Early intervention in low back disability among coal miners in West Virginia: negative findings.

A major issue in the field of workers' compensation is cost containment, not only of medical costs, but of extended disability costs as well. For a 9-month period in 1985 to 1986, the West Virginia Workers' Compensation Fund tested an early intervention case management approach begun within 2 weeks after injury and found it not to be cost effective. In a controlled study of 284 reported back injuries among underground coal miners, medical costs increased with the case management intervention, although only to the extent of the added costs of the intervention, and disability costs and time lost from work did not decrease. Permanent partial disability awards, litigation rates, number of hospitalizations, and return to work were similar between both the experimental and control groups. Regression analyses of 25 factors identified factors most highly predictive of disability and medical costs, but in predicting extended disability, although the factors were 100% sensitive, they were only 43.6% specific. The case management approach was insufficient to prevent extended disability or to lower medical costs.