VISUAL ANALOG PAIN SCALE (VAPS) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

In the Workers’ Compensation System, Doctors and Medical Evaluators ask Injured Workers to fill out various scales and questionnaires. One of these scales is the Visual Analog Pain Scale (VAPS.)

Scales and questionnaires can impact an Injured Worker’s ability to get treatment and disability payments. Therefore, Injured Worker should understand how to answer them properly.

This article will discuss the Visual Analog Pain Scale(VAPS), how the VAPS is administered, how VAPS is to be answered, how VAPS is graded, and how VAPS can be used within the workers’ compensation setting.

What is VAPS? What Is it Designed to Measure?

The Visual Analog Pain Scale is “a unidimensional measure of pain intensity, which is utilized in diverse adult populations.”  Measure of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP) Gillian A. Hawker, Samra Mian, Tetyana Kendzerska Melissa French 07 November 2011 https: //doi.org/10.1002/acr.20543

The VAPS is intended to explore the issue of pain.

What Does VAPS Look Like?

The VAP Scale can be set up either horizontally or vertically. Supra.

This is an example of a scale:    0 “no pain”   |————————————————–| 100 “worst imaginable pain.”

How Many Questions Are There in VAPS?

One. It is the simple answering of one’s pain level.  This is done by marking a spot on the spectrum to describe the pain. Supra.  The spot can be measured and assigned a number.  See below.  Some scales allow for the patient to assign a number.

How is the Score Interpreted?

“A higher score indicates greater pain intensity. Based on the distribution of pain VAS scores in post surgical patients (knee replacement, hysterectomy, or laparoscopic myomectomy) who described there postoperative pain intensity as none, mild, moderate, or severe, the following cut points on the pain VAS have been recommended: no pain (0-4mm), mild pain (5-44mm), moderate pain (45-74 mm) , and severe pain (75-100 mm) ” Supra.

Why Are These Terms important?

In workers’ compensation, the evaluators look at pain. Pain is often characterized by the terms of slight, moderate or severe.

The definitions for slight, moderate and severe are different in the field of industrial medicine. California used to use them to assign permanent disability.  In order to do so, they defined the terms.  The 1997 Permanent Disability Rating Schedule defined the terms as follows: “Pain is not always disabling. It becomes disabling when its degree affects function. Regulations define four degrees of subjective pain – minimal, slight, moderate and severe. By definition, minimal (mild) pain is not disabling because it causes no handicap in the activity precipitating the pain. However, slight, moderate and severe pain reflect increasingly greater degrees of handicap on work activity, and are ratable factors of disability.” P.1-7.  While these terms are no longer used for permanent disability purposes, they are frequently documented in medical reports.

Pain’s nature and extent, in certain circumstances, can be a factor in assessing whole person impairment. Whole person impairment is then translated into permanent disability.

How Can Testing Impact Injured Workers’ Claims?

Testing creates credibility issues.  When an Injured Worker provides a 100 score, it means either that they are in severe pain, they are exaggerating, or that they are making a cry for help.  In cases with minor injuries, high scores will impact the credibility of the pain reporting.

Also, an injured Worker may wish to ask how the question should be answered. Pain level when medicated or pain level during a certain period of time, i.e. this moment or this week, are legitimate questions.

What Is the Problem with this VAP Scale?

Pain assessments can be confounded with respect to an individual’s “pain reference.”

Some individuals have never experienced severe pain in their life.  For women who have experienced childbirth and for those who have passed a kidney stone, their pain references, however, can be in the severe range.  Thus, an individual’s past medical conditions is important to review as a reference.

It is quite conceivable that they have experienced pain in the 90s up to 100.   Some individuals also have strong pain tolerances.  A 70 to them would be a 95 to others Thus, these individual’s reporting may only be relevant when compared to other  assigned scores provided on different dates of evaluation or treatment.

How Should an Injured Worker Answer the VAPS?

An Injured Worker should make their best effort to accurately describe their pain.

If there is any confusion concerning how to answer or mark the scale, you should clarify with the evaluator. For instance, you could be a 50 on medications and a 70 without.  Thus, it is important that the doctor or evaluator understand your reason for assigning a particular level of pain.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.

THE QUEBEC BACK PAIN DISABILITY SCALE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

For both workers’ compensation treatment and evaluation, Injured Workers are frequently asked to fill out surveys concerning their medical conditions. The Quebec Back Pain Disability Scale (QBPDS) is one of those surveys.

This article will discuss how and why such scales are used within the workers’ compensation system, what is the Quebec Back Pain disability Scale, what questions are asked within the scale, how the scale is scored? and what it can mean to a workers’ compensation claim.

What is the QBPDS?

This questionnaire is one that addresses back pain.  It inquires as to the daily activities that impacted by Back Pain.

Why are Surveys and Scales Used?

Surveys and Scales which ask the Injured Worker to self-report on their conditions are helpful to both treating doctors and evaluators.  First, they are a cheap quick method of getting some insight into the Injured Worker’s complaints.  Second, they can give the doctor or evaluator a sense of how serious the worker perceives their injury.  Third, they can give some insight as to whether someone is exaggerating with respect to the complaints. Fourth, if the same scale is administered over time, it can reveal some insight as to the course of the injured Worker’s condition.  Repeated testing may show whether the Injured Worker sees their pain improving, staying the same, or getting worse.

What are the QBPDS Questions Asked?

There are twenty questions asked within the inventory. The questions are about getting out of bed, sleeping through the night, turning over in bed, riding in a car, standing up for 20-30 minutes, sitting in a chair for several hours, climbing one slight of stairs, walking a few blocks, walking several kilometers, reaching up to high shelves, throwing a ball, running one block, taking food out of the refrigerator, making your bed, putting socks or pantyhose on, bending over to clean the bathtub, moving a chair, pulling or pushing heavy doors, carrying two bags or groceries, and lifting and carrying a heavy suit case.

Note: The questions are interesting in that they include activities that an individual may rarely or never participate in.  For example, there are some people who do not throw balls or handle suit cases.

How Are the Responses Scored?

There are five responses that can be made. They are not difficult at all, minimally difficult, somewhat difficult, fairly difficult, very difficult, and unable to do.  They are scored from 0-5.

Note: The responses address ability to perform activities as opposed to the individual’s pain experience.

What Do the Scores Mean?

A higher score represents a greater level of perceived functional disability.  A lower score represents a lower level of perceived functional disability.

Is The QBPDS Helpful for Treating Evaluators and Physicians With Respect to Permanent Disability Assignment?

In California Workers’ Compensation Law, Activities of Daily Living are a basis for making impairment assessments.  Impairment assessments render a Whole Person Impairment which then translates into a Permanent Disability Percentage. The QBPDS can be helpful to an evaluator on their assessment.  The Activities of Daily Living based upon the AMA Guides 5th Edition are Self-care: urinating, defecating, brushing teeth, personal hygiene combing hair, bathing, dressing oneself, and eating,  Communication:  writing, typing, seeing, hearing, and speaking, Physical activity:  standing, sitting, reclining, walking, and climbing stairs, Sensory Function: hearing, seeing, tactile feeling, tasting, smelling, Nonspecialized Hand Activities: grasping, lifting, tactile discrimination,  Travel: riding, driving, flying, Sexual Function: orgasm, ejaculation, lubrication, erection, and Sleep: restful and nocturnal sleep pattern.

The QBPDS does not explore self-care and sexual function. Therefore, it is not fully comprehensive to render an ADL assessment.

As an Injured Worker, What Should I Do When I Fill Out These Scales?

When fill out these scales, try to be accurate as possible. Sometimes, I personally roll my eyes when I see scales in which every answer is the highest.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

 

 

 

AGE, PHYSICAL DEMANDING JOBS AND MUSCULOSKELETAL DISORDERS: OLDER WORKERS AT RISK FOR WORK INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

The Labor Market in the United States is aging. As a result, Older Workers are performing a large variety of task within the Open Labor Market. Older Workers performing more tasks that make them at risk for work injuries. This is the case with respect to musculoskeletal injuries. Musculoskeletal injuries are commonly known as orthopedics injuries which include medical conditions with respect to the spine, the upper and the lower extremities. A study was done with respect and there were some findings made.

This article will discuss Older Workers, injury rates for Older Workers, and laws which impact Older Workers’ Workers’ Compensation Claims.

Does Age Matter When Looking at the Risk of Work Injuries?

Age alone is not the issue. The type of labor is what is of import. In the labor market, there are jobs with minimal physical demands. There are other jobs which involve greater physical demands. Thus, some Older Workers perform light duty jobs such as receptionists or greeters. Other Older Workers perform more arduous jobs such as warehouse worker or construction worker.

The study, of interest, focused on jobs with physical demands.

Old Age combined with greater physical demands were relevant with respect to work injuries. See P. M. Smith, J. Berecki-Gisolf, Age, occupational demands and the risk of serious work injury, Occupational Medicine, Volume 64, Issue 8, December 2014, Pages 571–576, https://doi.org/10.1093/occmed/kqu125

It was found when the occupational [physical] demands were greater there was an increase of risk of injury. Further, “[t]he relationship between age and claim-risk was strongest when occupational demands were highest.” P. M. Smith, J. Berecki-Gisolf, Age, occupational demands and the risk of serious work injury, Occupational Medicine, Volume 64, Issue 8, December 2014, Pages 571–576, https://doi.org/10.1093/occmed/kqu125

Is the Increase Risk Associated only with Musculoskeletal Injuries?

It was found that “Older age was associated with a higher risk of work injury claims for both musculoskeletal and non-musculoskeletal conditions,” P. M. Smith, J. Berecki-Gisolf, Age, occupational demands and the risk of serious work injury, Occupational Medicine, Volume 64, Issue 8, December 2014, Pages 571–576, https://doi.org/10.1093/occmed/kqu125

Is there a Difference Between Musculoskeletal vs. Non-Musculoskeletal Disorders?

Yes. “with a slightly stronger relationship observed for occupational physical demands and risk of musculoskeletal, compared with non-musculoskeletal, conditions.” P. M. Smith, J. Berecki-Gisolf, Age, occupational demands and the risk of serious work injury, Occupational Medicine, Volume 64, Issue 8, December 2014, Pages 571–576, https://doi.org/10.1093/occmed/kqu125

Are There any Laws or Rules in Workers’ Compensation that Assist Older Workers?

Yes. Age is factored as part of the Permanent Disability Rating Formula.
Per the Schedule for Rating Permanent Disabilities, California Workers’ Compensation Law provides for an age adjustment which provides for an increase in permanent disability for ages 42 and older. It also scales up with age and tops out at age 62. The age used in this assessment is the age on the date of injury. There is a table upon which you obtain the figures. It is on Pages 6-1-6-5. See SCHEDULE FOR RATING PERMANENT DISABILITIES UNDER THE PROVISIONS OF THE LABOR CODE OF THE STATE OF CALIFORNIA (2005)

Are There Any Rules that Do Not Assist Injured Workers?

Yes. There is a legal issue of apportionment. Apportionment is a tool allowed to reduce an Injured Workers’ Award.

Labor Code Section 4663, provides that “[a] physician shall make an apportionment determination by finding what approximate percentage of the permanent disability was caused by the direct result of injury arising out of and occurring in the course of employment and what approximate percentage of the permanent disability was caused by other factors both before and subsequent to the industrial injury, including prior industrial injuries. See Escobedo v. Marshalls, CNA Ins. Co., 70 Cal. Comp. Cases 604, 2005 Cal. Wrk. Comp. LEXIS 71 (W.C.A.B. April 19, 2005). In Escobedo, the board indicated that apportionment of permanent disability can be made based on the preexisting arthritis in applicant’s knees was found acceptable. Note: Older Employees are more likely to have pre-existing arthritic processes which could allow for apportionment to be found.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

YOUNGER WORKERS AND WORK INJURIES:  YOUTHFUL WORKERS, SPECIAL CONCERNS FOR YOUNGER WORKERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

“When I was young, it seemed that life was so wonderful”

Supertramp

Does Age matter?  Yes.  Younger Workers get injured at different rates than Older Workers.  A recent study brought light onto the issue of Age as a factor with respect to Work Injuries.

Younger Workers make up a significant number of the workforce.  Adolescents and Young Adults represent approximately 13% of the U.S. workforce. Guerin RJ, Reichard AA, Derk S, Hendricks KJ, Menger-Ogle LM, Okun AH. Nonfatal Occupational Injuries to Younger Workers — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:1204–1209. DOI: https://dx.doi.org/10.15585/mmwr.mm6935a3external icon.

As a result of this, like all workers, they sustain work-related injuries. Per a study, it was estimated that “3.2 million nonfatal injuries to young workers were treated in hospital emergency departments, with the highest rates among workers aged 18–19 years. Data from 2018 indicate that the leisure and hospitality industry [i.e. food service such as McDonalds hotels, and amusement parks] contributed the highest percentage of injuries to workers aged 15–17 years requiring at least 1 day away from work.” Guerin RJ, Reichard AA, Derk S, Hendricks KJ, Menger-Ogle LM, Okun AH. Nonfatal Occupational Injuries to Younger Workers — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:1204–1209. DOI: https://dx.doi.org/10.15585/mmwr.mm6935a3external icon.

This article will discuss the rates of injury for Younger Workers, the implications for Younger Workers who sustain work injuries, the special concerns a Workers’ Compensation Attorney has with respect to these claims, and how the Workers’ Compensation Systems addresses Younger Workers’ Permanent Disability.

What Was the Study?

The study  that was done looked into nonfatal occupational injuries of Younger Workers within the United States during the years 2012 to 2018.  Guerin RJ, Reichard AA, Derk S, Hendricks KJ, Menger-Ogle LM, Okun AH. Nonfatal Occupational Injuries to Younger Workers — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:1204–1209. DOI: https://dx.doi.org/10.15585/mmwr.mm6935a3external icon.

How Does Age Make a Difference?

Yes. It was found that Younger Workers, aged 15-24, experienced a higher rate of job-related injury versus Adult Workers, aged 25-44.  Supra.

Are There Any Interesting Facts Concerning the Injury Rates?

AGE RANGE WITH HIGHEST RATE OF INJURY: The highest injury rate (404 per 10,000 FTE) occurred among workers aged 18–19 years.

MALE VERSUS FEMALE: Within each of the four age categories, the rate of injury was 1.4 to 1.5 times higher among males than among females.

YOUNGER VERSUS MIDDLE AGED WORKERS:  Annual rates of injuries among young workers aged 15–24 years were 1.2–2.3 times higher than those for workers aged 25–44 years. Guerin RJ, Reichard AA, Derk S, Hendricks KJ, Menger-Ogle LM, Okun AH. Nonfatal Occupational Injuries to Younger Workers — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:1204–1209. DOI: https://dx.doi.org/10.15585/mmwr.mm6935a3external icon.

How Do Young People Get Hurt?

Younger Workers can get injured in a variety of ways.  One of the reasons why Younger Workers get injured is that they are often learning on the job. This makes them more susceptible to injuries.

For example,

“Contact with objects and equipment was the leading cause of occupational ED-treated injuries among all age groups examined, with rates of injuries ranging from 64 per 10,000 FTE among workers aged 25–44 years to 182 per 10,000 FTE among workers aged 18–19 years.” Supra.

“Lacerations and punctures were the most common type of ED-treated injuries reported among workers aged <25 years, with injury rates ranging from 66 to 99 per 10,000 FTE, “ Supra.

To the contrary, it should be noted that

“strains and sprains were most common among workers aged 25–44 years (injury rate of 47 per 10,000 FTE).” Supra.

Why are Work Injuries to Younger Workers a Concern?

One of the big concerns with respect to Younger Workers in California is the issue of lifetime medical care.   Young Workers, to some extent, are more able to recover from injuries versus Older Workers.

Some injuries that have long term implications.   There are injuries which can cause arthritis.   Arthritis can take decades to become a problem for the worker. Therefore, Younger Worker may need medical care decades after the injury happened.  Many Young Workers do not understand or appreciate this fact.   This is an issue of discussion concerning settlement of their case.

How Does the California Workers’ Compensation System View Younger Workers’ Permanent Disability?

Younger Workers’ Permanent Disability is not viewed as significant as older workers’ permanent disability.  For the same injury, a Younger Worker will receive less money than an Older Worker.

How is a Younger Worker’s Age Factored into Permanent Disability?

In the SCHEDULE FOR RATING PERMANENT DISABILITIES UNDER THE PROVISIONS OF THE LABOR CODE OF THE STATE OF CALIFORNIA (2005) , there is a provision for adjusting with respect to the Injured Worker’s age.

One of the steps in the permanent disability rating formula is to make an age adjustment.  Using a Table, a Younger Worker’s Permanent Disability is lowered via the rating adjustment.   See Schedule at P. 1-9.

In sum, the Schedule has a specific table that is used in a permanent disability rating formula to lower the disability rating. The disability rating being lowered translates into less money for the Injured Worker.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information.

 

THE OWESTRY DISABILITY INDEX(ODI) AND WORKERS’ COMPENSATION: BACK INJURIES, EVALUATIONS, TREATMENT AND INDEXES: WHAT YOU NEED TO KNOW

Injured Workers are frequently given questionnaires and indexes to fill out as part of their workers’ compensation treatment and evaluations.   These questionnaires and indexes can play an important role with respect to workers’ compensation benefits.

One of the indexes that an Injured Worker may encounter is the Owestry Disability Index. This article will discuss the Owestry Disability Index (ODI), what it is used for, how is it scored, problems with scoring, and how it is used for in the workers’ compensation setting.

Why Are Indexes Used?

Indexes are a quick way of address one’s disability state.  Sometimes,  simple questions can provide an accurate picture as to an Individual’s physical state and their capabilities. In Workers’ Compensation, due to the employment of the American Medical Association Guide to the Evaluation of Permanent Impairment, 5th Edition, there is a focus on an Individual’s “Activities of Daily Living.” For an article on Activities of Daily Living, click here.

What is the Oswestry Disability Index?

“The Oswestry Disability Index (ODI) is one of the most commonly used outcome measures for individuals with low back pain (LBP)”Psychometric properties and clinical usefulness of the Oswestry Disability Index, Michael Vianin J Chiropr Med. 2008 Dec; 7(4): 161–163.

doi: 10.1016/j.jcm.2008.07.001 PMCID: PMC2697602 PMID: 19646379

“The ODI is a self-administered questionnaire that requires 5 minutes to complete and 1 minute to score. Scores are associated with degree of disability ranging from minimal to bedbound. The ease of administering, scoring, and interpreting renders the ODI a potentially meaningful tool in clinical practice.” Supra.

What is the Owestry Disability Index Used For?

As noted above, the Owestry Disability Index is used to make assessments for Low Back Injuries. Essentially, it is the self-reporting of the Patient.

For workers’ compensation purposes, functional status is important in assessing a variety of workers’ compensation issues. These issues can include disability status- temporary total, permanent and stationary, permanent total disability, and credibility.  Credibility can speak towards the truthfulness of the Injured Worker’s complaints versus possible malingering. A physician encountering malingering may use that finding as a basis to cut-off temporary disability benefits or assign a low level of impairment/permament disability.

“The ODI is a valid, reliable, and responsive condition-specific assessment tool that has withstood the test of time and scrutiny.3 So far, it has been used mostly in chronic and severely disabled populations, but shows good indicators for the assessments of less severe complaints.” Supra.  

How Does Owestry Approach Back Injuries?

The Owestry Disability Index looks at the Injured Worker’s ability to perform Activities of Daily Living.   The Index focuses on 10 sections designed to make such an assessment.  Each section is scored with a 0-5 number.   0 being the least disability and 5 being the greatest.

What Are The Questions Asked in the Owestry Disability Index?

  1. PAIN INTENSITY

I can tolerate the pain I have without having to use pain killers

The pain is bad but I manage without taking pain killers

Pain killers give complete relief from pain

Pain killers give moderate relief from pain

Pain killers give very little relief from pain … Pain killers have no effect on the pain and I do not use them

  1. PERSONAL CARE (e.g. Washing, Dressing)

I can look after myself normally without causing extra pain

I can look after myself normally but it causes extra pain

It is painful to look after myself and I am slow and careful

I need some help but manage most of my personal care

I need help every day in most aspects of self care

I don’t get dressed, I was with difficulty and stay in bed

  1. LIFTING

I can lift heavy weights without extra pain

I can lift heavy weights but it gives extra pain

Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, i.e. on a table

Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned

I can lift very light weights

I cannot lift or carry anything at all

  1. WALKING

Pain does not prevent me walking any distance

Pain prevents me walking more than one mile

Pain prevents me walking more than ½ mile

Pain prevents me walking more than ¼ mile

I can only walk using a stick or crutches

I am in bed most of the time and have to crawl to the toilet

  1. SITTING

I can sit in any chair as long as I like

I can only sit in my favorite chair as long as I like

Pain prevents me from sitting more than one hour

Pain prevents me from sitting more than ½ hour

Pain prevents me from sitting more than 10 minutes

Pain prevents me from sitting at all

  1. STANDING

I can stand as long as I want without extra pain

I can stand as long as I want but it gives me extra pain

Pain prevents me from standing for more than one hour

Pain prevents me from standing for more than 30 minutes

Pain prevents me from standing for more than 10 minutes

Pain prevents me from standing at all

  1. SLEEPING

Pain does not prevent me from sleeping well

I can sleep well only by using medication

Even when I take medication, I have less than 6 hrs sleep

Even when I take medication, I have less than 4 hrs sleep

Even when I take medication, I have less than 2 hrs sleep

Pain prevents me from sleeping at all

  1. SOCIAL LIFE

My social life is normal and gives me no extra pain

My social life is normal but increases the degree of pain

Pain has no significant effect on my social life apart from limiting my more energetic interests, i.e. dancing, etc.

Pain has restricted my social life and I do not go out as often

Pain has restricted my social life to my home

I have no social life because of pain

  1. TRAVELLING

I can travel anywhere without extra pain

I can travel anywhere but it gives me extra pain

Pain is bad, but I manage journeys over 2 hours

Pain restricts me to journeys of less than 1 hour

Pain restricts me to short necessary journeys under 30 minutes

Pain prevents me from traveling except to the doctor or hospital

  1. EMPLOYMENT/ HOMEMAKING

My normal homemaking/ job activities do not cause pain.

My normal homemaking/ job activities increase my pain, but I can still perform all that is required of me.

I can perform most of my homemaking/ job duties, but pain prevents me from performing more physically stressful activities (e.g. lifting, vacuuming)

Pain prevents me from doing anything but light duties.

Pain prevents me from doing even light duties.

Pain prevents me from performing any job or homemaking chores.

See Fairbank JC, Pynsent PB. “The Oswestry Disability Index.” Spine 2000: 25(22):2940-2952;  Fairbank JCT, Couper J, Davies JB. “The Oswestry Low Back Pain Questionnaire.” Physiotherapy 1980; 66:271-273

How It is Scored? Is There a Problem With Scoring?

 “The index is calculated by dividing the summed score by the total possible score, which is then multiplied by 100 and expressed as a percentage. Thus, for every question not answered, the denominator is reduced by 5. If a patient marks more than one statement in a question, the highest scoring statement is recorded as a true indication of disability.” Oswestry Disability Index Scoring Made Easy A MehraD BakerS Disney, and PB Pynsent Ann R Coll Surg Engl. 2008 Sep; 90(6): 497–499. doi: 10.1308/003588408X300984

Scoring of the test can be problematic.  First, the individual may not understand the questions asked and answer them incorrectly. There can be language or literacy issues that can come into play.  Second, the individuals scoring the test may not use the highest score or may calculate the result appropriately. See Oswestry Disability Index Scoring Made Easy A MehraD BakerS Disney, and PB Pynsent Ann R Coll Surg Engl. 2008 Sep; 90(6): 497–499. doi: 10.1308/003588408X300984  (re: Issues concerning staff scoring tests accurately and their training)

What Does the Score Mean?

 The scores of ODI are as follow:

0 – 4                 No disability

5 – 14               Mild disability

15 – 24             Moderate disability

25 – 34             Severe disability

35 – 50             Completely disabled

See Fairbank JC, Pynsent PB. “The Oswestry Disability Index.” Spine 2000: 25(22):2940-2952  Fairbank JCT, Couper J, Davies JB. “The Oswestry Low Back Pain Questionnaire.” Physiotherapy 1980; 66:271-273

What Do These Disability Terms Mean?

No disability The patient can cope with most living activities. Usually no treatment is indicated apart from advice on lifting, sitting and exercise.

Mild disability The patient experiences more pain and difficulty with sitting, lifting and standing. Travel and social life are more difficult and they may be disabled from work. Personal care, sexual activity and sleeping are not grossly affected and the patient can usually be managed by conservative means.

Moderate disability Pain remains the main problem in this group but activities of daily living are affected. These patients require a detailed investigation.

Severe disability Back pain impinges on all aspects of the patient’s life. Positive intervention is required.

Completely disabled These patients are either bed-bound or are exaggerating their symptoms.

Supra.

What Does This Mean In Workers’ Compensation?

The Index can help address the credibility of the Injured Worker. Is the scoring commensurate with the pathology? For example, if someone scores “Completely Disabled” but has a minor back sprain, malingering comes into question.  If someone post-back surgery scores as “Moderate”, they would most likely be viewed as credible. In sum, an ODI score can either raise a “red flag” concerning an Injured Work or be a confirmatory basis for assigning impairment, disability status or permanent disability.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information. Click Here.

 

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