Recurrent disabling work-related spinal disorders after prior injury claims in a chronic low back pain population.

BACKGROUND CONTEXT: Multiple compensation injury claims are an understudied phenomenon in the chronic back pain and occupational injury literature. Assumptions about poor treatment outcomes for patients presenting with prior injury can lead to denial of treatment, even though these assumptions have not been empirically addressed. Functional restoration has been demonstrated to be an effective rehabilitation treatment for disabling, work-related chronic back pain, although its' relative utility with recurrent injury (RI) patients has not been previously evaluated. PURPOSE: To assess demographic, psychosocial and work history/adjustment differences between the two groups, and to investigate whether patients with recurrent work-related spinal injury claims benefit from functional restoration treatment at a level equivalent to patients with nonrecurrent injuries. STUDY DESIGN/SETTING: A prospective cohort design assessing characteristics and outcomes of patients with recurrent work-related spinal disorders, compared with a group of patients without prior work-related spine injury claims, all treated with the same interdisciplinary rehabilitation protocol. PATIENT SAMPLE: A cohort of consecutively treated functional restoration rehabilitation patients (n=395) divided into two groups based on a history of prior work-related injury. The RI (n=172) group had at least one prior work-related injury claim (with or without lost time), whereas the nonrecurrent injury (NRI; n=223) group did not. OUTCOME MEASURES: The RI and NRI groups were assessed for prospectively collected demographic, psychosocial and work history/adjustment data. A structured clinical interview addressing socioeconomic outcomes and assessing work return, health utilization, recurrent injury and case closure was administered 1 year after discharge from the treatment program. METHODS: Consecutive patients from a regional referral center for tertiary rehabilitation treatment of chronic work-related musculoskeletal injuries were evaluated with a comprehensive biopsychosocial assessment protocol at pretreatment and posttreatment. Moreover, at 1 year after completing the program, a structural telephone interview was conducted that assessed health and socioeconomic outcomes. RESULTS: For the 1-year socioeconomic outcomes (such as posttreatment injury), the RI patients responded to rehabilitation at a level equivalent to the NRI patients. Demographic analyses revealed that RI patients, relative to NRI patients, were older, more represented by the dominant culture, had more education, had a shorter length of disability, had less severe types of injuries, had a greater rate of non-work-related health conditions, received higher disability payments, and had slightly greater job demand. The RI group also had a greater rate of pre-injury Axis I psychiatric disorders, particularly substance abuse/dependence disorders, than the NRI group. In addition, the RI group had greater job stability than the NRI group. CONCLUSIONS: The results of this study indicate that, although patients with recurrent injuries evidence differences in demographic, psychosocial and work history/adjustment differences when compared with patients with nonrecurrent injuries, their 1-year outcomes after tertiary, medically directed rehabilitation are identical. Both groups demonstrate very low rates of further work-related injuries through the first posttreatment year. Patients with recurrent injuries appear to develop skills in dealing with the workers' compensation system with a familiarity not seen in NRI patients. Of course, these results will need to be replicated in other settings to determine whether they can be generalized to the entire workers' compensation population.

Outcomes comparison of treatment for chronic disabling work-related upper-extremity disorders and spinal disorders.

Since 1986, the percentage of upper-extremity musculoskeletal disorders (UEMSDs) has increased from 1% to 4% of all occupational injury claims, while the average total medical and compensation cost is 80% higher than the average of all other claims. Because chronic disability leads to the highest cost, systematic evaluation of this growing occupational condition is needed. We performed a prospective case-series cohort study of patients (n = 163) with UEMSDs, compared with a matched group of spinal disorder (SD) patients (n = 163) treated with the same protocol. UEMSD patients were subclassified as those with one or more neuropathic diagnoses or those with non-neuropathic diagnoses. The neuropathic UEMSD subgroup had the poorest outcomes, with significantly higher surgery rates, higher health care utilization rates, and lower work retention when compared with the SD group. Rehabilitation outcomes for UEMSDs are similar to those for SDs. However, neuropathic-diagnosis patients are at risk for high-cost injuries and/or poorer prognoses.