No Consensus So Far on Best Way to Prevent Disability Following Back Injury
Many studies have been done regarding prevention and management of disabilities following back injuries. Despite these studies, there’s still little agreement as to what factors are the most important and how to tackle the problem of back injury disability. Many of the studies and recommendations have differing opinions.

In order to reach a consensus on the topic, the authors of this study, a modified Delphi panel, recruited 33 researchers and occupational stakeholders (those who cared for patients, workers, employers, and insurance representatives) to review evidence summaries of 32 factors that contribute to back injury disability. The study participants were asked to rank the factors in order of priority in their opinion, taking into account the factors’ relative impact on patients and their modifiability. Factors included those such as fitness, workplace stress, back supports, provider reassurance, pain and depressive symptoms.

After the ranking was evaluated, the researchers found that there were significant differences in opinion regarding the effect of the factors on a patient’s ability to return to work, the foremost indicator of recovery from back injury in most studies. That being said, there were two areas that did indicate a strong consensus among the participants. One was regarding the impact of care provider reassurance; this was considered important. This has also been a factor documented in several earlier studies. The second factor was regarding the use of back support and its low impact on occupational participation.

Other factors were agreed upon, although not overwhelmingly, such as expectation of recovery, decreased fears, and increased knowledge.

The authors concluded that there were many discrepancies among the panel members and that this led to an inability to agree on the relative impact and modifiability of different factors that contribute to back injury recovery. Because of the great variety in ranking, programs for back disability prevention intervention should try to include multiple factors simultaneously, allowing the patient to benefit from each. More research does need to be done on the interventions and the authors point out that results need to include other aspects of patients’ lives, including functioning in the home and non-occupational activities.
Jaime Guzman, MD, et al. Key Factors in Back Disability Prevention. In Spine. April 1, 2007. Vol. 32. No. 7. Pp. 807-815.