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

Abstract

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.

Does Patient-Reported Insomnia Improve in Response to Interdisciplinary Functional Restoration for Chronic Disabling Occupational Musculoskeletal Disorders?

“…Medical supervision includes interventions to improve function, medication management, and assessment of remaining surgical options. 44 The exercise component of the program, conducted under the direction of licensed physical and occupational therapists, is designed to restore muscular strength, fl exibility, endurance, and cardiovascular fi tness. A quantitative functional capacity evaluation is conducted at admission to the program, and objective physical measurements are periodically reassessed throughout treatment for safety purposes and to maintain physical training at optimum levels for injured body parts and whole-person activities of daily living.…”

Treatment and provider choice in worker injury rehabilitation: A systematic literature review

“…As with consideration of provider choice, no clear picture emerged of the impact of treatment choice on costs. Studies could not concur on the relationship between provider or treatment choice and costs; yet the ability to exercise choice has been found to have a positive impact on return to work, regardless of the treatment undertaken (Brede et al, 2014).…”

“…Whilst not as easily measured as costs, psychosocial factors and the worker's sense of satisfaction are an outcome of rehabilitation treatment. Two studies considered psychosocial outcomes of rehabilitation (Brede et al, 2014;Farholm et al, 2017), although what constituted psychosocial outcomes was not defined by either study. Five studies considered the impact of choice on worker satisfaction with treatment.…”

“…This impact extends beyond 31 economics to psychosocial losses for workers, their 32 families and society (Landstad et al, 2009). Despite Recovery from injury as well as return to employment and the income it provides are the goals of workplace injury rehabilitation (Neumark & Savych, 2018) with work participation recognised for the psychosocial benefits it confers (Brede et al, 2014;Farholm et al, 2017;Gouin et al, 2017;Neumark et al, 2007). Both government and employers encourage return to work, with the worker expected to participate in their recovery in a self-determined manner (van Hal et al, 2012).…”

Rehabilitation versus Spine Surgery: A Narrative Review of Role of Rehabilitation in Lumbar Degenerative Spine Conditions

“…Finally, participation in a rehabilitation program can help patients minimize ambivalence about participation in elective spine surgery, with lasting effect on decisions and acceptance of care pathways. 44 …”