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Prediction of Failure to Retain Work 1 Year After Interdisciplinary Functional Restoration in Occupational Injuries

      Abstract

      Brede E, Mayer TG, Gatchel RJ. Prediction of failure to retain work 1 year after interdisciplinary functional restoration in occupational injuries.

      Objective

      To identify risk factors for work retention (a patients' ability to both obtain and retain employment) at 1 year after treatment for a chronic disabling occupational musculoskeletal disorder (CDOMD).

      Design

      Prospective cohort study.

      Setting

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

      Participants

      A sample of 1850 consecutive CDOMD patients, who were admitted to and completed a functional restoration program, were subsequently classified as work retention or nonwork retention at a 1-year posttreatment evaluation.

      Interventions

      Not applicable.

      Main Outcome Measures

      Measures, including medical evaluations, demographic and occupational data, psychosocial diagnostic evaluation, and validated measures of pain, disability, and depressive symptoms, were obtained at admission to, and discharge from, the program.

      Results

      Using a multivariate logistic regression analysis, the following variables were found to be significant predictors of failure to retain work: older age (odds ratio [OR]=1.84; 95% confidence interval [CI], 1.33–2.54), female sex (OR=1.46; 95% CI, 1.09–1.94), nonworking status at discharge (OR=1.65; 95% CI, 1.11–2.45), extreme disability at admission (OR=1.46; 95% CI, 1.06–2.00), antisocial personality disorder (OR=2.11; 95% CI, 1.09–4.08), receipt of government disability benefits at admission (OR=2.28; 95% CI, 1.06–4.89), and dependence on opiate pain medications (OR=1.43; 95% CI, 1.02–2.00). The final model improved prediction by 75% over assigning all patients to the larger (work retention) group.

      Conclusions

      This study identified demographic, psychosocial, and occupational factors that were predictive of failure to retain work. These risk factors may be used to individualize treatment plans for CDOMD patients in order to provide optimal functional restoration.

      Key Words

      List of Abbreviations:

      BDI (Beck Depression Inventory), CDOMD (chronic disabling occupational musculoskeletal disorders), MVAS (million visual analog scale), NWR (nonwork retention), PRE (pretreatment (program admission)), POST (posttreatment (program discharge)), SSDI (Social Security Disability Insurance), SSI (Supplemental Security Income), WR (work retention), VAS (visual analog scale)
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      References

        • Schultz I.
        • Joy P.
        • Crook J.
        • Frasier K.
        Models of diagnosis and rehabilitation in musculoskeletal pain-related occupational disability.
        in: Schultz I. Gatchel R. Handbook of complex occupational disability claims: early identification, intervention, and prevention. Springer, New York2005: 43-66
        • Mayer T.
        • Gatchel R.
        • Kishino N.
        • et al.
        Objective assessment of spine function following industrial injury.
        Spine. 1985; 10: 482-493
        • Mayer T.
        • Gatchel R.
        • Mayer H.
        • Kishino N.
        • Keeley J.
        • Mooney V.
        A prospective two-year study of functional restoration in industrial low back injury: an objective assessment procedure.
        JAMA. 1987; 258: 1763-1767
        • Jordan K.
        • Mayer T.
        • Gatchel R.
        Should extended disability be an exclusion criterion for tertiary rehabilitation?.
        Spine. 1998; 23: 2110-2117
        • McGeary D.
        • Mayer T.
        • Gatchel R.
        High pain ratings predict treatment failure in chronic occupational musculoskeletal disorders.
        J Bone Joint Surg. 2006; 88: 317-325
        • Campello M.
        • Weiser S.
        • Nordin M.
        • Hiebert R.
        Work retention and nonspecific low back pain.
        Spine. 2006; 15: 1850-1857
        • Garcy P.
        • Mayer T.
        • Gatchel R.J.
        Recurrent or new injury outcomes after return to work in chronic disabling spinal disorders: tertiary prevention efficacy of functional restoration treatment.
        Spine. 1996; 21: 952-959
        • Gatchel R.J.
        • Mayer T.G.
        • Kidner C.L.
        • McGeary D.D.
        Are gender, marital status, or parenthood risk factors for outcome of treatment for chronic disabling spinal disorders?.
        J Occup Rehabil. 2005; 15: 191-201
        • Mayer T.
        • McMahon M.J.
        • Gatchel R.J.
        • Sparks B.
        • Wright A.
        • Pegues P.
        Socioeconomic outcomes of combined spine surgery and functional restoration in workers' compensation spinal disorders with matched controls.
        Spine. 1998; 23: 589-606
        • Mayer T.G.
        • Anagnostis C.
        • Gatchel R.J.
        • Evans T.
        Impact of functional restoration after anterior cervical fusion on chronic disability in work-related neck pain.
        Spine J. 2002; 2: 267-273
        • Mayer T.
        • Gatchel R.
        • Evans T.
        Effect of age on outcomes of tertiary rehabilitation for chronic disabling spinal disorders.
        Spine. 2001; 26: 1378-1384
        • McGeary D.D.
        • Mayer T.G.
        • Gatchel R.J.
        • Anagnostis C.
        • Proctor T.J.
        Gender-related differences in treatment outcomes for patients with musculoskeletal disorders.
        Spine J. 2003; 3: 197-203
        • Howard K.J.
        • Mayer T.G.
        • Gatchel R.J.
        Effects of presenteeism in chronic occupational musculoskeletal disorders: stay at work is validated.
        J Occup Environ Med. 2009; 51: 724-731
        • Proctor T.J.
        • Mayer T.G.
        • Theodore B.
        • Gatchel R.J.
        Failure to complete a functional restoration program for chronic musculoskeletal disorders: a prospective 1-year outcome study.
        Arch Phys Med Rehabil. 2005; 86: 1509-1515
        • Gatchel R.J.
        • Mayer T.
        • Dersh J.
        • Robinson R.
        • Polatin P.
        The association of the SF-36 health status survey with 1-year socioeconomic outcomes in a chronically disabled spinal disorder population.
        Spine. 1999; 24: 2162-2170
        • Anagnostis C.
        • Mayer T.G.
        • Gatchel R.J.
        • Proctor T.J.
        The Million visual analog scale: its utility for predicting tertiary rehabilitation outcomes.
        Spine. 2003; 28: 1051-1060
        • Gatchel R.J.
        • Mayer T.G.
        • Eddington A.
        MMPI disability profile: the least known, most useful screen for psychopathology in chronic occupational spinal disorders.
        Spine. 2006; 31: 2973-2978
        • Dersh J.
        • Mayer T.
        • Gatchel R.
        • Towns B.
        • Polatin P.
        Psychiatric comorbidity in chronic disabling occupational spinal disorders has minimal impact on functional restoration socioeconomic outcomes.
        Spine. 2007; 32: 1917-1925
        • McMahon M.J.
        • Gatchel R.J.
        • Polatin P.B.
        • Mayer T.G.
        Early childhood abuse in chronic spinal disorder patients: A major barrier to treatment success.
        Spine. 1997; 22: 2408-2415
        • Dersh J.
        • Mayer T.G.
        • Gatchel R.J.
        • Polatin P.B.
        • Theodore B.R.
        • Mayer E.A.
        Prescription opioid dependence is associated with poorer outcomes in disabling spinal disorders.
        Spine. 2008; 33: 2219-2227
        • Kidner C.L.
        • Mayer T.G.
        • Gatchel R.J.
        Higher opioid doses predict poorer functional outcome in patients with chronic disabling occupational musculoskeletal disorders.
        J Bone Joint Surg. 2009; 91: 919-927
        • Gatchel R.
        Clinical essentials of pain management.
        American Psychological Association, Washington, DC2004
        • Wilson H.
        • Mayer T.
        • Gatchel R.
        The lack of association between changes in functional outcomes and work retention in a chronic disabling occupational spinal disorder population: implications for the minimum clinical important difference.
        Spine. 2011; 36: 474-480
        • Gatchel R.
        • Mayer T.
        Testing minimal clinically important difference: consensus or conundrum?.
        Spine. 2010; 10: 321-327
        • Gatchel R.
        • Mayer T.
        Testing minimal clinically important difference: additional comments and scientific reality testing.
        Spine. 2010; 4: 330-332
        • Baldwin M.
        • Johnson W.
        • Butler R.
        The error of using returns-to-work to measure the outcomes of health care.
        Am J Ind Med. 1996; 29: 632-641
        • Mayer T.
        • Gatchel R.
        Functional restoration for spinal disorders: the sports medicine approach.
        Lea & Febiger, Philadelphia1988
        • Mayer T.
        • Polatin P.
        • Smith B.
        • et al.
        Spine rehabilitation: secondary and tertiary nonoperative care.
        Spine. 2003; 3: 28S-36S
        • Beck A.
        • Ward C.
        • Mendelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch Gen Psychiatry. 1961; 4: 561-571
        • Barnes D.
        • Smith D.
        • Gatchel R.J.
        • Mayer T.G.
        Psychosocioeconomic predictors of treatment success/failure in chronic low back pain patients.
        Spine (Phila Pa 1976). 1989; 14: 427-430
        • Curtis L.
        • Mayer T.G.
        • Gatchel R.J.
        Physical progress and residual impairment after functional restoration, part iii: isokinetic and isoinertial lifting capacity.
        Spine (Phila Pa 1976). 1994; 18: 401-405
        • Mayer T.
        • Towns B.
        • Neblett R.
        • Theodore B.
        • Gatchel R.
        Chronic widespread pain in patients with occupational spinal disorders: prevalence, psychiatric comorbidity, and association with outcomes.
        Spine. 2008; 33: 1889-1897
        • Proctor T.
        • Mayer T.
        • Gatchel R.
        • McGeary D.
        Unremitting health-care-utilization outcomes of tertiary rehabilitation of chronic musculoskeletal disorders.
        J Bone Joint Surg. 2004; 86: 62-69
        • Mayer T.
        • Gatchel R.
        • Polatin P.
        • Evans T.
        Outcomes comparison of treatment for chronic disabling work-related upper extremity disorders and spinal disorders.
        J Occup Environ Med. 1999; 41: 761-770
        • Faul F.
        • Erdfelder E.
        • Lang A.
        • Buchne A.
        G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Gatchel R.
        • Mayer T.
        Psychological evaluation of the spine patient.
        J Am Acad Orthop Surg. 2008; 16: 107-112
        • Tabachnick B.
        • Fidell L.
        Using multivariate statistics.
        in: 5th ed. Pearson Education, Inc, Boston2007
        • Chan S.
        • Stevens A.
        Job loss and employment patterns of older workers.
        J Lab Econ. 2001; 19: 484-521
        • Abraham K.
        • Houseman S.
        Work and retirement among older americans.
        in: Clark R.L. Mitchell O.S. Reinventing the reitrement paradigm. Oxford University Pr, New York2005: 70-91
        • US Social Security Administration, Office of Retirement and Disability Policy
        Annual Statistical Report on the Social Security Disability Insurance Program, 2008.
        (SSA Publication No. 13-11826) Government Printing Office, Washington, DC2009