The New York State Workers Compensation Board provides overarching principles to guide healthcare professionals in conducting diagnostic studies. These directives are intended to help healthcare practitioners determine suitable diagnostic approaches as an integral part of a thorough assessment.
Professionals specializing in diagnostic studies can depend on the guidance from the Workers Compensation Board to make informed decisions about the most appropriate diagnostic methods for their patients.
It is crucial to emphasize that these guidelines are not meant to substitute clinical judgment or professional expertise. The final decision regarding diagnostic studies should involve collaboration between the patient and their healthcare provider.
Therapeutic Procedures: Non-Operative
Prior to starting any therapeutic procedure, it’s crucial for the authorized treating provider, employer, and insurer to carefully consider these key aspects in the patient’s care. Firstly, individuals undergoing therapeutic procedures should ideally be allowed to resume modified or restricted duties at the earliest suitable stage of their rehabilitation.
Secondly, if there’s no significant improvement, both subjectively and objectively, in the patient’s condition, it’s essential to reassess or discontinue treatment modalities. If patients don’t show the expected response within the recommended timeframes, it’s advisable to explore alternative treatment options, conduct further diagnostic studies, or seek consultations.
Lastly, providers should furnish and document education for the patient. A comprehensive treatment plan should encompass addressing issues related to individual and/or group patient education, serving as a means to empower self-management of symptoms.
Finally, for individuals who do not show the anticipated improvement six to 12 weeks post-injury, and where their reported symptoms do not align with observed signs and test results, a reexamination, should be conducted to validate the accuracy of the initial diagnosis. Consideration may also be given to a formal psychological or psychosocial evaluation.
Home therapy plays a crucial role in treatment, incorporating both active and passive therapeutic procedures along with other modalities to aid in mitigating pain, reducing swelling, and addressing abnormal muscle tone. The listed components are organized alphabetically for easy reference.
Acupuncture
Suggested – Acupuncture is recommended for specific patients based on clinical needs. It’s indicated for non-acute back pain, serving as a complementary therapy alongside more effective treatments. Acupuncture may be advised for a limited duration, aligning with clear objectives and functional goals to be achieved during this time.
Not Advised – Routine use of acupuncture is not recommended for individuals dealing with acute back pain or radicular pain. It’s also not recommended for treating acute, subacute, radicular, or postoperative low back pain.
Indications – Considering time-limited use in non-acute back pain cases without underlying serious pathology, acupuncture can be considered as an adjunct to a conditioning program that involves graded aerobic exercise and strengthening exercises. The use of acupuncture is recommended solely to expedite the increase in functional activity levels, with the main focus remaining on the conditioning program.
This approach isn’t recommended for individuals not actively participating in a conditioning program or those not following the prescribed gradual increase in activity levels.
Frequency/Duration:
a) Quality studies employ various patterns, ranging from weekly sessions over a month to 20 appointments spread across 6 months. However, the standard is usually around eight to 12 sessions.
b) Starting with a trial of five to six appointments, in conjunction with a conditioning program involving aerobic and strengthening exercises, seems reasonable.
c) Subsequent appointments should be linked to improvements in objective measures, justifying an additional six sessions, totaling up to 12 sessions.
Discontinuation:
This intervention should be halted upon resolution of the issue, if the patient finds it intolerable, or in cases of non-compliance, which includes not adhering to the prescribed aerobic and strengthening exercises.
Appliances
Shoe Insoles and Shoe Lifts – It’s advised to use them for treating acute or non-acute back pain or radicular pain syndrome when there’s a significant difference in leg length. However, it’s not recommended when there’s no significant leg length difference.
Kinesiotaping, Taping, or Strapping – Not recommended.
Lumbar Supports – Recommended for specific patients based on clinical needs. Lumbar supports can be beneficial for treating conditions like spondylolisthesis, documented instability, or post-operative recovery. However, they’re not recommended for preventing or treating other back pain issues.
Magnets – Not recommended.
Mattresses, Water Beds, and Sleeping Surfaces:
i) It’s recommended that patients choose mattresses, pillows, bedding, or other sleeping options that are most comfortable for them.
ii) There’s no specific recommendation regarding mattresses, except that providers should be aware that instructing patients to sleep on firm mattresses or on the floor may be incorrect.
iii) There’s no high-quality evidence to guide recommendations regarding other optimal sleeping surfaces, such as bedding, water beds, and hammocks.
Bed Rest
Advised – It’s recommended in dealing with unstable spinal fractures or cauda equina. In situations where there’s no conclusive evidence from quality studies about the role of bed rest in managing unstable spinal fractures or cauda equina syndrome, there’s a consensus that such cases necessitate bed rest or significant activity limitations to prevent adverse events. Even though bed rest doesn’t have proven benefits, the potential dangers of mobilization in this context are considered catastrophic, making this treatment approach a recommended strategy.
Not Advised – It’s not recommended for handling acute or non-acute back pain, radicular pain syndromes (including sciatica), or other back pain-related issues like spondylolisthesis, spondylolysis, spinal stenosis, facet-related pain, or pain associated with the sacroiliac joint. The rationale behind this is that there’s no high-quality evidence proving the effectiveness of bed rest in treating these conditions, and there’s a likelihood of adverse effects. Despite being a non-invasive approach, bed rest lacks documented benefits and is expected to be linked with increased morbidity.
Biofeedback
Suggested – It’s recommended for specific individuals experiencing non-acute back pain, as part of a comprehensive interdisciplinary approach. For more detailed recommendations, please refer to the New York Non-Acute Pain Medical Treatment Guidelines.
Not Advised – It’s not recommended for patients dealing with acute back pain. It’s suggested that other treatments with proven efficacy, supported by quality evidence, would be more suitable in such cases.
Electrical Therapies
Interferential Therapy – It’s not recommended for treating acute or non-acute back pain, non-acute radicular pain syndromes, or other back-related conditions.
Transcutaneous Electrical Neurostimulation (TENS) – It’s recommended for specific use in the treatment of chronic low back pain or chronic radicular pain syndrome, serving as a second-line adjunct to other first-line treatments. Proper application and use should be taught in at least one instructional session. Indications include addressing muscle spasm, atrophy, and controlling concurrent pain in the office setting. The minimal parameters for TENS units should encompass pulse rate, pulse width, and amplitude modulation. Consistent, measurable, functional improvement needs to be documented, and the likelihood of chronicity must be determined before providing a home unit. TENS treatment should be used in conjunction with active physical therapy. The frequency is variable, with an immediate effect, and the optimum duration is three sessions. The maximum duration is three sessions, and if effective, a home unit can be purchased or provided.
Percutaneous Electrical Nerve Stimulation (PENS) – Not recommended for acute or subacute back pain or radicular pain syndromes.
Microcurrent Electrical Stimulation – Not recommended for patients with acute or non-acute back pain or radicular pain syndromes.
Electrical Nerve Block – Not recommended.
Electrical Stimulation (Physician or Therapist Applied) – It’s recommended as a component of a comprehensive treatment plan. The frequency is two to three times per week for a maximum of up to two months. However, using electrical stimulation, like other passive modalities, as a stand-alone treatment is not advised.
Transcutaneous Neurostimulator (TCNS) – It’s not recommended.
Wave Stimulation – Not recommended for treating acute or non-acute back pain or radicular pain syndromes.
High-Voltage Galvanic – Not recommended for the treatment of acute or non-acute back pain, radicular pain syndromes, or other back-related conditions.
Iontophoresis – Not recommended for the treatment of acute, subacute, or chronic low back pain, radicular pain syndromes, or other back-related conditions.
