Work-Related Repetitive Strain Injury Treatment in a Chiropractic Office

A retrospective analysis was performed on 222 work-related repetitive strain injury (RSI) cases referred to our office (Gregg J. Carb, D.C., C.A.E. in San Francisco, CA) by a local employer between 09/29/95 and 04/01/02 to determine the effectiveness of our therapy (Active Release Techniques or ART) and patient education program (posture and ergonomic awareness training) in resolving these cases. Males represented 56 (25%) of the cases while females represented 166 (75%).  Nearly 100% of the repetitive strain injury cases involved computer data entry.

The following information was obtained from each patient file and entered on a spreadsheet:

• Patient name
  

• Area(s) of complaint

• Number of body parts involved

• Date of initial consultation

• Date of last treatment

• Number of treatment visits

• Final case status

• Patient satisfaction rating

• Outcome risk factors present

• Number of outcome risk factors

The span of time between the date of initial consultation and the date of last treatment reflected management of the patient’s injury to the initial resolution.  Some cases 36 (16%) did have one or more recurrent episodes requiring additional care that was not included in our analysis.  Therefore, the number of treatment visits indicated the number of therapy sessions until initial resolution, which in most instances 186 (84%) was the end of the case.  The final status was considered to be the case standing at initial resolution, or actual final status (if known) in those cases with recurrent episodes.  The satisfaction rating was requested by written questionnaire from patients we released at the conclusion of their case.  The outcome risk factors we tracked (on initial intake forms) were self-reported, present or past occurrences of: high blood pressure, headache, pre-menstrual syndrome, high stress/anxiety, sleep disturbance, general fatigue, chronic depressed mood, any use of alcohol, any use of tobacco.

 

FINAL STATUS DATA:

Patients formally released, with no need for further care, were referred to as “Pre-Injury Status.”  Patients not formally released, but also with no need for further care, were referred to as “Resolved Pre-Injury.”  These cases combined numbered 166 (75%) and took an average of seven treatment visits to resolve.

Patients that discontinued treatment at our office, but who needed further care elsewhere, were referred to as “Discontinued Care.”  We felt these cases represented dissatisfied, unresolved patients.  These cases numbered 21 (9%) and had an average of eight treatment visits before dropping out of care.

Patients that required medical consultation or physical therapy referral for case management were referred to as “Referred.” These cases numbered 16 (7%) and had an average of seven and a half treatment visits prior to being referred out.

Patients that reached a maximum level of improvement with residual permanent disability/impairment were referred to as “P&S Status” (Permanent and Stationary).  These cases numbered 15 (7%) and had an average of seventeen treatment visits prior to reaching a P&S status.

Patients that relocated out of the area during care were referred to as “Relocated.” These cases numbered 5 (2%).

 

OUTCOME RISK FACTORS DATA:

Of all 222 cases, those reporting:

Alcohol Use = 78 (35%)

Depression = 27 (12%)

PMS = 23 (14% of females)

high Stress levels = 56 (25%)

Tobacco Use = 45 (20%)

The average number of outcome risk factors per case = 1.98.

We compared the outcome risk factors for all records to the outcome risk factors for cases that discontinued care.

Alcohol Use:                 52% Discontinued Care vs. 35% all records

Depression:                  29% Discontinued Care vs. 12% all records

PMS (females):             27% Discontinued Care vs. 14% all records

high Stress:                   33% Discontinued Care vs. 25% all records

Tobacco Use:               43% Discontinued Care vs. 20% all records

The average number of outcome risk factors per Discontinued Care cases = 3.0.  

 

PATIENT SATISFACTION

The number of cases that returned our patient satisfaction questionnaire = 127 (57%).  The average patient satisfaction = 9.3 (1-10 scale).

 

  SUMMARY OF DATA

We retroactively analyzed the case status and outcome risk factors on 222 work-related RSI cases referred to our chiropractic office from a local employer.  A total of 166 (75%) cases were resolved in an average of seven treatment visits using our therapy (Active Release Techniques) and patient education program (posture and ergonomic awareness training).  There were 21 (9%) cases that discontinued care after an average of eight treatment visits.  In comparing outcome risk factors for our unsuccessful cases (discontinued care group) with all cases, a significant difference was apparent.  The cases that dropped out of care had a greater tobacco use (by >100%), alcohol use, depression (by >100%), PMS (by ~100%), and stress, as well a greater average number of outcome risk factors (by 50%).

We conclude that this data suggests that variables such as the outcome risk factors we tracked can negatively affect a patient’s recovery from a work-related injury.  Tracking such variables from the onset of a case may help to identify patients at risk for a poor outcome.  Also, the number of cases that did resolve under our therapy and patient education program, without the need for referral, without residual permanent disability / impairment, and in a workers’ compensation setting, demonstrates the effectiveness of a therapeutic approach based in part on the posture principles described in The Science of Sitting Made Simple.