Preventing Chronic Disability from Low Back Pain - Welfare.ie

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7. MEDICAL ASSESSMENTSAs part of the project it was necessary to train medical assessors in the use ofthe Diagnostic Triage which categorises LBP into 3 main groups, to determinemanagement.The 3 groups are:1. Simple Back Pain – majority of cases (approximately 95%), prognosis isexcellent, with recovery expected in days to weeks.2. Nerve Root Pain – 3-5% of cases, prognosis is moderate, with recoveryexpected in weeks to months, only a minority requiring surgery3. Potential Serious Spinal Pathology – 1-2% of cases, which includes fractures,infections, inflammatory conditions and tumours. Prognosis depends on thediagnosis.Cases in the Simple Back Pain category were considered for work capacity.Fitness for work was determined not solely through categorisation as SimpleLBP. Medical assessors also took into consideration other relevant factors suchas the severity of the symptoms, type of work involved and potential for workrestriction or accommodation in the workplace.Cases in the other categories Nerve Root Pain and Potential Serious SpinalPathology were considered to be unfit for work for varying periods, dependingon the diagnosis.Detailed records of medical assessments were held for analysis which includeda breakdown by gender, work type and age group. See Appendix D.10
8. RESULTSThe incidence of progression from the acute Simple LBP to chronic disabilityemploying the method described above was reduced significantly; 64 per centof the LBP cases assessed under the project were declared capable of work,compared to circa 20 per cent of all claimants with a variety of illnesses,including LBP, who were assessed under the DB/IB schemes in 2002. SeeAppendix E.Under the DB/IB schemes where a person is found capable of work s/he canappeal against this finding. When this occurs the person undergoes a secondassessment by a different assessor who can find the person capable orincapable of work. Under the project fewer people appealed against thecapable decision than for all DB/IB claims in 2002 (44% versus 61%). Followingthe second assessment the percentage of people found incapable was 17%under the project. For all DB/IB claims in 2002 the percentage found incapableat the second assessment was 49%. See Appendix F.In comparisons with a similar group over a similar period in the previous year(the control group) there was a circa 40% reduction in claims progressing tolong duration. See Appendices G and H.A secondary benefit of the project is that the reduction in duration resulted in areduction in expenditure on the DB/IB schemes. If the patterns in expenditurein the project were retrospectively applied to expenditure in 2002 the estimatedsavings that would have occurred in DB/IB expenditure on LBP claims in 2002are shown in Appendix I.11
Page 1: Preventing Chronic Disabilityfrom L
Page 6 and 7: AcknowledgmentsThe author wishes to
Page 8 and 9: RENAISSANCE PROJECTPreventing Chron
Page 10 and 11: In appreciation of the facts that:a
Page 14 and 15: 9. PROMOTING THE RENAISSANCE PROJEC
Page 16 and 17: 14APPENDICES
Page 18 and 19: APPENDIX A2:FORMS DESIGNED FOR USE
Page 20 and 21: 3.2 CAUDA EQUINA SYNDROMEYES NO●
Page 22 and 23: C: MEDICAL REPORT ON BACK CONDITION
Page 24 and 25: APPENDIX BGROWTH IN ILLNESS SCHEMES
Page 26 and 27: APPENDIX CSTATEMENTS FROM INTERNATI
Page 28 and 29: APPENDIX EOUTCOMES OF MEDICAL ASSES
Page 30 and 31: APPENDIX FOUTCOMES FOR APPEALS CASE
Page 32 and 33: APPENDIX GANALYSIS OF CLAIMS DURATI
Page 34 and 35: APPENDIX HOUTCOMES OF CALLS FOR ASS
Page 36 and 37: APPENDIX IESTIMATED SAVINGS FROM PR
Page 38: Table J: Comparison of outcomes of

Preventing Chronic Disability from Low Back Pain - Welfare.ie

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