CHICAGO — Americans missed about 1.3 million workdays last year because their backs hurt. The cost, in terms of lost productivity and medical bills, was more than $16 billion.
This is not a little problem caused by a few malingerers. An estimated four out of five U.S. workers experience low back pain severe enough to stay out of work at some time during their careers, and 12% of those are chronic sufferers.
So it's a big problem--one that big business has done very little about until recently.
"About 1% of the work force is on permanent disability because of back injury," says Holly Mayer, a registered nurse and physical therapist. "Their company is paying them and may never see another day at work.
"It makes sense that it would be worth quite a bit to make them a working member of society again."
At the Productive Rehabilitation Institute of Dallas for Ergonomics, where Mayer is on faculty, they are charging $7,000 to $10,000 to do just that.
Through a comprehensive three-week, 171-hour program, the institute evaluates the functional deficits of the injured worker and implements a program to restore them. The regimen of exercise, training, education and work simulation is followed by several weeks of tests and monitoring to ensure the worker can do his work.
Even at the hefty price, at least a few insurance companies and businesses are beginning to realize comprehensive back rehabilitation is a bargain.
"The bottom line is they would end up paying out more in worker's comp and medical bills otherwise," Mayer says. "And we get them back to work."
In a recent Journal of the American Medical Assn., Mayer and researchers from the University of Texas Health Science Center compared 116 patients treated at the institute with 72 patients who were similar in all respects except that their insurance company refused to cover the program.
"These were all bad cases," Mayer says. A third of both groups had had back surgery, in many cases multiple surgeries. On average, their injuries had kept them out of work for 1.2 years. Two-thirds suffered from clinical depression.
Most Back at Work
Nevertheless, the back rehabilitation program put most back to work.
After one year, 85% of the treatment group was working, compared to only 39% of the comparison group; after two years, 87% of those treated and 41% of the comparison group were working.
Furthermore, in the year following treatment, only 33% of the rehab group saw a physician for the same injury, compared to 75% of the untreated group. The untreated group also made significantly more visits to the doctor (21 vs. 2.3 for the treated group).
These results, Mayer acknowledges, are a remarkable departure from the disappointing performance of other pain clinics.
"In fact, it was criticism of these earlier programs that led many insurance companies and employers to believe they weren't worth the money," she says. "But that's because early pain clinics did not do full functional analysis, and did not actively try to rehabilitate the back. They just had these stretching exercises and pain control, which doesn't get the person back to work.
"They treated the back like a bunch of bones," she said. "We know better now."