Chronic back pain and work disability: Vocational outcomes following multidisciplinary rehabilitation

Abstract

Studies indicate that work disabled chronic back pain patients out of work for longer than three months have a reduced probability of returning to work. The escalating personal and economic costs (indemnity and health care) associated with such long term disability have facilitated efforts at multiple levels to prevent and more effectively manage work disability. Multidisciplinary rehabilitation (MDR) targeted at return to work represents one such approach. The approach is based upon a multidimensional conceptualization of work disability and integrates medical, physical, psychological, educational and vocational interventions to increase physical function, reduce pain, increase stress coping skills and facilitate return to work. Seven outpatient multidisciplinary rehabilitation outcome studies for chronic back pain were identified that met the following selection criteria: 1) diagnosis of back pain, low back pain, spinal disorder (specific and nonspecific diagnosis), 2) chronic back pain of either longer than three months since injury or longer than three months absence from work, 3) use of an outpatient multidisciplinary rehabilitation approach that included some combination of medical management, physical conditioning, pain and stress management, vocational counseling/placement and education regarding back safety and health, and 4) work reentry was the primary focus of outcome. These were reviewed to determine the effectiveness of MDR in terms of return to work outcome. Analyses revealed that an average of 71 percent of work disabled chronic back pain patients who completed a multidisciplinary rehabilitation program were working or involved in vocational rehabilitation efforts at 12 month follow-up in contrast to an average of 44 percent in corresponding comparison groups. While these studies suggest the clinical utility of a multidisciplinary approach as compared to usual care in facilitating return to work for chronic back pain patients, the literature was characterized by several methodological limitations including the absence of randomization in the majority of studies, use of insurance company denials as control groups, heterogenous samples in terms of duration of work disability, job availability at discharge, extent of impairment and disability, age and duration of pain disorder, lack of specification as to exact treatment delivered in the control or usual care groups and varying definitions of return to work outcome. Research on predictors of return to work outcome following MDR were identified and included variables in five categories: demographics, medical history, physical findings, pain and psychological characteristics. The literature provides support for the use of integrated approaches that target the medical, physical, ergonomic and psychosocial factors that can exacerbate and/or maintain work disability. Future research should address current methodological limitations in the literature and focus on: 1) identifying critical treatment components of such approaches, 2) developing innovative scr...

Relationships Among Lifting Ability, Grip Force, and Return to Work

“…9,31,33 In addition to time off work and gender, we found that small amounts of variance in RTW were related to differences in performance of IWS-FCE lifting subtests. Although greater trunk force and leg force have each been associated with improved RTW, 34 our study is the first to show that the greater the lifting ability the greater the likelihood of RTW.…”

“…38 A review of several studies that used RTW as an outcome variable following rehabilitation for low back pain 9 showed that RTW is a multi-determinant outcome that often was not well defined and included several types of vocational outcomes. Because RTW is so important for individuals with disabilities and for the institutions that provide disability benefits, some authors 9,36,38 recom- There were limitations in our study.…”

“…This reliance on data about function occurs even though the validity of such data to predict disability has not been well studied. 8,9 Information from what are commonly called "functional capacity evaluations" (FCEs) has been used in making decisions about disability for many years. 10,11 In this process, a person with medical impairment is provided benefits if his or her abilities are not adequate for the demands of work.…”

Vocational outcome of intervention for low-back pain

“…Another 16 articles (56-71) were included by screening the references of the retrieved studies and of reviews about back schools (6,7,72), pain treatment centers (73)(74)(75), occupational rehabilitation (8,76) and spinal manipulation (9,10).…”

Employment and Disability: Evidence from the 1996 Medical Expenditures Panel Survey

“…It is important to explore the characteristics of what factors allow for the persistence of employment despite functional limitations. Whereas several studies, including some meta analyses (10)(11)(12) have explored the factors that address the duration of the absence from work following injury, particularly, the factors that lead to application for retirement or disability benefits, little work has been completed on those individuals with limitations who are working prior to the development of a chronic illness or injury.…”