Crook J. Moldofsky H.
The
probability of recovery and return to work from work disability as a function
of time.
Quality of Life Research. 3 Suppl 1:S97-109, 1994 Dec.
This paper describes a prospective longitudinal cohort study of musculoskeletal soft tissue pain impairment following a work related injury. It focuses on specific, univariate prognostic factors indicated in previous research studies that might affect the likelihood that injured workers will return to work or remain on work disability at any point in time. These factors include gender, age, return to work attempts and site of injury. Life table analysis was used to model the probability of work disability. The results showed that different Disability and return to work patterns emerged for males and females. Males were more likely to return to work; however, females had a higher probability than males of remaining at work once they returned to work. Older workers had the highest probability of being off work any given number of days after injury; were less likely To return to work, and if they did, had a higher probability of becoming disabled again. Efforts to return early to work contributed to a decrease in overall work disability. Workers with low back injuries had a greater likelihood of recurrence compared to injuries at other body sites.
Ferguson SA. Marras WS. Gupta P.
Longitudinal
quantitative measures of the natural course of low back pain recovery.
Spine. 25(15):1950-6, 2000 Aug 1.
STUDY
DESIGN: A prospective study was developed to quantify acute low back pain
recovery. OBJECTIVE: To compare traditional self-report measures of low back
pain recovery with a quantitative measure of recovery. SUMMARY OF BACKGROUND
DATA: The magnitude of low back disorders in society continues to be a problem.
To prevent secondary injuries, an understanding of recovery must be Gained by comparing the natural course of recovery using
several outcome measures. METHODS: For this study, 16 occupational and 16 nonoccupational patients with low back pain were recruited.
Recovery was monitored prospectively every 2 weeks for 3 to 6 months, using
subjective work status, pain symptoms, activities of daily living, and
objective functional performance probability (trunk kinematics). RESULTS:
Return to work underestimated the percentage of subjects impaired, as compared
with all other outcome measures. Symptoms, activities of daily living, and
functional performance probability all showed similar patterns of recovery for
0 to 12 weeks. At 14 weeks, there was a lag in functional performance recovery.
Both symptoms and activities of daily living indicated that 80% of the
population was recovered, whereas functional performance indicated the figure
to be 68%. CONCLUSION: This prospective study demonstrates the natural course
of recovery using several outcome measures. The objective kinematic functional
performance measure of recovery quantifies a different aspect of impairment not
evaluated by traditional subjective measures. Use of several outcome measures
may lead to a better understanding of low back pain recovery or residual
impairment, which may minimize the risk of recurrent injury.
Infante-Rivard C. Lortie M.
Prognostic
factors for return to work after a first compensated episode of back pain.
Occupational & Environmental Medicine. 53(7):488-94, 1996 Jul.
OBJECTIVES--To determine which factors measured at baseline and during the course of treatment influence time to return to work after a first compensated episode of back pain. METHODS--The design is a treatment inception cohort including 305 compensated workers
out of 402 eligible ones presenting at two rehabilitation centres for conventional treatment. Crude and adjusted rate ratios (RRs) along with 95% confidence intervals 95% CIs) were estimated with the Cox's proportional hazards regression. RESULTS--50% of workers had not returned to work after 112 days of follow up, and 11.3% still had not after 270 days. At the end of the study period (maximum follow up time was 1228 days), 230 workers (75.4%) had returned to work, 6.5% had not, and a similar percentage had retired, gone into vocational training, or returned to school. In the Final model stratified for radiating pain during
treatment, which was an important prognostic variable, workers between 21 to 30 years of age had a greater chance of returning to work (RR (95% CI) 1.43 (1.04 to 1.98)
than those > or = 30. The other factors associated with a greater chance of returning to work were: a diagnosis of sprain or pain upsilon a diagnosis of intervertebral disc disorder (2.20 (1.23-3.91)), < 30 days of waiting between the accident and the beginning of treatment
(1.30 (0.96 to 1.77)), a good flexion at baseline (1.52
1.04 to 2.23)), absence of neurological symptoms during treatment (1.40
(0.98-2.00)), > 24 months of employment in the industry (1.49 (1.10 to
2.03)), working for a public industry upsilon a private one (1.63 1.21 to
2.19)), and the ability to take unscheduled breaks (1.45 (1.06 to 1.97)).
CONCLUSIONS--Even with a first episode
of back pain, time to return to work is long and the proportion not returning
is high. Return to work as expected
is influenced by disease and host characteristics but also by social and work
factors. Reinstatement programmes should account for
all these factors.
Rossvoll I.
Benum P. Bredland TR. Solstad K. Arntzen E. Jorgensen S.
Incapacity for work
in elective orthopaedic surgery:a study of occurrence and the probability of
returning to work after treatment.
Journal of Epidemiology & Community Health.
47(5):388-94, 1993 Oct.
STUDY
OBJECTIVE--The extent to which patients undergoing elective surgery for orthopaedic disorders were incapacitated for work while
they were on the waiting list and whether they were able to return to work
after surgery were studied. DESIGN--This was a prospective cohort study of patients admitted to hospital For elective orthopaedic surgery.
Main outcome measures were occurrence of sickness certification during the
waiting time, and whether those incapacitated for work at the time of surgery returned
to work during the First year after treatment. Multivariate logistic regression
was used to estimate adjusted odds ratios for Factors influencing return to
work. SETTING--Orthopaedic department in charge of
all elective orthopaedic surgery in a population of
197,354 persons in central
Injury. 2004 Sep;35(9):891-5. Related
Articles, Links
Early management and
outcome following soft tissue injuries of the neck-a randomised
controlled trial.
Crawford JR,
Khan RJ, Varley GW.
Department of Trauma and Orthopaedics,
A total of 108 consecutive patients presenting to our hospital following a soft tissue injury of the neck from a road traffic accident were included in a prospective trial. Each patient was randomised to either early mobilisation using an exercise regime or 3 weeks treatment in a soft collar followed by the same exercise regime. Patients were assessed clinically at 3, 12 and 52 week intervals from injury. No differences were found between the two groups for pain, range of movement or activities of daily living at any of the follow up intervals. The collar treatment group took significantly longer to return to work after injury (17 days) compared with the early mobilisation group (34 days), [Formula: see text]. Treatment with a soft collar was found to have no obvious benefit in terms of functional recovery after neck injury and was associated with a prolonged time period off work. This study supports the use of an early mobilisation regime following soft tissue injuries of the neck.
Eur J Pain. 2004 Aug;8(4):359-69.
Returning the
chronically unemployed with low back pain to employment.
Watson PJ, Booker CK, Moores L, Main CJ.
Much of the
research into return to work following rehabilitation for low back pain in the
literature reflects work done in those employed. Unemployment is a consequence
of chronic low back pain which has considerable health and economic
consequences for the individual and society. This paper describes an
occupationally orientated rehabilitation programme
for long-term unemployed people (mean duration of unemployment 38.9 months).
The aim of the project was to identify factors which predict return to work and
progress towards employment. Eight six subjects underwent a pain management
rehabilitation programme incorporating vocational focussing and advice, subjects were followed up at 6 months
to determine work status. At follow-up 38.4% of subjects were employed and
another 23% were in voluntary work, or education/training. There were no
significant differences on presenting characteristics between those who
returned to work and those who did not. Subjects were divided into those who made
positive progress (work, education/training or voluntary work) and those who
did not (remained unemployed, dropped out of the programme
or lost to follow up). Those who failed to make positive progress were characterised by longer duration of unemployment and higher
scores on somatic anxiety and depression. A
predictive model was able to identify 80% of those who failed to make progress
but prediction of those achieving a positive outcome was poor (44% correct
prediction). The factors predicting return to work in unemployed people
with low back pain differs from the employed, the need for employment skills training and a
vocational focus to rehabilitation are highlighted.
BMC Musculoskelet Disord. 2004 May 24;5(1):14.
Prediction of
chronic disability in work-related musculoskeletal disorders: a prospective,
population-based study.
Turner JA, Franklin G, Fulton-Kehoe D, Egan
K, Wickizer TM, Lymp JF, Sheppard L, Kaufman JD.. jturner@u.washington.edu
BACKGROUND: Disability associated with
work-related musculoskeletal disorders is an increasingly serious societal
problem. Although most injured workers return quickly to work, a substantial
number do not. The costs of chronic disability to the injured worker, his or
her family, employers, and society are enormous. A means of accurate early
identification of injured workers at risk for chronic disability could enable
these individuals to be targeted for early intervention to promote return to
work and normal functioning. The purpose of this study is to develop
statistical models that accurately predict chronic work disability from data
obtained from administrative databases and worker interviews soon after a work
injury. Based on these models, we will develop a brief instrument that could be
administered in medical or workers' compensation settings to screen injured
workers for chronic disability risk. METHODS: This is a population-based,
prospective study. The study population consists of workers who file claims for
work-related back injuries or carpal tunnel syndrome (CTS) in
Brain Inj. 2004 Mar;18(3):221-38.
Acute predictors of
real-world outcomes following traumatic brain injury: a prospective study.
Dawson DR, Levine B, Schwartz ML, Stuss DT.
Kunin-Lunenfeld Applied Research Unit, Baycrest
Centre for Geriatric Care,
PRIMARY
OBJECTIVE: To determine whether the recovery of acute attention and memory
improves the prediction of real-world outcomes over that provided by standard
demographic and injury-severity measures. RESEARCH DESIGN: Participants were
recruited consecutively at the time of injury and followed prospectively at 1
(time 1, or T1) and 4 years (time 2, or T2). METHODS
AND PROCEDURES: Measures of attention and memory and the Galveston Orientation
and Amnesia Test (GOAT) were administered to 94 participants daily from the
time of injury until the criterion was met. Sixty-three per cent returned at T1
and 53% returned at T2. Outcomes were psychosocial distress, return to work
and/or school, and quality of life. MAIN OUTCOMES AND RESULTS: Recovery of
attention, memory and orientation did not significantly improve prediction of
outcomes at T1, but did so at T2. At T2, recovery of free recall of three words
over 24 h was a more sensitive predictor of psychosocial distress and return to
productivity than the GOAT. CONCLUSIONS: Free
recall of three words may be a useful acute clinical test to enhance prediction
of long-term outcomes.
J Occup Environ Med. 2003 Jul;45(7):763-70.
Prediction of
prolonged work disability in occupational low-back pain based on nurse case
management data.
Okurowski L, Pransky G, Webster B, Shaw WS, Verma
S.
Harvard
This study
evaluated whether risk prediction data captured by nurse case managers (NCMs) could predict prolonged disability from occupational
low back pain. Cases of uncomplicated occupational low back pain referred to NCMs, with dates of injury between January 1, 1997 and June
30, 1998, were selected (n = 986). Predictive information was obtained from the
NCM screening checklist of potential risk factors and other administrative
claims data. Data were collected on 23 variables thought to predict work status
at 6 months postinjury. In a multivariate logistic
regression model, being out of work was significantly associated with older
age, language barriers, earlier referral to NCM, and neutral or negative
attorney attitude toward return to work. The overall predictive power of the
model was low (area under curve = 0.6). Although
NCM risk factor data collection is feasible and practical in insurance
settings, future studies should explore additional variables and refined data
collection methods in order to achieve a more accurate prediction.
J Head Trauma Rehabil. 2003 Mar-Apr;18(2):128-38.
Moderating
factors in return to work and job stability after traumatic brain injury.
Kreutzer JS, Marwitz JH, Walker W, Sander
A, Sherer M, Bogner J, Fraser R, Bushnik T.
The Department
of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Box
980542, Richmond, VA 23298-0542, USA.
OBJECTIVE: To
examine job stability moderating variables and develop a postinjury
work stability prediction model. DESIGN: Multicenter
analysis of individuals with traumatic brain injury (TBI) who returned for
follow-up at 1, 2, and 3, or 4 years postinjury, were
of working age (between 18 and 62 years of age at injury), and were working preinjury. SETTING: Six National Institute on Disability
and Rehabilitation Research TBI Model System centers for coordinated acute and
rehabilitation care. PARTICIPANTS: A total of 186 adults with TBI were included
in the study. MAIN OUTCOME MEASURES: Job stability was categorized as stably
employed (employed at all 3 follow-up intervals); unstably employed (employed
at one or two of all three follow-up intervals); and unemployed (unemployed at
all three follow-up intervals). RESULTS: After injury, 34% were stably
employed, 27% were unstably employed, and 39% were unemployed at all three
follow-up intervals. Minority group members, people who did not complete high
school, and unmarried people were more likely to be unemployed. Driving
independence was highly influential and significantly related to employment
stability. A discriminant function analysis, which
included age, length of unconsciousness and Disability Rating Scale scores at 1
year postinjury, accurately predicted job stability
groupings. CONCLUSION: Data analysis
provided evidence that employment stability is predictable with a combination
of functional, demographic, and injury severity variables. Identification of
people at risk for poor employment outcomes early on can facilitate
rehabilitation planning and intervention.
Schmerz. 1997 Feb 25;11(1):30-41.
[Multidisciplinary treatment
program on chronic low back pain, part 4. Prognosis of treatment outcome
and final conclusions] [Article in German]
Pfingsten M, Hildebrandt J, Saur P, Franz
C, Seeger D.
Schwerpunkt Algesiologie, Zentrum
Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universitat
Gottingen.
PROBLEM: Studies
using a multimodal approach in order to prognose
therapeutic success in patients suffering from back pain were seen to have highly
diverse results. However, in spite of various independent health care systems,
a common interest prevails in identifying determinants of therapeutic success
in order to improve therapy. METHODS: Ninety disabled patients with chronic low
back pain were admitted to an 8-week out-patient program of functional
restoration and behavioral support. The program consisted of a pre-program
(education, stretching and calisthenic exercises 4 h
a day, three times a week for 3 weeks) and an intensive treatment period (physical
exercises, back school education, cognitive behavioral group therapy,
relaxation training, occupational therapy, socioeconomic and vocational
counseling) which took place for 5 weeks, 7 h a day as an outpatient program.
The program's philosophy encourages active effort on the patients' part in
order to improve their functional status within a therapeutic environment. This
reinforces behavior conducive to getting well, enhances the patients' sense of
self-control over their pain and the resulting disability. The main therapeutic
target was to facilitate the patients' return to work. Apart from medical
examination and personal interview, the patients' physical impairment, pain
descriptions, and psychological distress were also measured. This included
variables such as depression, psychovegetative
complaints, quality of life and workplace satisfaction, disability, and coping
with disease. Measurements were repeated at the end of the 8-week program, and
following 6 and 12 month intervals. The reliability of prognostic factors in
predicting treatment outcome (return to work, reduction of pain intensity, self-assessment of success by the patients) was tested by
analyses of variance and discriminant function
analyses. RESULTS: Patients' return to
the workplace could be predicted in 85% of cases based on whether an
application for pension had been made, on the length of duration of work
disability, and on "fixed" assumptions on the part of the patient
concerning his work situation. Pre-treatment somatic findings (for example,
diagnosis, degree of physical impairment, and functional debilities), together
with depressive and psychovegetative reactions, were
shown to have no connection with the patient's ability to return to the
workplace. Similar findings were demonstrated for the prediction of pain
reduction and patient satisfaction with treatment. CONCLUSIONS: Predicting
successful treatment is hardly possible without analyzing individual
circumstances, focusing on sociodemographic
variables, workplace-related conditions, and aspects of individual motivation.
With regard to objective therapeutic success, subjective perceptions proved
highly influential. Treatment proved successful only when the patient's
perception of functional disability was minimized. Hence, individual
perceptions and experiences were more important than physical capabilities.
Spine. 2002 Dec 1;27(23):2720-5.
Biopsychosocial
multivariate predictive model of occupational low back disability.
Schultz IZ, Crook JM, Berkowitz J, Meloche
GR, Milner R, Zuberbier OA, Meloche W.
Department of
Educational and Counselling Psychology and Special
Education, University of British Columbia, Vancouver, Canada. ischultz@telus.net
STUDY DESIGN: To
establish outcome, 253 workers with subacute and
chronic low back conditions were assessed with a comprehensive multimethod biopsychosocial
protocol at baseline, 3 days after the initial examination, and 3 months later.
OBJECTIVE: To validate empirically a biopsychosocial
model for prediction of occupational low back disability. SUMMARY OF BACKGROUND
DATA: Costs of low back occupational disability continue to spiral despite
stabilization of low back injury rates. An empirically based model to predict
occupational disability in workers with low back injuries is required. METHODS:
Workers with subacute low back injuries (4-6 weeks
after injury, n = 192) and those with chronic back pain (6-12 months after
injury, n = 61) were the study participants. The biopsychosocial
protocol included five groups of variables: 1) sociodemographic,
2) medical, 3) psychosocial, 4) pain behavior, and 5) workplace-related
factors. Predictive validity was investigated through a 3-month follow-up
assessment, at which time the return to work outcome was determined. Stepwise
logistic regression models were developed to predict work status. RESULTS: The final integrated model consisted of
variables from a wide biopsychosocial spectrum:
vitality, health transition, feeling that job is threatened due to injury,
expectations of recovery, guarding behavior, perception of severity of
disability, time to complete walk, and right leg typical sciatica.
CONCLUSIONS: The "winning"
variables identified in the integrated model are dominated by cognitions, which
are accompanied by disability behaviors. A cognitive-behavioral model with an
adaptation-oriented rather than a pathology-oriented focus is favored for early
intervention with high-risk workers since cognitions are amenable to change.
Spine. 2002 Dec 1;27(23):2715-9.
Are components of a
comprehensive medical assessment predictive of work disability after an episode
of occupational low back trouble?
Hunt DG, Zuberbier OA, Kozlowski AJ, Berkowitz J, Schultz IZ, Milner
RA, Crook JM, Turk DC.
Workers Compensation
Board of
STUDY DESIGN:
One hundred fifty-nine subacute low back work-injured
patients completed a full medical assessment at baseline. A full repeat
examination was performed 3 months later, when return-to-work status was
determined. OBJECTIVE: To determine the prognostic value of a comprehensive
medical assessment for the prediction of return-to-work status. SUMMARY OF
BACKGROUND DATA: A systematic review of the work disability prediction literature
of low back trouble prognosis revealed that no high-quality studies included a
full medical history and physical examination in the design. The results of
studies included in the systematic review were equivocal with respect to
predictive usefulness of medical variables. METHODS: Participants completed
medical history questionnaires and then were clinically examined by one of six
experienced examiners (three physicians and three physiotherapists).
Return-to-work status was measured 3 months later, and predictive validity was
evaluated using logistic regression modeling. RESULTS: Medical variables (,
medical history subscales, physical examination subscales, and lumbar
range-of-motion tests) showed modest correct classification rates varying
between 61.6% and 69.1% for participants. CONCLUSIONS: Comprehensive medical
assessments play a crucial role in the early identification of serious
pathology after low back trouble. We were unable to identify, however, any
medical evaluation variables that would account for significant proportions of
variance in return to work. The weight of evidence obtained in this study
suggests that injured workers' subjective interpretations and appraisals may be
more powerful predictors of the course of postinjury
recovery than exclusively medical assessments.
Work. 1999;12(1):25-35.
The model of human
occupation and prediction of return to work: a review of related empirical
research.
Braveman B.
Department of Occupational Therapy,
The purpose of
this paper is to investigate through a review of research literature whether
empirical support exists to support the theoretical arguments of the Model of
Human Occupation. A literature review of 44 predictive studies of factors
influencing return-to-work published over the last 25 years was conducted. The
factors most commonly found to be associated with return to work or with
long-term disability were then organized according to the subsystems of the
Model of Human Occupation.
Eur Spine J. 2002 Jun;11(3):258-66. Epub 2001 Oct 05.
Predictive tests
for non-return to work in patients with chronic low back pain.
Kool JP, Oesch PR, de Bie RA.
Research Department, Rehabilitation Centre, Klinik
Valens, 7317
Return to work
(RTW) is the primary goal in the rehabilitation of patients with chronic low
back pain. In spite of expensive rehabilitative efforts, many patients do not
RTW. To increase cost effectiveness, predictive tests for non-RTW are needed to
select patients for rehabilitation. The reliability of these tests must be
high, to prevent exclusion of patients who might improve. This study evaluates
the reliability and predictive validity of four tests and the following
psychosocial factors for non-RTW: nationality, off-work duration, unemployment
and work load. It was designed as a prospective cohort study of 99 patients
with chronic low back pain. Upon entry, physical work load, time off work,
unemployment and nationality were recorded. The study investigated four tests with an anticipated prognostic
value for non-RTW: the Numeric Pain Rating Scale (NRS, 9-10 of a maximum of
10), the Step Test and Pseudo Strength Test (precipitous cessation) and Behavioural Signs. After 12 months, the RTW rate was
obtained from the physicians responsible for sick-listing by postal survey. The
response rate regarding RTW was 91% at 1 year. The RTW rate at 1 year was 20%.
All investigated tests significantly correlated with non-RTW. Regression analysis showed that the best
prediction of non-RTW was obtained when at least two out of the four tests were
positive (positive predictive value 0.97, sensitivity 0.45). Unemployment, time
off work, nationality and physical work load were less predictive. The results
show that the combination of the four prognostic tests allows a very reliable
prognosis of non-RTW. The cost effectiveness of rehabilitation aiming at RTW
will, therefore, be increased by excluding patients with two or more positive
tests.