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Guideline Summary
Guideline Title
Shoulder (acute & chronic).
Bibliographic Source(s)
Work Loss Data Institute. Shoulder (acute & chronic). Encinitas (CA): Work Loss Data Institute; 2011. Various p.
Guideline Status

Note: This guideline had been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

FDA Warning/Regulatory Alert

Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released.

  • August 1, 2013 – Acetaminophen External Web Site Policy: The U.S. Food and Drug Administration (FDA) notified healthcare professionals and patients that acetaminophen has been associated with a risk of rare but serious skin reactions. Acetaminophen is a common active ingredient to treat pain and reduce fever; it is included in many prescription and over-the-counter (OTC) products. These skin reactions, known as Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP), can be fatal. These reactions can occur with first-time use of acetaminophen or at any time while it is being taken. Other drugs used to treat fever and pain/body aches (e.g., non-steroidal anti-inflammatory drugs, or NSAIDS, such as ibuprofen and naproxen) also carry the risk of causing serious skin reactions, which is already described in the warnings section of their drug labels.

Scope

Disease/Condition(s)

Work-related shoulder disorders (acute and chronic)

Guideline Category
Diagnosis
Evaluation
Management
Treatment
Clinical Specialty
Family Practice
Internal Medicine
Orthopedic Surgery
Physical Medicine and Rehabilitation
Radiology
Sports Medicine
Intended Users
Advanced Practice Nurses
Health Care Providers
Health Plans
Nurses
Occupational Therapists
Physician Assistants
Physicians
Utilization Management
Guideline Objective(s)

To offer evidence-based step-by-step decision protocols for the assessment and treatment of workers' compensation conditions

Target Population

Workers with occupational shoulder disorders

Interventions and Practices Considered

The following interventions/procedures were considered and recommended as indicated in the original guideline document:

  1. Acupuncture
  2. Anterior scalene block
  3. Arthrography
  4. Arthroplasty for selected patients
  5. Bone-growth stimulators
    • Electrical
    • Ultrasound
  6. Cardiovascular functional testing
  7. Causality (determination)
  8. Cold packs
  9. Computed tomography (CT)
  10. Continuous-flow cryotherapy
  11. Deep friction massage
  12. Diagnostic arthroscopy
  13. Dynasplint system
  14. Electrodiagnostic testing for thoracic outlet syndrome (TOS)
  15. Exercises
  16. Extracorporeal shock wave therapy (ESWT)
  17. Home health services
  18. Hospital length of stay
  19. Hyaluronic acid injections for glenohumeral joint osteoarthritis
  20. Impingement tests
  21. Low level laser therapy (LLLT)
  22. Magnetic resonance imaging (MRI)
  23. Manipulation/chiropractic
  24. Magnetic resonance (MR) arthrogram
  25. Myoelectric upper extremity (hand and/or arm) prosthesis
  26. Nerve blocks
  27. Office visits
  28. Physical therapy/occupational therapy
  29. Postoperative abduction pillow sling
  30. Prosthesis (artificial limb)
  31. Pulsed electromagnetic field
  32. Radiography
  33. Range of motion (ROM) assessment
  34. Return to work
  35. Superior labrum, anterior and posterior (SLAP) lesion diagnosis
  36. Static progressive stretch (SPS) therapy
  37. Steroid injections
  38. Surgery for impingement syndrome
  39. Surgery for pectoralis tendon repair
  40. Surgery for rotator cuff repair
  41. Surgery for shoulder dislocation/Partial claviculectomy (Mumford procedure)
  42. Surgery for SLAP lesions
  43. Surgery for thoracic outlet syndrome
  44. Transcutaneous electrical neurostimulation (TENS)
  45. Ultrasound (diagnostic and therapeutic)
  46. Work/activity restrictions
  47. Work conditioning, work hardening

The following interventions/procedures are under study and are not specifically recommended:

  1. Disodium EDTA (ethylenediaminetetraacetic acid)
  2. Ergonomic interventions
  3. Graft, rotator cuff
  4. Hydroplasty/hydrodilation
  5. Manipulation under anesthesia (MUA)
  6. Massage
  7. Neuromuscular electrical stimulation (NMES devices)
  8. Surgery for adhesive capsulitis
  9. Thermal capsulorrhaphy
  10. Thermotherapy
  11. Vacuum-assisted closure wound-healing

The following interventions/procedures were considered, but are not recommended:

  1. Adson's test (AT)
  2. Biofeedback
  3. Biopsychosocial rehabilitation
  4. Bipolar interferential electrotherapy
  5. Clavicle fracture surgery
  6. Continuous passive motion (CPM)
  7. Costoclavicular maneuver (CCM)
  8. Cutaneous laser treatment
  9. Delayed treatment
  10. Diathermy
  11. Electrical stimulation
  12. Elevated arm stress test (EAST)
  13. Hyaluronic acid injections for rotator cuff tear and adhesive capsulitis
  14. Immobilization
  15. Interferential current stimulation (ICS)
  16. Iontophoresis
  17. Kinesio tape (KT)
  18. Low level laser wound-healing
  19. Mechanical traction
  20. Osteochondral autologous transplantation (OATS)
  21. Platelet-rich plasma (PRP)
  22. Porcine small intestinal submucosa
  23. Postoperative pain pump
  24. Scapula fracture surgery
  25. Supraclavicular pressure (SCP)
  26. Surgery for acromioclavicular (AC) joint separation
  27. Surgery for ruptured biceps tendon (at the shoulder)
  28. Transdermal nitroglycerin
Major Outcomes Considered
  • Sensitivity, specificity, and accuracy of diagnostic tests
  • Effectiveness of treatment in relieving pain and restoring normal function

Methodology

Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Work Loss Data Institute (WLDI) conducted a comprehensive medical literature review (now ongoing) with preference given to high quality systematic reviews, meta-analyses, and clinical trials published since 1993, plus existing nationally recognized treatment guidelines from the leading specialty societies. WLDI primarily searched MEDLINE and the Cochrane Library. In addition, WLDI also reviewed other relevant treatment guidelines, including those in the National Guideline Clearinghouse, as well as state guidelines and proprietary guidelines maintained in the WLDI guideline library. These guidelines were also used to suggest references or search terms that may otherwise have been missed. In addition, WLDI also searched other databases, including MD Consult, eMedicine, CINAHL, and conference proceedings in occupational health (i.e., American College of Occupational and Environmental Medicine [ACOEM]) and disability evaluation (i.e., American Academy of Disability Evaluating Physicians [AADEP], American Board of Independent Medical Examiners [ABIME]). Search terms and questions were diagnosis, treatment, symptom, sign, and/or body-part driven, generated based on new or previously indexed existing evidence, treatment parameters and experience.

In searching the medical literature, answers to the following questions were sought: (1) If the diagnostic criteria for a given condition have changed since 1993, what are the new diagnostic criteria? (2) What occupational exposures or activities are associated causally with the condition? (3) What are the most effective methods and approaches for the early identification and diagnosis of the condition? (4) What historical information, clinical examination findings or ancillary test results (such as laboratory or x-ray studies) are of value in determining whether a condition was caused by the patient's employment? (5) What are the most effective methods and approaches for treating the condition? (6) What are the specific indications, if any, for surgery as a means of treating the condition? (7) What are the relative benefits and harms of the various surgical and non-surgical interventions that may be used to treat the condition? (8) What is the relationship, if any, between a patient's age, gender, socioeconomic status and/or racial or ethnic grouping and specific treatment outcomes for the condition? (9) What instruments or techniques, if any, accurately assess functional limitations in an individual with the condition? (10) What is the natural history of the disorder? (11) Prior to treatment, what are the typical functional limitations for an individual with the condition? (12) Following treatment, what are the typical functional limitations for an individual with the condition? (13) Following treatment, what are the most cost-effective methods for preventing the recurrence of signs or symptoms of the condition, and how does this vary depending upon patient-specific matters such as underlying health problems?

Criteria for Selecting the Evidence

Preference was given to evidence that met the following criteria: (1) The article was written in the English language, and the article had any of the following attributes: (2) It was a systematic review of the relevant medical literature, or (3) The article reported a controlled trial – randomized or controlled, or (4) The article reports a cohort study, whether prospective or retrospective, or (5) The article reports a case control series involving at least 25 subjects, in which the assessment of outcome was determined by a person or entity independent from the persons or institution that performed the intervention the outcome of which is being assessed.

More information about the selection of evidence is available in the "Methodology Outline" and "Appendix A. ODG Treatment in Workers' Comp. Methodology description using the AGREE instrument" (see "Availability of Companion Documents" field).

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Ranking by Type of Evidence

  1. Systematic Review/Meta-Analysis
  2. Controlled Trial - Randomized (RCT) or Controlled
  3. Cohort Study - Prospective or Retrospective
  4. Case Control Series
  5. Unstructured Review
  6. Nationally Recognized Treatment Guideline (from www.guideline.gov External Web Site Policy)
  7. State Treatment Guideline
  8. Other Treatment Guideline
  9. Textbook
  10. Conference Proceedings/Presentation Slides

Ranking by Quality within Type of Evidence

  1. High Quality
  2. Medium Quality
  3. Low Quality
Methods Used to Analyze the Evidence
Review of Published Meta-Analyses
Systematic Review
Description of the Methods Used to Analyze the Evidence

The Work Loss Data Institute (WLDI) reviewed each article that was relevant to answering the question at issue, with priority given to those that met the following criteria: (1) The article was written in the English language, and the article had any of the following attributes: (2) It was a systematic review of the relevant medical literature, or (3) The article reported a controlled trial – randomized or controlled, or (4) The article reported a cohort study, whether prospective or retrospective, or (5) The article reported a case control series involving at least 25 subjects, in which the assessment of outcome was determined by a person or entity independent from the persons or institution that performed the intervention the outcome of which is being assessed.

Especially when articles on a specific topic that met the above criteria were limited in number and quality, WLDI also reviewed other articles that did not meet the above criteria, but all evidence was ranked alphanumerically (see the "Rating Scheme for the Strength of the Evidence" field) so that the quality of evidence could be clearly determined when making decisions about what to recommend in the Guidelines. Articles with a Ranking by Type of Evidence of Case Reports and Case Series were not used in the evidence base for the Guidelines. These articles were not included because of their low quality (i.e., they tend to be anecdotal descriptions of what happened with no attempt to control for variables that might affect outcome). Not all the evidence provided by WLDI was eventually listed in the bibliography of the published Guidelines. Only the higher quality references were listed. The criteria for inclusion was a final ranking of 1a to 4b (the original inclusion criteria suggested the methodology subgroup), or if the Ranking by Type of Evidence was 5 to 10, the quality ranking should be an "a."

Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

The guideline developers reviewed published cost analyses.

Method of Guideline Validation
External Peer Review
Description of Method of Guideline Validation

Prior to publication, select organizations and individuals making up a cross-section of medical specialties and typical end-users externally reviewed the guideline.

Recommendations

Major Recommendations

Note: This guideline had been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.

Note from the Work Loss Data Institute (WLDI) and the National Guideline Clearinghouse (NGC): The following recommendations were current as of February 17, 2011. However, because the Work Loss Data Institute updates their guidelines frequently, users may wish to consult the Work Loss Data Web site External Web Site Policy for the most current version available.

Initial Diagnosis

  • First visit: with Primary Care Physician MD/DO (100%)
  • Initial evaluation should include:
    • Determine the type of trauma (e.g., direct trauma, fall, repetitive motion, twisting incident, etc.)
    • Test the range-of-motion of the joint (normal, mild restriction, severe restriction, or complete restriction)
    • An initial evaluation of the shoulder requires accurate diagnosis of shoulder injuries by careful inspection and palpation of the shoulder area. Although the shoulder is generally swollen, the injury is usually defined by direct tenderness over the injured area.
  • Determine "degenerative changes" versus "acute trauma":
    • Degenerative changes (Go to Initial Conservative Treatment) Lesions of the rotator cuff are a continuum, from mild inflammation and degeneration to full avulsions. Studies of normal subjects document the universal presence of degenerative changes and conditions, including full avulsions without symptoms. Conservative treatment has results similar to surgical treatment but without surgical risks. Surgical outcomes are much better in younger patients with a rotator cuff tear, than in older patients, who may be suffering from degenerative changes in the rotator cuff. Impingement syndrome, shoulder tendonitis, shoulder sprain, and subacromial bursitis are all closely related entities with the same etiology. They involve friction, abrasion, and inflammation of the rotator cuff and the long head of the biceps tendon with the subacromial arch (anterior lip of the acromion, coracoacromial ligament, and acromioclavicular joint). These conditions involve consequences of aging or repetitive use, or a combination thereof, such as:
      • Impingement syndrome (age >40 years, weakness, cuff tenderness, painful range of motion [ROM], impingement sign, radiographic findings, night pain, history of catching, or pain with shoulder motion)
      • Rotator cuff tendonitis (similar)
      • Rotator cuff tear (only Types I and II, partial tear, age >40 yrs)
      • Adhesive capsulitis, frozen shoulder (progressive pain and stiffness, diabetes or trauma, decreased passive ROM, normal x-rays, night pain)
      • Tendinopathy
      • Bicipital tendon disorders
      • Bursitis
    • Acute trauma (Go directly to Aggressive Treatment)
      • Acute rotator cuff tear (type III, age <40 yrs)
      • Acromioclavicular (AC) joint strain or separation
        • Types I-III versus Types IV-VI (rare, surgery may be indicated)
  • Rule out diagnoses (See other treatment parameters for each of these):
    • Referred neck pain (see the original guideline document for International Classification of Diseases, Ninth Revision [ICD-9] codes for this and other diagnoses)
    • Thoracic outlet syndrome, brachial plexus disorders
    • Fractures (treat clavicular fractures mostly nonoperatively)
    • Laceration
    • Glenohumeral shoulder joint dislocation
    • Arthritis

Mild/Moderate -- Initial Conservative Treatment (90% of cases)

  • Also first visit (day 1):
    • Prescribe alteration of activity (home and work), no overhead work, stretching (gentle range-of-motion exercises), appropriate analgesia (i.e., acetaminophen) and/or anti-inflammatory (i.e., ibuprofen) [Benchmark cost: $14], back to work--modified duty: if condition caused by job, possible ergonomic evaluation of job
Official Disability Guidelines (ODG) Return-To-Work Pathways

Medical treatment (Grade I or II1, impingement, no tear), modified work: 0 days
Medical treatment (impingement, no tear), manual work: 7 days

(See ODG Capabilities & Activity Modifications for Restricted Work under "Work" in the Procedure Summary of the original guideline document)
  • Second visit (day 8 to 20 – about 2 weeks after first visit or sooner because delayed treatment is not recommended)
    • Document progress
    • If not significantly improved, then prescribe physical therapy (gentle range-of-motion exercises plus exercises that strengthen the rotators and stabilize the scapula); should be started for home exercise training [Benchmark cost: $250]: Refer to Physical Therapist (50%) or Occupational Therapist (50%) for up to 3 visits per week for 2 weeks.
  • Third visit (day 21 to 35 - about 1 month after first visit)
    • Document progress
    • Further relaxation and pain control can be achieved by injecting an anesthetic under the acromion (laterally or anteriorly) into the shoulder joint.
    • Corticosteroid injection trial [Benchmark cost: $276]. Should be performed by musculoskeletally trained physician. Sprains of the rotator cuff cause swelling within a closed space and add an element of chronic impingement which may be slow to resolve. By decreasing swelling, local infiltration of the rotator cuff with corticosteroids may quicken the resolution of this problem. Repeat corticosteroid injection may be necessary, but should not be done any sooner than every two weeks, up to a maximum of three injections. Injection should be avoided in patients under 30 years of age.
    • If prescribe therapy, then continue therapist, change from passive to active modality, up to 2 visits per week, teach home exercises.
ODG Return-To-Work Pathways

Medical treatment (impingement, no tear), manual overhead work: 28 days
Medical treatment, regular work if cause of disability: 42 days
Medical treatment, heavy manual work: 42 days

  • Fourth visit (day 42 - about 6 weeks after first visit)
    • Refer for imaging

Imaging (30% of cases)
[Benchmark cost: $370-$1,200]

  • Magnetic resonance images (MRIs) are quite accurate in differentiating chronic impingement from tears of the rotator cuff and should be employed when:
    • A surgical approach is being considered
    • The diagnosis is unclear, and
    • The clinical examination is limited.
  • MR arthrograms are accurate in diagnosing labral tears.
  • X-rays: special views of AC joint, with weights in hand for AC separation
  • Diagnostic ultrasound is an option.
  • If indicated by imaging, and no improvement from initial conservative therapy, refer for aggressive treatment at three months.

Aggressive Treatment (10% of cases)
[Benchmark cost: $2,621]

  • Include imaging as above
  • Dislocation: After reduction, the first and second dislocations of the shoulder are treated nonsurgically except in unusual circumstances. An initial dislocation should generally be treated with three or more weeks of immobilization in a sling and swathe. This is followed by a progressive exercise program to strengthen the muscles of the shoulder girdle and, thus, reduce the probability of recurrent dislocations. A second dislocation may be treated in a sling until asymptomatic. After a third dislocation, further dislocations may be presumed to be imminent, and orthopedic referral for consideration of a surgical repair is appropriate.
  • Arthroscopy, Shoulder, Surgical: Rotator cuff repair, with decompression of subacromial space with partial acromioplasty, with or without coracoacromial release. Performed by Orthopedic Surgeon (90%) or General Surgeon (10%) on an outpatient or 23-hour basis. May be endoscopic. Decompression/acromioplasty alone should be performed after at least six weeks of conservative treatment.
  • Labral tears: When the glenoid labrum becomes injured or torn, it is described as a labral tear. These tears may be classified by the position of the tear in relation to the glenoid (which is often called the "shoulder socket"). A Bankart tear is a tear in the labrum located in the front, lower (anterior, inferior) part of the shoulder socket. This type of tear occurs most commonly during a shoulder dislocation. A Bankart tear makes the shoulder more prone to recurrent dislocations. A Superior Labral tear from Anterior to Posterior (SLAP) is a tear in the labrum that covers the top part of the shoulder socket from front to back. A SLAP tear occurs at the point where the long head of biceps tendon attaches. This type of tear occurs most commonly during falls on an outstretched arm. Most superior labral tears can be treated with anti-inflammatory medications, activity modification and physical therapy, but if nonoperative treatment fails, surgery may be indicated.
  • Clavicle (collarbone) fractures are common injuries, and they can occur different ways. Some patients fall on an outstretched hand, others fall and hit the outside of their shoulder. Treatment of clavicle fractures most commonly involves resting the affected extremity in a sling. It is unusual for a clavicle fracture to require surgery, but surgery is required in some situations when either the skin is broken or the fracture is severely displaced or shortened.
  • Post-surgical treatment
    • Physical/Occupational Therapy: A short course may be needed; if so then post-surgical treatment (endoscopic): 14 visits over 8 weeks; post-surgical treatment (open): 20 visits over 10 weeks
ODG Return-To-Work Pathways

Arthroscopic surgical repair/acromioplasty (Grade III1), clerical/modified work: 28 to 56 days
Arthroscopic surgical repair/acromioplasty, manual work, non-dominant arm: 56 to 90 days
Arthroscopic surgical repair/acromioplasty, manual work, dominant arm: 70 to 90 days
Open surgery (Grade III1), clerical/modified work: 42 to 56 days
Open surgery, manual work, non-dominant arm: 70 to 90 days
Open surgery, manual work, dominant arm: 90 to 106 days
Open surgery, heavy manual work if cause of disability: indefinite

1Definition of Sprain/Strain Severity Grade: In general, a Grade I or mild sprain/strain is caused by overstretching or slight tearing of the ligament/muscle/tendon with no instability, and a person with a mild sprain usually experiences minimal pain, swelling, and little or no loss of functional ability. Although the injured muscle is tender and painful, it has normal strength. A Grade II sprain/strain is caused by incomplete tearing of the ligament/muscle/tendon and is characterized by bruising, moderate pain, and swelling, and a Grade III sprain/strain means complete tear or rupture of a ligament/muscle/tendon. A sprain is a stretch and/or tear of a ligament (a band of fibrous tissue that connects two or more bones at a joint). A strain is an injury to either a muscle or a tendon (fibrous cords of tissue that connect muscle to bone).

Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

During the comprehensive medical literature review, preference was given to high quality systematic reviews, meta-analyses, and clinical trials over the past ten years, plus existing nationally recognized treatment guidelines from the leading specialty societies.

The heart of each Work Loss Data Institute guideline is the Procedure Summary (see the original guideline document), which provides a concise synopsis of effectiveness, if any, of each treatment method based on existing medical evidence. Each summary and subsequent recommendation is hyper-linked into the studies on which they are based, in abstract form, which have been ranked, highlighted and indexed.

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

These guidelines unite evidence-based protocols for medical treatment with normative expectations for disability duration. They also bridge the interests of the many professional groups involved in diagnosing and treating work-related shoulder disorders.

Potential Harms
  • Complications related to cryotherapy (i.e., frostbite) are extremely rare but can be devastating.
  • The primary adverse events of hyaluronic acid injections were transient mild increases in local pain or swelling.

Contraindications

Contraindications
  • Extracorporeal shock wave therapy (ESWT) is contraindicated in:
    • Pregnant women
    • Patients younger than 18 years of age
    • Patients with blood clotting diseases, infections, tumors, cervical compression, arthritis of the spine or arm, or nerve damage
    • Patients with cardiac pacemakers
    • Patients who had physical or occupational therapy within the past 4 weeks
    • Patients who received a local steroid injection within the past 6 weeks
    • Patients with bilateral pain
    • Patients who had previous surgery for the condition
  • Corticosteroid injections should be avoided in patients under 30 years of age.

Qualifying Statements

Qualifying Statements

The Treatment Planning section is not designed to be a rule, and therefore should not be used as a basis for Utilization Review. The Treatment Planning section outlines the most common pathways to recovery, but there is no single approach that is right for every patient and these protocols do not mention every treatment that may be recommended. See the Procedure Summaries (in the original guideline document) for complete lists of the various options that may be available, along with links to the medical evidence. The Procedure Summaries are the most important section of Official Disability Guidelines (ODG) Treatment, and that section, not the Treatment Planning section, should be used as a basis for Utilization Review.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools
Patient Resources
Resources
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness
Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)
Work Loss Data Institute. Shoulder (acute & chronic). Encinitas (CA): Work Loss Data Institute; 2011. Various p.
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2003 (revised 2011 Feb 17)
Guideline Developer(s)
Work Loss Data Institute - For Profit Organization
Source(s) of Funding

Not stated

Guideline Committee

Not stated

Composition of Group That Authored the Guideline

Editor-in-Chief, Philip L. Denniston, Jr. and Senior Medical Editor, Charles W. Kennedy, Jr., MD, together pilot the group of approximately 80 members. See the ODG Treatment in Workers Comp Editorial Advisory Board External Web Site Policy.

Financial Disclosures/Conflicts of Interest

There are no conflicts of interest among the guideline development members.

Guideline Status

Note: This guideline had been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

Guideline Availability

Electronic copies of the updated guideline: Available to subscribers from the Work Loss Data Institute Web site External Web Site Policy.

Print copies: Available from the Work Loss Data Institute, 169 Saxony Road, Suite 210, Encinitas, CA 92024; Phone: 800-488-5548, 760-753-9992, Fax: 760-753-9995; www.worklossdata.com External Web Site Policy.

Availability of Companion Documents

The following are available:

  • Methodology outline is available from the Work Loss Data Institute (WLDI) Web site External Web Site Policy.
  • Appendix A. Official Disability Guidelines (ODG) Treatment in Workers' Comp. Methodology description using the AGREE instrument. Available from the WLDI Web site External Web Site Policy.
  • ODG for eReader. Treatment and disability duration guidelines are available for purchase from the WLDI Web site External Web Site Policy.
Patient Resources

The following is available:

  • Appendix C. ODG Treatment in Workers' Comp. Patient information resources. Electronic copies: Available to subscribers from the Work Loss Data Institute Web site External Web Site Policy.

Print copies: Available from the Work Loss Data Institute, 169 Saxony Road, Suite 210, Encinitas, CA 92024; Phone: 800-488-5548, 760-753-9992, Fax: 760-753-9995; www.worklossdata.com External Web Site Policy.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC Status

This summary was completed by ECRI on February 2, 2004. The information was verified by the guideline developer on February 13, 2004. This NGC summary was updated by ECRI Institute on March 29, 2005, January 18, 2006, April 13, 2006, November 13, 2006, April 2, 2007, August 29, 2007, January 22, 2009, and May 27, 2011. This summary was updated by ECRI Institute on October 28, 2013 following the U.S. Food and Drug Administration advisory on Acetaminophen.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouseâ„¢ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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