RESUMEN
The relationship of Workers' Compensation and litigation to low back pain (LBP) outcome is not established in the literature. Our study investigated the characteristics of disabled persons applying for Worker's Compensation or employing a lawyer, the factors predicting receipt of compensation, and the effects of compensation and litigation on employment outcome. One hundred sixty-nine unemployed persons with LBP were assessed by medical history, physical exam, biomechanical testing, psychiatric interview, and MMPI. Subjects were asked whether they had applied for compensation, received it, or had employed a lawyer. Six months later, subjects were asked about their employment and compensation status. Neither compensation status nor involvement of a lawyer significantly improved prediction of employment status 6 months later. Receipt of compensation predicted better outcome in those at risk for poor outcome due to external locus of control. Factors predicting failure to obtain compensation over 6 months, having applied, include education, spinal flexion, ability to do daily activities and affective inhibition. Neurological dysfunction did not predict receipt of compensation in univariate or multivariate analyses; emotional distress reduced the probability of receiving compensation, after controlling for severity of spinal dysfunction. Receipt of compensation and use of a lawyer did not reduce the probability of RTW in disabled persons in the present sample, but increased the likelihood of return to work for groups of individuals at higher risk such as those with external locus of control. Although compensation is awarded on the basis of physical evaluation under the present system, the present findings suggest that the likelihood of receiving compensation is also significantly determined by level of emotional distress.
Asunto(s)
Absentismo , Dolor de la Región Lumbar/economía , Indemnización para Trabajadores , Adulto , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/psicología , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Estrés PsicológicoRESUMEN
This prospective study identifies physical, behavioral, and psychosocial correlates of subsequent employment status in a sample of low back pain patients. The sample of 150 subjects was drawn from 2 populations of persons with chronic low back pain: 87 individuals who were receiving care at a university low back pain clinic, and 63 individuals who had applied for (but not yet received) Social Security compensation on the basis of low back pain. All subjects had worked at least 3 months prior to their latest unemployment period and were currently out of work. Initial assessment included a medical history, physical examination, biomechanical testing, psychiatric interview, and MMPI testing. All subjects were followed up 6 months later to determine whether they had returned to work. Cross-sectional group comparisons at the time of initial assessment showed that, after controlling for the effects of age, the two samples differed on several physical and biomechanical measures, the Social Security group reflecting a more chronic picture. Group differences on physical variables were found, but most significant differences disappeared when adjusted for length of time out-of-work. Longitudinal analyses showed that few objective physical or biomechanical measures were associated with return-to-work at 6 months, while a number of psychosocial variables were significant predictors of 6-month work status. The data suggest that exclusive reliance on the physical examination to determine level of disability, without consideration of psychosocial conditions, and without adjusting for the confounding effects of age and length of time out-of-work, is not empirically justified. Logistic regression analysis was used to ascertain the relative contribution of each predictor to outcome and to illustrate the hypothetical effects of changes in the levels of selected risk factors on the likelihood of return-to-work. Implications for interventions with low back pain patients are discussed and future research directions suggested.