spine 10 x 25 initiative, research summit july 18 th, 2015 matthew smuck, md chief, physical...
TRANSCRIPT
Spine 10 x 25 Initiative, Research SummitJuly 18th, 2015
Matthew Smuck, MDChief, Physical Medicine & Rehabilitation
Associate Professor, Department of OrthopaedicsStanford University
Etiology of Spine-Related Disability: Occupational Factors
DISCLOSURES
Cytonics - Research support ($ - paid to institution)
Lumo BodyTech - Advisor (stock options)
BlueJay Mobile Health - Advisor (stock options)
Vivametrica - Founder (20% owner)
State Farm Auto Insurance - Consultant & Expert
Witness ($ - hourly)
ISIS - Board of Directors ($ - travel/honoraria)
The Spine Journal - Executive Editorial Board ($ - travel)
INTRODUCTIONOccupational Factors
- Back Pain Risk- Disability Risk
PerspectivesPreventionOpportunities
Spine-Related Disability
http://www.spine.foundation
OCCUPATIONAL FACTORS Specific tasks associated with back pain
- Heavy lifting- Frequent bending/twisting- Awkward postures- Whole body vibration- Prolonged sitting
Back injury claims highest in manual labor professions- Construction- Delivery- Manufacturing- Nursing
Spine-Related Disability
1. Hadler NM, Tait RC, Chibnall JT. Back pain in the workplace. JAMA. 2007;297:1594–6. [PubMed: 17426279]2. Gregg CD, McIntosh G, Hall H, Hoffman CW. Prognostic factors associated with low back pain outcomes. J Prim Health Care. 2014;6:23–30. [PubMed: 24624408]3. Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR. Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ.
2010;340:c1035. [PubMed: 20234040]
OCCUPATIONAL FACTORS
Prevalence rates similar between countries
Injury claim rates vary between countries- Cultural influences – Japan vs USA- Financial influences – Compensation - Psychological influences – Follows unemployment rates
Spine-Related Disability
1. Hadler NM, Tait RC, Chibnall JT. Back pain in the workplace. JAMA. 2007;297:1594–6. [PubMed: 17426279]2. Volinn E, Nishikitani M, Volinn W, Nakamura Y, Yano E. Back pain claim rates in Japan and the United States: framing the puzzle. Spine (Phila Pa 1976). 2005 Mar 15;30(6):697-704. PMID:
15770188
OCCUPATIONAL FACTORSRisk factors for chronicity and recurrence
(varied proof)- Lack of decision-making freedom- Low workplace social support- Return to work expectations- Salary inadequacy- Low prospects for promotion/development- Monotony
Spine-Related Disability
1. Hadler NM, Tait RC, Chibnall JT. Back pain in the workplace. JAMA. 2007;297:1594–6. [PubMed: 17426279]2. Gregg CD, McIntosh G, Hall H, Hoffman CW. Prognostic factors associated with low back pain outcomes. J Prim Health Care. 2014;6:23–30. [PubMed: 24624408]3. Sultan T. Al-Otaibi. Prevention of occupational Back Pain. J Family Community Med. 2015. PMCID: PMC4415130
OCCUPATIONAL FACTORSRisk factors for chronicity and recurrence
(varied proof)- Lack of decision-making freedom- Low workplace social support- Return to work expectations- Salary inadequacy- Low prospects for promotion/development- Monotony
Job Dissatisfaction
Spine-Related Disability
1. Hadler NM, Tait RC, Chibnall JT. Back pain in the workplace. JAMA. 2007;297:1594–6. [PubMed: 17426279]2. Gregg CD, McIntosh G, Hall H, Hoffman CW. Prognostic factors associated with low back pain outcomes. J Prim Health Care. 2014;6:23–30. [PubMed: 24624408]3. Sultan T. Al-Otaibi. Prevention of occupational Back Pain. J Family Community Med. 2015. PMCID: PMC4415130
HIGH JOB DEMANDS(Physical or Psychological)
Increased risk of injury
Reduced recovery
Occupational Factors
SPINE DISABILITY
http://www.brainpickings.org/2013/02/01/which-came-first-the-chicken-or-the-egg/
PERSPECTIVES
Spine-Related Disability
Risks for Disability Duration
Effect Size- Age
(1.30)- Sitting >75% (1.38)- Heavy work (1.40)- Dissatisfaction (1.40)- Vibration (1.67)- Obesity
(1.68)- Driving >75% (1.82)- Social isolation (2.13)- Severe depression (2.47)- General health (2.78)
Risks factors for Back Pain Odds
- Prior back pain 10x- Morbid obesity 4x- Heavy lifting
4x - Poor posture
2x
1. Steenstra IA, Verbeek JH, Heymans MW, Bongers PM. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occup Environ Med. 2005 Dec;62(12):851-60. PMID: 16299094
HIGH JOB DEMANDS(Physical or Psychological)
Increased risk of injury
Reduced recovery
Occupational Factors
SPINE DISABILITY “PREVENTION IS BETTER THAN CURE” ERASMUS
Secondary & Tertiary Prevention
Primary Prevention
OCCUPATIONAL FACTORS
Primary Prevention Opportunities
- Standardized assessment of job satisfaction
“THE PAY IS GOOD, AND I CAN WALK TO WORK.”JOHN F. KENNEDY
Spine-Related Disability
OCCUPATIONAL FACTORS
Secondary Prevention Opportunities
- Performance measures
Spine-Related Disability
OCCUPATIONAL FACTORS
Tertiary Prevention Opportunities
- Workplace involvement improves return to work rates
“EVERY NOTABLE WORK IS AT FIRST IMPOSSIBLE.”THOMAS CARLYLE
Spine-Related Disability
Thank You!
Matthew Smuck, MDChief, Physical Medicine & RehabilitationAssociate Professor, Orthopaedic Surgery
Stanford University