Faculty Bibliography

Accommodations are interventions designed to reduce exposure to factors that limit the activities of an impaired individual. The process incurs costs due to job analysis, implementation and follow up. This theoretical paper expands a model of the ergonomic intervention process and provides data on costs of accommodating individuals with musculoskeletal disorders, particularly low back pain. Accommodations begin with evaluation and documentation of exposure to risk factors. The methods depend on the budget and clinical utility of the data. A full hazard analysis may require 1-hour managerial time plus 1-hour employee time per job. Studies by the Department of Labor and others indicate that at least a quarter of problem jobs could be addressed faster and for less than US dollars 500. Follow-up incurs variable employee and managerial time; an ergonomist may be required in 15% of cases. The benefit is expected mainly from reducing compensation costs. Universal solutions could increase the benefits

A taxonomy of functional assessment constructs was developed to help the Social Security Administration refine the measurements of work disability. This report addresses content validity of the new taxonomy by examining the relevance of its constructs to a specific disability, and by examining the relationship between these constructs and constructs in other taxonomies. Seven experts linked the new taxonomy to consequences of low-back impairments. The selected constructs were compared to those reported independently by patients (Harper AC, Harper DA, Lambert L, Andrews HB, Lo SK, Ross FM, Straker LM. Pain 1992; 50(2): 189-195). The International Classification of Impairments, Disabilities and Handicaps served to bridge the two exercises. The findings reveal that it is feasible to use the taxonomy to define the impact of a specific disability and consequently link it to a set of standard measurements. Low-back impairments may be best assessed through measures of physical functional limitations, vocational impact, and interpersonal and emotional behavior. The study did not yield cognitive and intellectual measures that were relevant to this impairment.

This study reports the test-retest reliability of a 25-item occupational risk factor questionnaire that can be self-administered in clinical settings and used in outcome studies of low back pain or return to work programs. Subjects were 24 patients (workers on sick leave due to acute low back pain), 29 co-workers on active duty in the same jobs in a utility company, and 53 supervisors. Eighty-six subjects were re-tested within a mean interval of 7-10 days; one group of 20 supervisors was re-tested within 81 days. The questionnaire was self-administered during individual interviews. Reliability was estimated by the kappa statistic as the agreement on the scores within the raters in each group. The agreement ranged from 'slight' (0.15) to 'almost perfect' (0.93) when the re-test interval was less than 43 days. Patients and non-patients were consistent in their assessment of the job demands. rights reserved