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Association of Comorbidity and Outcome in Episodes of Nonspecific Low Back Pain in Occupational Populations

Nordin, Margareta Drsci; Hiebert, Rudi BS; Pietrek, Markus MD, PhD; Alexander, Michelle MD; Crane, Michael MD, MPH; Lewis, Stuart MD

Journal of Occupational and Environmental Medicine: July 2002 - Volume 44 - Issue 7 - p 677-684
ORIGINAL ARTICLES
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We examined the relationship between comorbidity and first return to work after episodes of work-disabling, nonspecific low back pain (NSLBP). An inception cohort of workers with new episodes of NSLBP was identified from administratively maintained occupational health records. We compared 6-month return-to-work rates between workers with one or more comorbid conditions with those without documented comorbidity. Workers with comorbidity were 1.31 times more likely to remain work disabled than those with uncomplicated NSLBP, after adjusting for age, gender, lifting demands, and company membership (adjusted hazards ratio [HR] = 1.31; 95% confidence interval [CI] 1.12 to 1.52). Concurrent injury (ie, sprains or strains of the neck, upper extremity, and lower extremity; contusions; and lacerations) had the strongest association (adjusted HR = 1.49; 95% CI, 1.21 to 1.83), followed by musculoskeletal disorders (adjusted HR = 1.13; 95% CI, 0.77 to 1.66). Comorbidities should be routinely evaluated at first visit by occupational health professionals to better manage disability associated with LBP.

From the Occupational and Industrial Orthopaedic Center (Dr Nordin), and the Epidemiology Unit, Hospital for Joint Diseases, New York University Medical Center, New York, NY (Mr Hiebert); the Department of Traumatology and Reconstructive Surgery, General Hospital Wandsbek, Hamburg, Germany, and the Occupational and Industrial Orthopaedic Center, Hospital for Joint Diseases, New York University Medical Center, New York, NY (Dr Pietrek); Occupational Health, New York City Transit Authority, New York, NY (Dr Alexander); Occupational Health Department, Consolidated Edison of New York Inc, New York, NY (Dr Crane); and the Occupational and Industrial Orthopaedic Center, Hospital for Joint Diseases, New York University Medical Center, New York, NY (Dr Lewis).

Address correspondence to: Margareta Nordin, DrSci, Research Professor and Director, Occupational and Industrial Orthopaedic Center, Hospital for Joint Diseases, 63 Downing St, New York, NY 10014; margareta.nordin@ nyu.edu

This study was funded by the National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Grant No. 1 RO1 AR44288-01.

Copyright © by American College of Occupational and Environmental Medicine

©2002The American College of Occupational and Environmental Medicine