Outcomes and prognostic variables of radiofrequency zygapophyseal joint neurotomy in Utah workers' compensation patients.

PURPOSE: The prevalence of radiofrequency zygapophyseal joint neurotomy (RFN) has increased substantially across the past decade. Limited research exists that has examined pre-procedure predictors of RFN outcomes, particularly within workers' compensation populations. The purpose of this study was to determine if pre-procedure biopsychosocial variables are predictive of outcomes in a cohort of compensated Utah patients who have undergone RFN. PATIENTS AND METHODS: This was a retrospective cohort study consisting of a review of pre-procedure medical records and a telephone outcome survey. The sample consisted of 101 compensated workers from Utah who had undergone RFN. Fifty-six patients (55%) responded to the outcome survey. Patients were an average of 46 months post-neurotomy at the time of follow-up. Outcome measures included patient satisfaction, disability status, Roland-Morris Disability Questionnaire, Stauffer-Coventry Index, and Short-Form Health Survey-36 (v.2). Statistical techniques utilized included frequencies, mean comparisons, and logistic and multiple regressions. RESULTS: Forty percent of patients were totally disabled at the time of follow-up. Lawyer involvement, older age, and a positive history of depression were predictors of poor outcomes in logistic and multiple regression equations. CONCLUSION: Presurgical biopsychosocial variables were predictive of multidimensional patient outcomes, and a high rate of total disability was observed. Additional research on the effectiveness of RFN for workers' compensation patients is recommended.

Lumbar Fusion in Utah Workers' Compensation Patients: Changing Outcomes Across a Decade.

STUDY DESIGN: This study was a retrospective-cohort design involving a review of patient medical and cost records and a 2-year postsurgery follow-up outcome survey. OBJECTIVE: To evaluate the functional and cost outcomes associated with recent lumbar fusion surgeries in Utah workers and compare these outcomes with a comparable prior study cohort. SUMMARY OF BACKGROUND DATA: Lumbar fusion performed on injured workers has dramatically increased over the past 2 decades and this likely coincided with the increased use of more advanced surgical instrumentation. Considering the recent changes in lumbar fusion surgery, there is a need to identify how patient outcomes have changed among injured workers. MATERIALS AND METHODS: Retrospective chart review and 2-year postsurgery follow-up survey of patient outcomes were performed. Postsurgical outcomes for this sample were compared with established norms for back pain patients and a previous cohort of compensated lumbar fusion patients obtained from Workers' Compensation Fund of Utah. RESULTS: The current cohort evidenced a solid fusion rate of 89% and significant increase in the use of surgical instrumentation, particularly titanium fusion cages. Despite increased solid fusion rates, injured workers who have undergone lumbar fusion in Utah demonstrated equivalent and in some cases worse outcomes than those documented a decade ago. Specifically, there were significant increases in back pain dysfunction and narcotic medication usage in the current versus the past cohort. Medical and compensation costs for compensated lumbar fusion patients in Utah also significantly increased since the mid-1990s. CONCLUSION: Over the past decade, injured workers who have undergone lumbar fusion in Utah showed an increase in solid fusion rates and costs without a corresponding improvement in patient outcomes. LEVEL OF EVIDENCE: 3.

Occupational and biopsychosocial risk factors for carpal tunnel syndrome.

OBJECTIVE: To investigate a biopsychosocial model of risk for carpal tunnel syndrome (CTS). In addition, a host of exploratory psychosocial variables was investigated as potential risk factors for CTS. METHODS: A case-control design was used comparing 87 CTS and 74 sex-matched general orthopedic patients from an outpatient orthopedic clinic. All participants underwent the same diagnostic protocol (ie, physical evaluation and electrodiagnostic testing) and completed a self-report questionnaire assessing a wide range of potential occupational, personological, and psychosocial risk factors. RESULTS: Multiple logistic regression analyses revealed that occupational repetition, not engaging in vigorous exercise, physical activities with wrist strain, poorer physical health, and lower job satisfaction were significantly related to the presence of CTS. Obesity was borderline significantly related to the presence of CTS. CONCLUSIONS: The biopsychosocial model provides a useful heuristic for conceptualizing CTS risk among injured workers.

Specificity of psychological treatments for bulimia nervosa and binge eating disorder? A meta-analysis of direct comparisons.

Treatment guidelines state that cognitive-behavioral therapy (CBT) and interpersonal therapy are the best-supported psychotherapies for bulimia nervosa (BN) and that CBT is the preferred psychological treatment for binge eating disorder (BED). However, no meta-analysis which both examined direct comparisons between psychological treatments for BN and BED and considered the role of moderating variables, such as the degree to which psychotherapy was bona fide, has previously been conducted Thus, such an analysis was undertaken. We included 77 comparisons reported in 53 studies. The results indicated that: (a) bona fide therapies outperformed non-bona fide treatments, (b) bona fide CBT outperformed bona fide non-CBT interventions by a statistically significant margin (only approaching statistical significance for BN and BED when examined individually), but many of these trials had confounds which limited their internal validity, (c) full CBT treatments offered no benefit over their components, and (d) the distribution of effect size differences between bona fide CBT treatments was homogeneously distributed around zero. These findings provide little support for treatment specificity in psychotherapy for BN and BED.

Predicting back pain treatment outcomes among workers' compensation patients: important information for clinical neuropsychologists.

Low back pain is an increasingly prevalent and costly issue in the United States. It is a particularly relevant problem for Workers' Compensation patients, who typically experience worse surgical and functional outcomes than their non-compensated counterparts. Neuropsychologists often provide intervention and assessment services to compensated patients with back pain, and thus it is critical they possess a basic understanding of the factors that might predispose an injured worker to poor spine surgery outcomes. This paper will review the current literature regarding presurgical biopsychosocial factors which have been implicated in poor back surgery outcomes among injured workers. We provide some tentative guidelines for neuropsychologists to utilize in providing services to injured workers with back pain.

Predicting compensation and medical costs of lumbar fusion patients receiving workers' compensation in utah using presurgical biopsychosocial variables.

STUDY DESIGN: A retrospective-cohort investigation (N = 245) utilizing a review of patient medical records and costs accrued through the Workers' Compensation Fund of Utah. OBJECTIVE: To replicate a previous study of compensation and medical costs in compensated lumbar fusion patients, to identify changes in costs across time, and to identify biopsychosocial variables predictive of current costs. SUMMARY OF BACKGROUND DATA: Previous studies have demonstrated that medical costs associated with lumbar fusion have been rising drastically. It is unclear whether rising fusion costs are occurring in compensation populations. Prior studies have also demonstrated that costs can be predicted on the basis of presurgical biopsychosocial variables, and there is a need to determine whether such variables are still relevant. METHODS: A retrospective review of patient medical records and compensation and medical costs paid by the Workers' Compensation Fund of Utah was performed. RESULTS: Since the mid-1990s, medical costs for compensated lumbar fusion patients in Utah have risen approximately 174%, whereas compensation costs have increased roughly with the pace of inflation. Wage and assignment to nurse case management predicted compensation costs, whereas assignment to nurse case management also predicted medical costs. CONCLUSION: Medical costs among compensated Utah patients receiving lumbar fusion have risen dramatically since the 1990s, whereas compensation costs have not. Biopsychosocial variables continue to be predictive of these costs, although to a more modest degree than in prior studies. Further investigations should look at other factors leading to increased medical costs.

Presurgical biopsychosocial variables predict medical, compensation, and aggregate costs of lumbar discectomy in Utah workers' compensation patients.

BACKGROUND CONTEXT: Elective lumbar discectomy among injured workers is a prevalent spine surgery that often requires a lengthy rehabilitation. It is important to determine presurgical biopsychosocial predictors of compensation and medical costs in such patients. PURPOSE: To determine if presurgical biopsychosocial variables are predictive of compensation and medical costs in a cohort of Utah patients who have undergone open or microlumbar discectomy that are receiving workers' compensation. STUDY DESIGN/SETTING: A retrospective cohort study consisting of a review of presurgical medical records and accrued medical and compensation costs. PATIENT SAMPLE: A consecutive sample of 266 compensated workers from Utah who had undergone either open discectomy or microlumbar discectomy from 1994 to 2000. All patients were at least 2 years postsurgery at the time of follow-up. OUTCOME MEASURES: Total accrued medical, compensation, and aggregate costs. METHODS: A retrospective review of presurgical biopsychosocial variables and total accrued medical, compensation, and aggregate costs. RESULTS: Presurgical variables were statistically significantly correlated with medical and compensation costs. Multiple linear regression models accounted for 31% of variation in compensation costs, 32% in medical costs, and 43% in total aggregate costs. CONCLUSIONS: Presurgical biopsychosocial variables are important predictors of compensated lumbar discectomy costs. Medical cost control programs might benefit from identifying biopsychosocial variables related to increased costs.