Biomechanical requirements of meat cutting tasks: A pilot study quantifying tasks sustainability and assistance required at the wrist.

The meat processing industry is particularly affected by distal upper limb musculoskeletal disorders. This pilot study aims at proposing a methodology able to quantify biomechanical requirements of meat cutting tasks at butchers' dominant wrist and, when necessary, at estimating the assistance needed to reach sustainability. Six professional butchers repeatedly cut pieces of pork. Joint angles were recorded using a motion capture system, cutting forces using an instrumented knife. Sustainability was computed by the maximal acceptable effort method. Assistance requirements were computed for isolated stressful exertions and for overall work cycle sustainability. Five butchers exceeded the sustainability threshold for wrist flexion. Ulnar or radial deviation torques were excessive for 2 and 3 of them, respectively. Extension torques were sustainable. The peak assistive torque for isolated exertions was at most 1.1Nm, 1.6Nm and 1.1Nm, and the percentage of assistance for overall sustainability was at most 60%, 56% and 56% for wrist flexion, ulnar and radial deviation, respectively.

[Meta analysis of the prevalence and influencing factors of WMSDs among dentists in China].

Objective: To explore the relevant factors of work-related musculoskeletal disorders (WMSDs) among dentists through Meta analysis, providing a basis for the prevention and control of WMSDs among dentists. Methods: In April 2022, cross-sectional research literatures on the prevalence correlation of WMSDs among Chinese dentists were searched in databases such as China National Knowledge Infrastructure, Wanfang, VIP, PubMed, Web of Science, and Em Base database. The search was conducted from the establishment of the database until April 2022, literatures were selected using keywords such as musculoskeletal disorders and dentists. To extract gender, age, length of service, disease classification and other related influencing factors as indicator, and prevalence was selected as the outcome indicator. After evaluating the quality of the literatures, RevMan 5.3 software was used to calculate the combined RD (95%CI) values of the included literatures. Results: A total of 15 articles were included, with a total sample size of 3646 people. Meta analysis results showed that the prevalence of WMSDs among dentists in China was 80%, and the top three parts of the incidence rates were 65% of the waist, 58% of the neck, and 50% of the back. Gender, age, length of service, region and disease classification all increased the risk of WMSDs, and the combined effect size were 75%, 78%, 71%, 77% and 82% respectively (P<0.05) . Conclusion: The occurrence of WMSDs among dentists in China is related to multiple factors such as gender, age, length of service and disease classification. The above risk factors should be taken into account in the workplace and preventive measures should be actively implemented to prolong the working life of dentists.

Meta analysis of the prevalence and influencing factors of WMSDs among dentists in China / 中华劳动卫生职业病杂志

Objective: To explore the relevant factors of work-related musculoskeletal disorders (WMSDs) among dentists through Meta analysis, providing a basis for the prevention and control of WMSDs among dentists. Methods: In April 2022, cross-sectional research literatures on the prevalence correlation of WMSDs among Chinese dentists were searched in databases such as China National Knowledge Infrastructure, Wanfang, VIP, PubMed, Web of Science, and Em Base database. The search was conducted from the establishment of the database until April 2022, literatures were selected using keywords such as musculoskeletal disorders and dentists. To extract gender, age, length of service, disease classification and other related influencing factors as indicator, and prevalence was selected as the outcome indicator. After evaluating the quality of the literatures, RevMan 5.3 software was used to calculate the combined RD (95%CI) values of the included literatures. Results: A total of 15 articles were included, with a total sample size of 3646 people. Meta analysis results showed that the prevalence of WMSDs among dentists in China was 80%, and the top three parts of the incidence rates were 65% of the waist, 58% of the neck, and 50% of the back. Gender, age, length of service, region and disease classification all increased the risk of WMSDs, and the combined effect size were 75%, 78%, 71%, 77% and 82% respectively (P<0.05) . Conclusion: The occurrence of WMSDs among dentists in China is related to multiple factors such as gender, age, length of service and disease classification. The above risk factors should be taken into account in the workplace and preventive measures should be actively implemented to prolong the working life of dentists.

Slouched and Erect Sitting Postures Affect Upper Limb Maximum Voluntary Force Levels and Fatiguability: A Randomized Experimental Study.

OCCUPATIONAL APPLICATIONSModifying the spinal curvature is an empirical approach to treating upper limb musculoskeletal disorders, often attributed to the balance between physical stress and individual functional capacities. We completed an experimental biomechanical study to quantify the effect of seated spinal posture on upper limb functional capacities. Isometric maximum muscle voluntary forces (MVFs) were measured at participants' shoulder, elbow, and wrist. Fatiguability was also assessed during a repetitive painting task. Participants were asked to assume both slouched and erect spinal postures, in a random order. In the erect posture, participants achieved higher shoulder and elbow isometric MVF levels and took longer to reach a fatigue threshold. Thus, spinal posture tends to remotely influence upper limb functional capacities, especially at the shoulder and elbow. Ergonomists should consider spinal posture even when focusing on musculoskeletal disorders of the upper limb.

Background Musculoskeletal disorders are a major public health issue, and current treatments often remain unsatisfactory. Treatments based on spinal curvature modifications are empirically used for upper limb musculoskeletal disorders.Purpose To determine whether a slouched or erect sitting posture has an effect on upper limb functional capacities, with tests and outcomes focused on the risk of upper limb musculoskeletal disorders.Methods Randomized experimental study, crossover design. Twenty-two right-handed healthy participants from the local area were assessed in a research laboratory. Participants' spinal curvatures were increased or decreased, through verbal instructions and light touch, to place them in a slouched or an erect posture that was stable and easily maintained, in a random order. Isometric maximum muscle voluntary forces (MVFs) were measured. Participants also performed a repetitive task that simulated painting, with fatigue level assessed using the CR10 Borg scale. Upper limb positioning, task setting, and instructions to participants were standardized, and the investigator was blind to the results of MVF measurements. The main outcomes were normalized differences in MVF values and time-to-reach "7" on the CR10 scale.Results There were significantly higher MVF values in the erect posture for the shoulder and elbow, with respective mean (SD) normalized differences of 11.4 (18.2)% and 11.8 (19.2)%; differences approached significance at the wrist [7.7 (18.5)%]. The normalized difference in time-to-reach "7" on the CR10 scale was significantly higher in the erect posture (by 11.4%).Conclusions Spinal posture modified individual upper limb functional capacities and could thus influence the risk of upper limb musculoskeletal disorders.

Prevalence of occupational musculoskeletal disorders among workers inheavy-duty automobile parts factories in Beijing Municipality / 预防医学

Objective@#To investigate the prevalence and risk factors of occupational musculoskeletal disorders among workers in heavy-duty automobile parts factories in Beijing Municipality, so as to provide insights into development of effective interventions for occupational musculoskeletal disorders.@*Methods@#The workers in three heavy-duty automobile truck parts factories in Beijing Municipality were recruited using the convenient sampling method during the period from May 2019 to October 2020. Subjects' demographic characteristics, type of job and prevalence of occupational musculoskeletal disorders at various sites were collected using self-designed electronic questionnaires, and the factors affecting the development of occupational musculoskeletal disorders were identified using a multivariable logistic regression model.@*Results@#A total of 264 workers were enrolled, including 260 males (98.48%) and 4 females (1.52%). The participants had a mean age of (31.71±6.13) years, and mean duration of (7.51±5.25) years at current position, and mechanical technician was the major type of work (129 workers, 48.86%). The prevalence of occupational musculoskeletal disorders was 70.08% among the participants, and high prevalence of occupational musculoskeletal disorders was found in the lower back/waist (41.28%), shoulder (40.15%), neck (39.02%) and upper back (33.33%). Multivariable logistic regression analysis identified females (OR=1.280, 95%CI: 1.021-1.602) and head-down posture at work (OR=2.644, 95%CI: 1.034-6.763) as risk factors for occupational musculoskeletal disorders at neck; females (OR=1.633, 95%CI: 1.624-2.117), sheet metal workers, mechanical technicians and painters (OR: 5.811-10.452, 95%CI: 1.205-54.027), working in an uncomfortable posture (OR：1.376-7.749, 95%CI: 1.034-27.270) and frequent working overtime (OR=2.081, 95%CI: 1.192-4.137) as risk factors for occupational musculoskeletal disorders at shoulder; and sheet metal workers, mechanical technicians and painters (OR: 8.760-11.948, 95%CI: 1.630-66.927), working in an uncomfortable posture (OR：4.067-12.185, 95%CI: 1.332-47.523) and frequent working overtime (OR=2.201, 95%CI: 1.142-4.244) as risk factors for occupational musculoskeletal disorders at waist/back.@*Conclusions@#The prevalence of occupational musculoskeletal disorders is high among workers in heavy-duty automobile parts factories, which mainly occur at shoulder, neck, waist and back. Type of work, working posture and working duration are main factors affecting the development of occupational musculoskeletal disorders.

[Analysis of the prevalence and influencing factors of occupational musculoskeletal disorders among rural migrant workers in Tianjin].

Objective: To explore the prevalence of occupational musculoskeletal disorders (OMD) and its influencing factors among rural migrant workers in Tianjin, with the aim of developing strategies to improve the health condition of this specific population. Methods: Questionnaire survey was conducted among 415 rural migrant workers working in Tianjin about their fundamental state and occupational musculoskeletal disorders (OMD) during January 2015 to January 2016. Statistical methods were utilized to analyze the influencing factor. Results: A total of 415 rural migrant workers were investigated, in which young Young adults and low education level were in the majority of rural migrant workers. The prevalence of OMD for whole population, male and female were 28.92% (120/415), 33.06% (81/245) and 22.94% (39/170), respectively. Prevalence showed significant differences njin and workplace hygiene. Multivariate logistic regression analysis showed that the risks of OMD increased with age group, and decreased with higher education level. The risk of OMD among rural migrant workers with monthly income between 3000 to 5000 yuan was 2.26 times (95%CI: 1.37-3.75) higher than that of low-income workers (<3000 yuan per month). Workers engaged in housekeeping service had 2.28 times higher risk of OMD than those in manufacturing industry (95%CI: 1.06-4.89) . Conclusion: Prevalence of OMD among rural migrant workers is higher than that of general people. Age, education, monthly income, occupation are the independent influencing factors for OMD among rural migrant workers.

Analysis of the prevalence and influencing factors of occupational musculoskeletal disorders among rural migrant workers in Tianjin / 中华劳动卫生职业病杂志

Objective@#To explore the prevalence of occupational musculoskeletal disorders (OMD) and its influencing factors among rural migrant workers in Tianjin, with the aim of developing strategies to improve the health condition of this specific population.@*Methods@#Questionnaire survey was conducted among 415 rural migrant workers working in Tianjin about their fundamental state and occupational musculoskeletal disorders (OMD) during January 2015 to January 2016. Statistical methods were utilized to analyze the influencing factor.@*Results@#A total of 415 rural migrant workers were investigated, in which young Young adults and low education level were in the majority of rural migrant workers. The prevalence of OMD for whole population, male and female were 28.92% (120/415), 33.06% (81/245) and 22.94% (39/170), respectively. Prevalence showed significant differences njin and workplace hygiene. Multivariate logistic regression analysis showed that the risks of OMD increased with age group, and decreased with higher education level. The risk of OMD among rural migrant workers with monthly income between 3000 to 5000 yuan was 2.26 times (95%CI: 1.37-3.75) higher than that of low-income workers (<3000 yuan per month). Workers engaged in housekeeping service had 2.28 times higher risk of OMD than those in manufacturing industry (95%CI: 1.06-4.89) .@*Conclusion@#Prevalence of OMD among rural migrant workers is higher than that of general people. Age, education, monthly income, occupation are the independent influencing factors for OMD among rural migrant workers.

[The correlation of Occupational musculoskeletal disorders and occupational safety behaviors in assembly line workers].

Objective: To study the correlation of occupation musculoskeletal disease (OMD) and safety behavior in assembly line workers. Methods: Selected assembly line workers of 3 manufacturing factory in Pacity as the objects of this study by judgement sampling. Questionnaires were used for messages collection including the general sociodemographic characteristic, OMD condition, occupational safety behaviors. Results: This study shows that, 826 OMD workers were found that the annual prevalence was 38.03%. The scores of work posture, handling habits, health habit in OMD group was lower than non-OMD group (P<0.01) but personal protection behavior was higher than non-OMD group (P<0.01) . Test of binary logistic regression revealed that age, workage, work posture, handling habits were the factors of OMD (P<0.01) . Conclusion: Safety behaviors were the potent factors of OMD that work posture and handling habits should be broadcast.

Does the Length of Disability between Injury and Functional Restoration Program Entry Affect Treatment Outcomes for Patients with Chronic Disabling Occupational Musculoskeletal Disorders?

Purpose Functional restoration programs (FRPs), for patients with chronic disabling occupational musculoskeletal disorders (CDOMDs), have consistently demonstrated positive socioeconomic treatment outcomes, including decreased psychosocial distress and increased work return. The pre-treatment length of disability (LOD), or time between injury and treatment admission, has been shown to influence FRP work outcomes. Some studies have found that shorter LOD is associated with better work outcomes. However, few studies have actually examined cohorts with LOD duration longer than 18 months. This present study evaluated the effects of extended LOD (beyond 18 months) on important treatment outcomes. Methods A total cohort of 1413 CDOMD patients entered an FRP. Of those, 312 did not complete the program, so they were eliminated from outcome analyses. The 1101 patients who completed the FRP were classified based on LOD: Late Rehabilitation (LR, 3-6 months, n = 190); Chronic Disability (CD, 7-17 months, n = 494); and Late Chronic Disability (LCD). The LCD, in turn, consisted of four separate subgroups: 18-23 months (LCD-18, n = 110); 24-35 months (LCD-24, n = 123); 36-71 months (LCD-36, n = 74); and 72+ months (LCD-72, n = 110). Patients were evaluated upon admission and were reassessed at discharge. Those patients who chose to pursue work goals post-treatment (n = 912) were assessed 1-year later. Results Longer LOD was associated with less likelihood of completing the FRP (p < .001). Compared to the other LOD groups, a relatively large percentage of patients (47%) in the longest- disability group were receiving social security disability benefits. Associations were found between longer LOD and more severe patient-reported pain, disability, and depressive symptoms at treatment admission. At discharge, symptom severity decreased for these patient-reported variables in all LOD groups (p < .001). Using binary logistic regressions, it was found that LOD significantly predicted work-return (Wald = 11.672, p = .04) and work-retention (Wald = 11.811, p = .04) after controlling for covariates. Based on the LOD groups, the percentage of patients returning to, and retaining work, ranged from 75.6 to 94.1%, and from 66.7 to 86.3%, respectively. The odds of LCD-24 and LCD-72 patients returning to work were 2.9, and 7.4, respectfully, less likely, compared to LR patients. Furthermore, the odds of LCD-24 and LCD-72 patients retaining work were 3.3 and 3.8 times, respectively, less likely, compared to LR patients. Conclusions Long LOD was a risk factor for FRP non-completion, and was associated with more severe patient-reported variables, including pain intensity and perceived disability. Furthermore, long LOD was a significant predictor for work outcomes at 1 year following FRP discharge. Nevertheless, a large percentage of longer LOD (>24 months) patients had returned to work within the year after discharge (above 85%), and had retained at least part-time work 1-year later (above 66%). These results support the effectiveness of the FRP in mitigating the effects of extended LOD in a large percentage of long-term LOD patients.

Relationship between occupational stress and occupational musculoskeletal disorders in coal miners / 中国职业医学

OBJECTIVE: To explore the relationship between occupational stress and occupational musculoskeletal disorders( OMD) in coal miners. METHODS: A total of 362 coal miners were selected through cluster sampling method. The prevalence of OMD was investigated by the Nordic Standardized Questionnaires for Musculoskeletal Disorders( Chinese version). The Job Content Questionnaire and Effort Reward Imbalance Questionnaire were used to assess the occupational stress and depression of coal miners was determined by the Epidemiological Studies Depression Scale. RESULTS: The prevalence of OMD in coal miners was 63. 5%. There were 45. 9%( 166/362) of coal miners suffered from occupational stress with job demand-control model imbalance and 62. 4%( 226/362) of coal miners have occupational stress with effortreward model imbalance. The multiple logistic non-conditional regression analysis showed that the longer service length with exposure to occupational hazard factors,the more working days per week,the lower job contents and technical decisionmaking power,the higher the occupational stress with effort-reward imbalance,and the higher the depression and the higher the risk of OMD( P < 0. 05). CONCLUSION: Occupational stress and depression are both risk factors of OMD in coal miners.

The correlation of Occupational musculoskeletal disorders and occupational safety behaviors in assembly line workers / 中华劳动卫生职业病杂志

Objective@#To study the correlation of occupation musculoskeletal disease (OMD) and safety behavior in assembly line workers.@*Methods@#Selected assembly line workers of 3 manufacturing factory in Pacity as the objects of this study by judgement sampling. Questionnaires were used for messages collection including the general sociodemographic characteristic, OMD condition, occupational safety behaviors.@*Results@#This study shows that, 826 OMD workers were found that the annual prevalence was 38.03%. The scores of work posture, handling habits, health habit in OMD group was lower than non-OMD group (P<0.01) but personal protection behavior was higher than non-OMD group (P<0.01) . Test of binary logistic regression revealed that age, workage, work posture, handling habits were the factors of OMD (P<0.01) .@*Conclusion@#Safety behaviors were the potent factors of OMD that work posture and handling habits should be broadcast.

Influencing factors of occupational musculoskeletal disorders in workers of manufacturing industry / 中国职业医学

OBJECTIVE: To investigate the prevalence of occupational musculoskeletal disorders(OMD) in workers of manufacturing industry,and to analyze its influencing factors.METHODS: A total of 1 168 first-line workers from 3manufacturing enterprises were selected as study subjects using convenient sampling.The self-designed questionnaire was used to investigate the basic information and the ergonomics of work process.The Nordic Musculoskeletal Questionnaire was used to investigate the prevalence of OMD.The workers were divided into non-OMD group and OMD group.RESULTS: The prevalence of OMD in these 1 168 workers was 34.9%.Comparing with the non-OMD group,the score of using auxiliary tools to carry the weights in the OMD group was higher(P<0.01),and the scores of straight waist and bent knees when transporting heavy object was lower(P<0.01).Logistic regression analysis showed that male workers had a higher risk of OMD than female workers(P<0.05).The longer the length of service,the greater the risk of OMD(P<0.01).Shift workers had the higher risk of OMD than non-shift workers(P<0.01).The higher scores of using auxiliary tools to carry the weights and straight waist and bent knees when transporting heavy object(it mean that less use of the above labor behavior and posture),the greater the risk of OMD(P<0.05).CONCLUSION: Sex,length of service,shift,labor behavior and posture are the influencing factors of OMD.

The Potential Utility of the Patient Health Questionnaire as a Screener for Psychiatric Comorbidity in a Chronic Disabling Occupational Musculoskeletal Disorder Population.

OBJECTIVES: The patient health questionnaire (PHQ) is designed for screening psychopathology in primary care settings. However, little is known about its clinical utility in other chronic pain populations, which usually have high psychiatric comorbidities. DESIGN: A consecutive cohort of 546 patients with chronic disabling occupational musculoskeletal disorder (CDOMD) was administered and compared upon psychosocial assessments, including the PHQ and a structured clinical interview for DSM-IV (SCID). Four PHQ modules were assessed: major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), and alcohol use disorders (AUD) [including both alcohol abuse and dependence]. Based on the SCID diagnosis, sensitivity and specificity were determined. RESULTS: The specificity of the PHQ ranged from moderate to high for all 4 PHQ modules (MDD, 0.79; GAD, 0.67; PD, 0.89; AUD, 0.97). However, the sensitivity was relatively low: MDD (0.58); GAD (0.61); PD (0.49); and AUD (0.24). The PHQ was also associated with psychosocial variables. Patients whose PHQ showed MDD, GAD, or PD reported significantly more depressive symptoms and perceived disability than patients who did not (Ps < 0.001). Patients with MDD or GAD reported significantly higher pain than those without (Ps < 0.001). CONCLUSIONS: The strong specificity of the PHQ appears to be its primary strength for this cohort. Due to its high specificity, the PHQ could be employed as an additional screening tool to help rule out potential psychiatric comorbidity in patients with CDOMD. The low sensitivity of the PHQ in this population, however, remains a weakness of the PHQ.

Facilitating surgical decisions for patients who are uncertain: a pilot surgical option process within an interdisciplinary functional restoration program.

BACKGROUND CONTEXT: For chronic pain patients, recovery may be slowed by indecisiveness over optional surgery. These patients may be delayed from participating in interdisciplinary functional restoration (FR), pending resolution of the surgical decision. Uncertainty about surgery or rehabilitation leads to delayed recovery. A surgical option process (SOP) was developed to permit patients with chronic disabling occupational musculoskeletal disorders to enter FR, make a final determination halfway through treatment, and return to complete rehabilitation after surgery, if surgery was elected. PURPOSE: This study assessed the frequency with which an FR program can resolve an uncertain surgical option. It also assessed program completion rate and 1-year post-program outcomes for subgroups that decline surgery, request and receive surgery, or request surgery but are denied by surgeon or insurance carrier. STUDY DESIGN: Retrospective study of a consecutive cohort. PATIENT SAMPLE: A cohort of 44 consecutively treated chronic disabling occupational musculoskeletal disorder patients were admitted to an FR program and identified as candidates for a surgical procedure but were either ambivalent about undergoing surgery, had a difference of opinion by two or more surgeons, or were denied a surgical request by an insurance carrier. Patients attended half (10 full day visits) of an FR program before making their own final determination to pursue a request or decline surgery. OUTCOME MEASURES: Patients were assessed on surgical requests and whether surgery was ultimately performed, program completion status after the surgical determination, demographic variables, and 1-year outcomes on work status, additional surgery, and other health utilization measures. METHODS: Patients became part of the SOP on program entry and were included in the study if they participated in a surgical-decision interview halfway through the program. Those who elected to decline surgery (DS) completed the program without delay, but those requesting surgery were placed on hold from the program while consultation and preauthorization steps took place. Those requesting surgery, but denied (RSD), and those undergoing surgery (US) were given the opportunity to complete FR following postoperative physical therapy or resolution of the surgical re-evaluation process. RESULTS: There were 32 DS patients (73%), indicating that a large majority of patients declined the surgery that was still being considered when offered participation in the SOP. Of the 12 patients wanting a surgery, there were four US patients who received surgery previously denied (9% of cohort), and eight RSD patients (18% of cohort). Patients from the DS group completed the FR program at an 88% rate, as did 75% of US patients. However, despite an opportunity to re-enter and complete rehab, only 50% of RSD patients completed the FR option. Overall, patients who persistently sought surgery, contrary to the recommendations of a surgeon, had poorer outcomes. These 1-year post-FR outcomes included lower return-to-work and work retention rates, with higher rates of treatment seeking from new providers (resulting in higher rates of post-discharge surgery) and higher rates of recurrent injury claims after work return. CONCLUSIONS: A SOP tied to participation in an interdisciplinary FR program resolves uncertainty regarding surgical options in a high proportion of cases, resulting in a large majority declining surgery and completing the FR program. Timely surgery is also promoted decisively when needed. Findings suggest that patients who persistently seek surgery, contrary to the recommendations of a surgeon, frequently fail to complete FR and have poorer outcomes overall.

Facilitating unequivocal and durable decisions in workers' compensation patients eligible for elective orthopedic surgery.

UNLABELLED: Timely intervention and recovery is beneficial to patients with chronic disabling occupational musculoskeletal disorders. Therefore, a surgical option process was developed for use in a functional restoration program (FRP) to allow chronic disabling occupational musculoskeletal disorder patients who were undecided about elective orthopedic surgery to participate in interdisciplinary rehabilitation, rather than suspending treatment, until the surgical option could be resolved. A consecutive cohort of 295 chronic disabling occupational musculoskeletal disorder patients with an unresolved surgical option was admitted to an FRP and their surgical preference at FRP midpoint was determined. The majority of patients declined surgery (n = 164) and were invited to complete the FRP. The remainder elected to pursue surgery and either underwent surgery (n = 43) or had their surgical request denied (n = 38). In the post-FRP year, only .8% of patients reversed their original decision and underwent surgery. Patients whose surgical preferences were accommodated (ie, the declined-surgery/underwent-surgery groups) demonstrated significant psychosocial improvement and excellent socioeconomic outcomes, which were similar to those of FRP patients without a surgical option. Patients whose request for surgery was denied had poorer outcomes than the other groups, but still outperformed FRP dropouts. This suggests that the addition of a formal surgical option process to an interdisciplinary FRP facilitated the surgical decision-making process and helped prevent delayed recovery. PERSPECTIVE: This study introduces a surgical option process to improve outcomes for patients with chronic disabling occupational musculoskeletal disorders who are undecided about elective orthopedic surgery. The addition of a surgical option process to interdisciplinary rehabilitation may resolve surgical indecision, improve outcomes, promote psychosocial recovery, and facilitate progression to Maximum Medical Improvement.