Patients With Chronic Disabling Occupational Musculoskeletal Disorder Failing to Complete Functional Restoration: Analysis of Treatment-Resistant Personality Characteristics

Abstract 

Howard KJ, Mayer TG, Theodore BR, Gatchel RJ. Patients with chronic disabling occupational musculoskeletal disorder failing to complete functional restoration: analysis of treatment-resistant personality characteristics.

Objective

To identify the risk factors for noncompletion of a functional restoration program for patients with chronic disabling occupational musculoskeletal disorders.

Design

Prospective cohort study.

Setting

Consecutive patients undergoing functional restoration treatment in a regional rehabilitation referral center.

Participants

A sample of 3052 consecutive patients, classified as either completers (n=2367) or noncompleters (n=685), who entered a functional restoration program.

Interventions

Not applicable.

Main Outcome Measures

The measures used included medical evaluations, demographic data, Diagnostic and Statistical Manual of Mental Disorders psychiatric diagnoses, the Minnesota Multiphasic Personality Inventory, and validated questionnaires evaluating pain, depression, and occupational factors.

Results

The findings revealed that patients who did not complete the program had a longer duration of total disability between injury and admission to treatment (completers=20mo vs noncompleters=13mo; P<.001). Furthermore, patients who were opioid-dependent were 1.5 times more likely to drop out of rehabilitation, and patients diagnosed with a socially problematic Cluster B Personality Disorder were 1.6 times more likely to drop out.

Conclusions

Although some risk factors associated with program noncompletion may be addressed in treatment, socially maladaptive personality disorders, long-neglected disability, and chronic opioid dependence are the major barriers to successful treatment completion. The patients identified with personality disorders may display resistance to treatment and may be difficult for the treatment staff to deal with. Early recognition of these treatment-resistant personality characteristics in the functional restoration process may assist the treatment team in developing more effective strategies to help this dysfunctional group.

Key Words: Personality disorders, Rehabilitation, Risk factors

List of Abbreviations: BDI, Beck Depression Inventory, DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, MMPI, Minnesota Multiphasic Personality Inventory, MVAS, million visual analog scale, OR, odds ratio, PD, personality disorder