Tool helps target worker injury risk
Primary prevention presents greatest challenge
Everyone loses when workers are injured or disabled for long periods of time. For example, a bilateral carpal tunnel syndrome surgery can cost as much as $75,000 in direct and indirect costs," notes Mark Melhorn, MD, an orthopedic hand surgeon at The Hand Center in Wichita, KS. The high costs of injury, both in treatment and in lost time and productivity, are what drive Melhorn and his colleagues to focus on injury prevention. In reality, he notes, there are three prevention formats:
• Primary prevention: Keeping injuries and illnesses from occurring.
• Secondary prevention: Traditional healthcare; diagnosis and treatment.
• Tertiary prevention: Designed for injuries that have reached advanced stages and threaten to produce significant side effects and complications.
Of the three, says Melhorn, primary prevention is the most cost-effective. It is also the most difficult, however, requiring an instrument or a tool to measure risk. To that end, Melhorn and his colleagues developed a questionnaire to help determine risk levels. Based on the responses, a score of 1-7 is assigned. Those at a level of five or higher are considered high risk.
"The biggest challenge is actually preventing something that may not occur," Melhorn admits. "Let’s say you come to me and we test you and find that based on your risk characteristics you are more likely to have muscle pain with physical activity than your co-worker, and we assign you a relative value of six. Then, we start you on an exercise program, we look at the workstation and make changes, and you never develop a problem. Now the question is, is identifying you as at risk’ what prevented you from ever having a problem, or would you not have had one anyway?"
Worth the effort
Despite the inherent uncertainty, says Melhorn, the benefits of early detection argue in favor of identifying at-risk employees. "If you’re overweight for one year and then decide to lose weight, it will not have a long-term effect," he poses. "If you are overweight for five or 10 years, you are more likely to have negative cardiovascular components. In our scenario, the longer you perform physical activities in an awkward position, the more likely you are to have muscle pain in the future. If we identify people who are at risk early and make some small changes, we are more likely stop injuries down the road. If we find out too late, we may run into problems that require, say, carpal tunnel surgery."
It is precisely the avoidance of such expensive — and painful — complications that led to the creation of the questionnaire. It is, says Melhorn, like an HRA (Health Risk Appraisal) for musculoskeletal pain. It includes 85 questions, covering everything from the employee’s age and gender to their genetic makeup (diabetes, arthritis, and so on). Questions are asked about current symptoms, such as muscle pain. (See box below.)
Sample questions from the Hand Center risk survey
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"These pieces are statistically analyzed, and we come up with a risk score of 1-7. If you are at higher risk, you could benefit from primary prevention in the form of education, awareness, physical exercise and conditioning and modification of tasks," says Melhorn. The questions are asked in a confidential manner, he says. "We only send back composite scores for the individual."
Such screenings are rare in occupational medicine, Melhorn asserts, "We do cancer, diabetes and stroke protection screenings, but very few companies do musculoskelatal pain prevention," he says. "A physical exam tells you where a person is today, but a symptom survey gives you a better idea of predicting the future."
The management challenge
Convincing upper management that such a screening is necessary can be difficult, Melhorn admits. "Most people in health care management come from a traditional management background that does not include a broad exposure to the concept of prevention — even in a hospital situation," he says. Nevertheless, Melhorn adds, they sit up and take notice when presented with survey results. "We’ve done research with a local hospital, where most employees have jobs they considered to be low risk, like unit clerks. However, when they scored high risk on the survey, that spurred them into a desire to do prevention on a wide-scale basis."
Melhorn says his group is interested in sharing its tool with occupational health professionals who want to start using primary prevention; in fact, they will allow participants to use it for a period of one year to see how beneficial it is for them. "We want to increase our database," he explains. "We are willing to offer the use of our instrument for one year for free. In exchange, we ask only that the facility share their costing data to help us demonstrate the value of the survey."
[For more information, contact Mark Melhorn, MD, The Hand Center, 625 North Carriage Parkway, Suite 125, Wichita, KS 67208. Telephone: (316) 688-5656. E-mail: [email protected].]
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