Diagnoses and treatment recommendations on workers compensation medical certificates

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Abstract
Objective To review the diagnostic descriptions and treatment recommendations for back and neck pain on the new workers compensation medical certificates and compare these with evidence‐based guidelines. Design Retrospective analysis of 251 medical certificates of workers with compensable neck and back pain held by a workers compensation insurer. Main outcome measures Diagnoses given and treatments prescribed by the nominated treating doctors. Results The diagnoses most frequently used were “sprain/strain” and “pain/ache”. Physiotherapy was the most frequently prescribed treatment, followed by rest and medication. Rest was prescribed for 68 (27%) workers, 87% of whom were classified as having an acute injury. Activity‐based treatments were prescribed for 45 (18%) workers. Conclusions Not all doctors used diagnostic terms consistent with recommended anatomical taxonomy. The drug therapy prescribed was consistent with current evidence‐based treatment guidelines. However, the prescribing of rest, and the omission, in most cases, of explicit recommendations to resume normal activities, including work, are not consistent with current guidelines.