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Guideline Summary
Guideline Title
Hip & pelvis (acute & chronic).
Bibliographic Source(s)
Work Loss Data Institute. Hip & pelvis (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 injuries of the hip and pelvis

Guideline Category
Diagnosis
Evaluation
Management
Treatment
Clinical Specialty
Anesthesiology
Chiropractic
Emergency Medicine
Family Practice
Internal Medicine
Orthopedic Surgery
Physical Medicine and Rehabilitation
Radiology
Rheumatology
Intended Users
Advanced Practice Nurses
Health Care Providers
Health Plans
Nurses
Occupational Therapists
Physical 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 injuries of the hip and pelvis

Interventions and Practices Considered

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

  1. Acetaminophen (paracetamol)
  2. Acupuncture
  3. Anesthesia
  4. Aquatic therapy
  5. Arthrography
  6. Arthroplasty
  7. Arthroscopy
  8. Bed rest
  9. Bone-growth stimulators, electrical and ultrasound
  10. Bone scan (radioisotope bone scanning)
  11. Calcium phosphate cement when used for augmentation in unstable trochanteric fractures
  12. Causality (determination)
  13. Closed reduction
  14. Computed tomography (CT)
  15. Computer-aided training
  16. Education
  17. Epidural analgesia
  18. Exercise
  19. External fixation
  20. Femoral nerve block
  21. Fondaparinux
  22. Heparin
  23. Hip fracture surgery
  24. Hip-spine syndrome treatment
  25. Home health services
  26. Hospital length of stay (LOS)
  27. Hydrotherapy
  28. Ilioinguinal nerve ablation
  29. Internal fixation
  30. Magnetic resonance imaging (MRI)
  31. Manipulation/chiropractic treatment
  32. Non-steroidal anti-inflammatory drugs (NSAIDS)
  33. Office visits
  34. Open reduction
  35. Osteotomy
  36. Physical therapy/occupational therapy
  37. Positron emission tomography (PET)
  38. Physical medicine treatment
  39. Piriformis injections/psoas blocks
  40. Prophylaxis (antibiotic and anticoagulant)
  41. Protein and energy supplementation
  42. Radiotherapy
  43. Return to work
  44. Revision total hip arthroplasty
  45. Rivaroxaban
  46. Sacroiliac joint blocks/sacroiliac joint injections
  47. Sacroiliac support belt
  48. Skilled nursing facility (SNF) for 10 to 18 days or inpatient rehabilitation facility (IRF) for 6 to 12 days
  49. Sliding hip screw
  50. Total hip resurfacing (in patients under the age of 65 years)
  51. Tranexamic acid
  52. Transcutaneous electrical nerve stimulation (TENS) as a treatment for pain
  53. Trochanteric bursitis injections
  54. Ultrasound (sonography)
  55. Venous thrombosis
  56. Vitamin D
  57. Walking aids (canes, crutches, braces, orthoses, and walkers)
  58. Work conditioning, work hardening
  59. Wound closure (sutures over staples)
  60. X-rays (plain radiography)
  61. Zoledronic acid

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

  1. Botulinum toxin (Botox®)
  2. Chi machine
  3. Intra-articular steroid hip injection (IASHI) for moderately advanced or severe hip osteoarthritis
  4. Manipulation under anesthesia (MUA)
  5. Sacroiliac joint debridement (SJD)
  6. Traction (manual)
  7. Viscosupplementation/hyaluronic acid injection

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

  1. Closed suction drainage
  2. Diathermy
  3. Enoxaparin
  4. Glucosamine and chondroitin sulphate
  5. Hemiarthroplasty
  6. Hip protectors
  7. Intra-articular growth hormone injection (IAGH)
  8. Intra-articular steroid hip injection
  9. Low level laser therapy (LLLT)
  10. Magnet therapy
  11. Reflexology
  12. Sacroiliac joint fusion
  13. Sacroiliac joint radiofrequency neurotomy
  14. Total hip resurfacing (in patients over 64-years old)
  15. Tumor necrosis factor alpha (TNFalpha) blockers
Major Outcomes Considered
  • Diagnostic value of tests
  • Effectiveness of treatments in relieving pain, improving stability, restoring normal function, and improving survival

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 April 28, 2011. However, because the Work Loss Data Institute updates their guidelines frequently, users may wish to consult the WLDI Web site External Web Site Policy for the most current version available.

Initial Diagnosis

  • First visit: with Primary Care Physician MD/DO or to emergency care
  • Determine cause: Initial evaluation:
    • Determine the type of trauma (fall, motor vehicle accident, etc.)
    • Determine patient history and whether the problem is acute, subacute, chronic, or of insidious onset
    • Determine the severity and specific anatomic location of the pain
    • Assess the ability of the patient to walk and assess range of motion
    • Search for evidence of an open or penetrating wound
    • Determine any present medication, co-morbidities or pre-existing conditions (including pregnancy, anemia, etc.) that may affect medication or surgery
  • Initial diagnosis:
    • Traumatic (see "Fractures" or "Dislocations" below)
      • Fractures or Dislocations (see the original guideline document for International Classification of Diseases, Ninth Revision [ICD-9] codes for this and other diagnoses)
      • Avascular necrosis (AVN) (the death of bone tissue due to a lack of blood supply most often affects the head of femur, causing hip pain)
    • Other (see "Conservative Treatment" below)
      • Sprain or contusion
      • Laceration
      • Coccygodynia
      • Sacroiliitis
      • Hip overuse syndrome

Management in Accident & Emergency

Early assessment, in accident & emergency or on the ward, should include a formal recording of:

  • Pressure sore risk
  • Hydration and nutrition
  • Fluid balance
  • Pain
  • Core body temperature using a low reading thermometer
  • Continence
  • Co-existing medical problems
  • Mental state
  • Previous mobility
  • Previous functional ability
  • Social circumstances

Fractures and Dislocations

Fractures

Possible Causes

  • Trauma (most common)
  • Lytic lesions (cancerous metastasis, Paget disease, bone cysts)
  • Osteoporosis

Patients admitted to accident & emergency with a suspected hip fracture should be managed as follows:

  • Use soft surfaces to protect the heel and sacrum from pressure damage
  • Keep the patient warm
  • Administer pain relief to allow for regular, comfortable change of patient position
  • Instigate early radiology
  • Measure and correct any fluid and electrolyte abnormalities

Patients should be transferred to the ward within two hours of their arrival in accident and emergency.

See "Imaging Studies" below.

Hip Fracture Classifications

Determine the anatomic locations (head, neck, intertrochanteric, trochanteric, and subtrochanteric) and note whether it is intracapsular or extracapsular. Femoral head and neck fractures are considered intracapsular, while trochanteric, intertrochanteric, and subtrochanteric fractures are considered extracapsular. Intracapsular hip fractures frequently have complicated healing.

Preoperative Care

Patients should be operated on as soon as possible (within 24 hours).

All patients undergoing hip fracture surgery should receive antibiotic prophylaxis.

Patients should have clinical and laboratory assessment of possible hypovolemia and electrolyte balance, and deficiencies appropriately and promptly corrected.

Oxygen saturation should be checked on admission. Supplementary oxygen should be administered to all patients with hypoxemia.

Anesthetic Management

Regional anesthesia is recommended for patients undergoing hip fracture repair, providing there are no specific indications for general anesthesia or contraindications to regional anesthesia.

Surgical Management

Most undisplaced intracapsular hip fractures that are treated surgically should have internal fixation, except in the very elderly, when hemiarthroplasty may be considered.

Extracapsular hip fractures should all be treated surgically unless there are medical contraindications.

Femoral Head Fractures

Type 1 (single fragment fractures): Reduce dislocated femoral head and fracture fragment as soon as possible to avoid avascular necrosis of fracture fragment. Early orthopedic consultation is a must. Small fracture fragments may need to be removed.

Type 2 (comminuted fractures): Early orthopedic consultation for admission and arthroplasty is recommended.

Femoral Neck Fractures

Type 1 (stress fractures or incomplete fractures): Some practitioners handle these fractures nonoperatively with initial immobilization in selected patients, while others prefer operative treatment in all patients.

Types 2, 3, and 4 (impacted fractures, partially displaced fractures, completely displaced or comminuted fractures): Management usually includes internal fixation or arthroplasty; however selected cases of impacted fracture can be treated conservatively. Early orthopedic consultation is recommended.

Intertrochanteric Fractures

Note potential for significant blood loss. Intravenous (IV) fluid resuscitation may be necessary.

Stable and unstable fractures usually are treated with open reduction and internal fixation unless patient is not an operative candidate for other reasons.

Early orthopedic consultation is recommended.

Trochanteric Fractures

Type 1 (nondisplaced fractures): Management is most often conservative, and orthopedic consultation is recommended.

Type 2 (displaced fracture): These usually are treated with reduction and internal fixation, except in older or debilitated patients in whom conservative treatment is appropriate.

Subtrochanteric Fractures

Significant hemorrhage is common, and IV fluid resuscitation is frequently necessary.

Emergency department (ED) application of traction or traction splint is necessary.

Consult orthopedic surgeon for admission and open reduction with internal fixation for most patients.

Dislocations

Possible Causes

  • Trauma (most common)
  • Congenital disorder

A hip dislocation requires immediate pain management, full medical screening examination, and reduction of the dislocation within 6 to 12 hours. The incidence of subsequent avascular necrosis (AVN) of the femoral head is a time-dependent phenomenon, one most likely to occur if relocation is delayed beyond 6 hours.

See "Imaging Studies" below.

Determine type of dislocation:

Anterior Hip Dislocation

Anterior dislocation of the hip occurs from a direct blow to the posterior aspect of the hip or, more commonly, from a force applied to an abducted leg that levers the hip anteriorly out of the acetabulum. Because of the mechanism of force causing this dislocation, the patient should also be evaluated for femur fractures, ligamentous stability, and pelvic fractures.

Central Hip Dislocation

Central dislocations occur when a direct impact to the lateral aspect of the hip forces the hip centrally through the acetabulum into the pelvis. This is a fracture-dislocation.

Posterior Hip Dislocation (90% of all hip dislocations)

Posterior dislocations occur when the knee and hip are flexed and a posterior force is applied at the knee. Conduct a full medical screening, including examination of the knee, foot and ankle joints.

Closed reduction is recommended for hip dislocation if possible.

Indications for open reduction include:

  • Irreducible dislocation (approximately 10% of all dislocations)
  • Persistent instability of the joint following reduction (e.g., fracture-dislocation of the posterior acetabulum)
  • Fracture of the femoral head or shaft
  • Neurovascular deficits that occur after closed reduction

Imaging Studies for Fractures and Dislocations

Plain Radiography

  • Plain radiographs of the pelvis should routinely be obtained in patients with a severe mechanism of injury, such as a motor vehicle accident (MVA) or fall from a substantial height. Pelvic fractures may occur in as many as 10% of patients.

Computed Tomography (CT)

  • CT scan of the hip is accurate in delineating the extent and nature of acetabular and hip fractures and dislocations.
  • If the patient's condition is sufficiently stable and if surgical repair is contemplated, CT scans provide essential information for the orthopedist.
  • The severity of acetabular fractures tends to be underestimated on plain radiographs, which are therefore less useful than CT scans in this situation.

Magnetic Resonance Imaging (MRI)

  • MRI of the hip is usually impractical in the initial evaluation of a trauma patient. It is, however, the best imaging modality in detecting and assessing AVN of the hip and in detecting nondisplaced stress fractures of the femoral neck.
  • MRI is also useful in the diagnosis of bone tumors, osteomyelitis, osteoarthritis, and congenital abnormalities of the hip joint.

Conservative Treatment

Conservative treatment applies to most cases of osteoarthritis, inflammatory arthritis, strains and sprains, tendonitis and non-displaced trochanteric fractures.*

Minor Injuries

Following MRI or ultrasonography, rest, ice, compression, and physical therapy are recommended.

Arthritic Conditions

Oral analgesics and exercise are recommended. Joint arthroplasty may be needed for end stage osteoarthritis. Following progression of inflammatory arthritis, anti-rheumatic drugs may be prescribed.

*Most non-displaced greater trochanteric fractures can be treated conservatively with protected weight bearing on the affected leg until the symptoms resolve. However, a nondisplaced greater trochanteric fracture that results from a fall needs to be evaluated to confirm that the fracture does not extend into the intertrochanteric region, which could result in displacement of the fracture. To evaluate the fracture, limited MRI or a bone scan may be useful. If the trochanteric fracture involves a large, completely displaced, and mechanically significant fragment of bone, it may require reduction and fixation.

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 injuries of the hip and pelvis.

Potential Harms
  • Acetaminophen has been associated with liver toxicity in overdose situations or in chronic alcohol use.
  • One high quality review concluded that in comparison with internal fixation, arthroplasty for the treatment of a displaced femoral neck fracture significantly reduces the risk of revision surgery, but could cause greater infection rates, blood loss, and operative time and possibly an increase in early mortality rates.
  • Results showed an increased risk of cut-out, non-union, implant breakage and re-operation for fixed nail plates in comparison with the sliding implants. In addition patients treated with fixed nail plates had a higher mortality and the survivors were more likely to have residual pain in the hip and impaired mobility.
  • Internal fixation increases the chances of revision surgery compared to arthroplasty.
  • Iatrogenic femoral fractures associated with the use of dynamic screw-intramedullary nail (DSIN) devices represent a rare, but persistent, risk.
  • Open reduction significantly increases the length of surgery. Early or open reduction of hip fractures may not reduce the risk of non-union (NU) or avascular necrosis (AVN). There is a suggestion of a higher incidence of NU following open reduction than closed reduction.
  • Liver and renal function should be monitored at least every six months in patients on chronic nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs should be used with caution among patients with cardiovascular risk factors. Long-term use of NSAIDs should be avoided if possible.
  • One high quality meta-analysis concluded that mortality with nonoperative treatment was higher with bed rest (73%) compared to early mobilization (odds ratio 3.8, 95% confidence interval [CI] 1.1-14.0). Bed rest was 2.5 times more likely to be associated with mortality compared to operative treatment (95% CI 1.1-5.5).

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
IOM Domain
Effectiveness
Patient-centeredness

Identifying Information and Availability

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

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

Date Released
2006 (revised 2011 Apr 28)
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. Official Disability Guidelines (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 NGC summary was completed by ECRI on April 13, 2006. This NGC summary was updated by ECRI on November 10, 2006 and March 30, 2007. This summary was updated by ECRI Institute on June 22, 2007 following the U.S. Food and Drug Administration (FDA) advisory on heparin sodium injection. This NGC summary was updated by ECRI Institute on August 27, 2007. This summary was updated by ECRI Institute on March 14, 2008 following the updated FDA advisory on heparin sodium injection. This NGC summary was updated by ECRI Institute on January 21, 2009. This NGC summary was updated by ECRI Institute on June 7, 2011. This summary was updated by ECRI Institute on October 12, 2011 following the U.S. Food and Drug Administration (FDA) advisory on Reclast (zoledronic acid). 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

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