12. Although postmorbidly he still maintained a relatively high level of cognitive functioning, his case highlights special challenges during workplace rehabilitation of patients with cognitively demanding jobs, including (a) a higher potential for patient frustration given the gap between function and job expectations and (b) confidentiality issues regarding business employees and competitors. Rehabilitation health care providers can benefit from lessons learned here, including tapping into these patients' strong motivation for return to work, accessing the likely higher remaining cognitive level, and drawing upon the likely strong social and professional networks available. Finally, the importance of the role of stress-management techniques in order to cope with high frustration levels is highlighted.

Health effects and occupational exposures among office workers near the World Trade Center disaster site.

The extent of health effects and exposure to environmental contaminants among workers and residents indirectly affected by the September 11, 2001, attack on the World Trade Center (WTC) is unknown. The objective of this study was to evaluate concerns related to health effects and occupational exposures three months after the WTC disaster among a population of employees working in a building close to the disaster site. A cross-sectional questionnaire survey was performed of Federal employees working near the WTC site in New York City (NYC) and a comparison group of Federal employees in Dallas, Texas. An industrial hygiene evaluation of the NYC workplace was conducted. Constitutional and mental health symptoms were reported more frequently among workers in NYC compared to those in Dallas; level of social support was inversely related to prevalence of mental health symptoms. Post-September 11th counseling services were utilized to a greater degree among workers in NYC, while utilization of other types of medical services did not differ significantly between the groups. No occupational exposures to substances at concentrations that would explain the reported constitutional symptoms were found; however, we were unable to assess potential occupational exposures in the time immediately after the WTC disaster. There is no evidence of ongoing hazardous exposure to airborne contaminants among the workers surveyed. Specific causes of reported constitutional health symptoms have not been determined. Health care providers and management and employee groups should be aware of the need to address mental health issues as well as constitutional symptoms among the large number of workers in the NYC area who have been indirectly affected by the WTC disaster.