Patients With Chronic Disabling Occupational Musculoskeletal Disorder Failing to Complete Functional Restoration: Analysis of Treatment-Resistant Personality Characteristics

Howard, Krista; Mayer, Tom G.; Theodore, Brian R.; Gatchel, Robert J.

doi:10.1016/j.apmr.2008.11.009

Cited by 23 publications

(42 citation statements)

References 45 publications

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“…There were no subgroup differences in post-FRP disability benefits among program completers. Patients who failed to complete the FRP had poorer socioeconomic outcomes than FRP completers, as has been shown in other studies, 20, 35 irrespective of their SOP subgroup. Of the program non-completers who could be contacted, only 32% returned to work and 21% retained employment throughout the follow-up period.…”

Section: Resultssupporting

confidence: 79%

“…These contact rates are similar to the findings of previous FRP studies. 20, 35 As can be seen in Table 4, RSD patients were substantially more likely to fail to return to work compared to the US, DS, and COMP groups ( OR =6.5, 11.1, and 4.5, respectively), despite completing the FRP. In addition, the RSD patients were more likely to fail to retain work at one year compared to the DS and COMP groups ( OR = 5.0 and 3.3, respectively).…”

Section: Resultsmentioning

confidence: 99%

“…20, 35 However, DS patients were significantly more likely to complete the FRP (p = .01) than the COMP group, possibly as a result of seeing substantial improvements in their physical and psychosocial condition that allowed them to turn down the elective orthopedic surgery; the US group had dropout rates identical to the COMP group. In contrast, the RSD group dropped out of treatment at more than double the rate of the COMP and US groups.…”

Section: Discussionmentioning

confidence: 97%

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Facilitating Unequivocal and Durable Decisions in Workers' Compensation Patients Eligible for Elective Orthopedic Surgery

Brede¹,

Mayer²,

Shea³

et al. 2014

The Journal of Pain

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Timely intervention and recovery is beneficial to patients with chronic disabling occupational musculoskeletal disorders (CDOMD). Therefore a Surgical Option Process (SOP) was developed for use in a functional restoration program (FRP) to allow CDOMD 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 CDOMD patients with an unresolved surgical option was admitted to a FRP, and determined their surgical preference at FRP midpoint. The majority of patients declined surgery (DS, N=164) and were invited to complete the FRP. The remainder elected to pursue surgery and either underwent surgery (US, N=43) or had their surgical request denied (RSD, N=38). In the post-FRP year, only 0.8% of patients reversed their original decision and underwent surgery. Patients whose surgical preferences were accommodated (i.e., the DS/US groups) demonstrated significant psychosocial improvement and excellent socioeconomic outcomes; which were similar to those of FRP patients without a surgical option. RSD patients had poorer outcomes than the other groups, but still outperformed FRP dropouts. This suggests that the addition of a formal SOP to an interdisciplinary FRP facilitated the surgical decision-making process and helped prevent delayed recovery.

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Section: Resultssupporting

confidence: 79%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Facilitating Unequivocal and Durable Decisions in Workers' Compensation Patients Eligible for Elective Orthopedic Surgery

Brede¹,

Mayer²,

Shea³

et al. 2014

The Journal of Pain

Self Cite

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“…There can be individual complications during rehabilitation, and in rehabilitation programs, after injury. A diagnosis of an Axis II disorder has previously been identified as predictive of noncompletion [53,54], poor outcome [55] and non-adherence [56] in treatment programs. Daily skin care and treatment over a long period of time after a burn can be demanding, and conceivable difficulties could result in worse actual as well as perceived skin health.…”

Section: Discussionmentioning

confidence: 99%

Impact of personality disorders on health-related quality of life one year after burn injury

Ekeblad

Gerdin

Öster

2014

Disability and Rehabilitation

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This study identified an above normal prevalence of PDs among individuals afflicted by burn and these individuals reported poor burn-specific health-related quality of life. The identification of difficulties with compliance and endurance regarding daily skin care may cause negative consequences for optimal rehabilitation and underscore the importance of offering more tailored interventions in rehabilitation. Inflexible behavioral patterns related to the PD diagnosis imply the need for communication strategies by the rehabilitation team, which include flexibility, creativity, and diplomacy. There is a need for further research focusing on identifying the factors that facilitate the individual's own ability to take action and have control.

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“…Although no selection bias was evident for demographic and occupational factors in terms of program completion, it should be noted that the efficacy of this rehabilitation program has been previously demonstrated by a comparison of program completers versus non-completers. 53,54 For example, program non-completers were 10 times less likely to return to work, 7 times less likely to retain work, and 7 times more likely to have re-operations, relative to program completers. In terms of the concept of a “continuum of care,” these findings generally reflect that program dropouts have chosen to pursue disability benefits offered under state WC jurisdictions or federal benefits like Social Security Disability.…”

Section: Discussionmentioning

confidence: 99%

Lumbar surgery in work-related chronic low back pain: can a continuum of care enhance outcomes?

et al. 2014

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Background Context Systematic reviews of lumbar fusion outcomes in purely workers’ compensation (WC) patient populations have indicated mixed results for efficacy. Recent studies on lumbar fusions in the WC setting have reported return-to-work rates of 26–36%, re-operation rates of 22–27%, and high rates of persistent opioid use two years post-surgery. Other types of lumbar surgery in WC populations are also acknowledged to have poorer outcomes than in non-WC. The possibility of improving outcomes by employing a biopsychosocial model with a continuum of care, including post-operative functional restoration in this “at risk” population, has been suggested as a possible solution. Purpose To compare objective socioeconomic and patient-reported outcomes for WC patients with different lumbar surgeries followed by functional restoration, relative to matched comparison patients without surgery. Study Design/Setting A prospective cohort study of chronic disabling occupational lumbar spinal disorder (CDOLD) patients with WC claims treated in an interdisciplinary functional restoration program. Patient Sample A consecutive cohort of 564 patients with pre-rehab surgery completed an functional restoration and was divided into groups based on surgery type: lumbar fusion (F group, n = 331) and non-fusion lumbar spine surgery (NF group, n = 233). An unoperated comparison group was matched for length of disability (U group, n = 349). Outcome Measures Validated patient-reported measures of pain, disability and depression were administered PRE- and POST-rehab. Socioeconomic outcomes were collected via a structured one-year POST interview. Methods All patients completed an intensive, medically-supervised FRP, combining quantitatively-directed exercise progression with a multimodal disability management approach. The writing of this manuscript was supported in part by NIH Grant 1K05-MH-71892 and no conflicts of interest are noted among the authors. Results The F group had a longer length of disability compared to the NF and U groups (M = 31.6, 21.7, and 25.9 months, respectively, p < .001). There were relatively few statistically significant differences for any socioeconomically-relevant outcome among groups, with virtually identical POST-rehab return-to-work (F=81%, NF=84%, U=85%, p =.409). The groups differed significantly after surgery on diagnosis of major depressive disorder and opioid dependence disorder, as well as patient-reported depressive symptoms and pain intensity PRE-rehab. However, no significant differences in patient-reported outcomes were found POST-rehab. PRE-rehab opioid dependence disorder significantly predicted lower rates of work return and work retention, as well as higher rates of treatment-seeking behavior. Higher levels of PRE-rehab perceived disability and depressive symptoms were significant risk factors for poorer work return and retention outcomes. Conclusions Lumbar surgery in the WC system (particularly lumbar fusion) have the potential achieve positive outcomes that are comparable t...

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Patients With Chronic Disabling Occupational Musculoskeletal Disorder Failing to Complete Functional Restoration: Analysis of Treatment-Resistant Personality Characteristics

Cited by 23 publications

References 45 publications

Facilitating Unequivocal and Durable Decisions in Workers' Compensation Patients Eligible for Elective Orthopedic Surgery

Facilitating Unequivocal and Durable Decisions in Workers' Compensation Patients Eligible for Elective Orthopedic Surgery

Impact of personality disorders on health-related quality of life one year after burn injury

Lumbar surgery in work-related chronic low back pain: can a continuum of care enhance outcomes?

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