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)To read this article in full you will need to make a payment
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Article info
Footnotes
Supported in part the National Institutes of Health (grant nos. K05 MH01107, 2R01 MH46402, and 2R01 DE10713).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
