TY - JOUR
T1 - Disability Determination
T2 - Validity With Occupational Low Back Pain
AU - Tait, Raymond C.
AU - Chibnall, John T.
AU - Andresen, Elena M.
AU - Hadler, Nortin M.
N1 - Funding Information:
Supported by Agency for Healthcare Research and Quality grant R01-HS-013087-01.
PY - 2006/12
Y1 - 2006/12
N2 - Disability determination for occupational low back pain challenges indemnification systems because spinal pathoanatomy is weakly related to pain intensity and functional capacity, making judgments of disability vulnerable to such confounding factors as sociodemographic variables (eg, race, socioeconomic status). To assess the contribution of impairment, race, and socioeconomic status to disability ratings and post settlement functional status, the current study investigated 580 African American and 892 white workers' compensation claimants with occupational low back pain who were surveyed an average of 21 months after claim settlement. Results indicated that diagnosis, surgery, and medical costs (indicators of impairment) were associated with disability ratings at the time of case settlement. African American race was negatively associated with disability ratings and also with diagnosis/surgery and medical costs. Disability ratings, however, correlated only weakly with post settlement status at 21-month follow-up. The association between race and disability ratings suggests that inequities operate in disability determination. Furthermore, the relative lack of association between disability ratings and postsettlement status raises questions about the validity of disability determination for workers' compensation claimants with low back pain. Perspective: Results demonstrated apparent racial/ethnic disparities in treatment and little association between disability ratings and post settlement status. Together, these results raise questions about social justice in the management of occupational back pain, as well as the validity of associated disability determination processes.
AB - Disability determination for occupational low back pain challenges indemnification systems because spinal pathoanatomy is weakly related to pain intensity and functional capacity, making judgments of disability vulnerable to such confounding factors as sociodemographic variables (eg, race, socioeconomic status). To assess the contribution of impairment, race, and socioeconomic status to disability ratings and post settlement functional status, the current study investigated 580 African American and 892 white workers' compensation claimants with occupational low back pain who were surveyed an average of 21 months after claim settlement. Results indicated that diagnosis, surgery, and medical costs (indicators of impairment) were associated with disability ratings at the time of case settlement. African American race was negatively associated with disability ratings and also with diagnosis/surgery and medical costs. Disability ratings, however, correlated only weakly with post settlement status at 21-month follow-up. The association between race and disability ratings suggests that inequities operate in disability determination. Furthermore, the relative lack of association between disability ratings and postsettlement status raises questions about the validity of disability determination for workers' compensation claimants with low back pain. Perspective: Results demonstrated apparent racial/ethnic disparities in treatment and little association between disability ratings and post settlement status. Together, these results raise questions about social justice in the management of occupational back pain, as well as the validity of associated disability determination processes.
KW - Disability determination
KW - back pain
KW - outcomes
KW - racial/ethnic disparities
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UR - http://www.scopus.com/inward/citedby.url?scp=33845198656&partnerID=8YFLogxK
U2 - 10.1016/j.jpain.2006.05.007
DO - 10.1016/j.jpain.2006.05.007
M3 - Article
C2 - 17157782
AN - SCOPUS:33845198656
SN - 1526-5900
VL - 7
SP - 951
EP - 957
JO - Journal of Pain
JF - Journal of Pain
IS - 12
ER -