Saturday, March 3, 2001
A study of 13,930 patients who were evaluated in the 28 centers comprising the National Spine Network found that the 1,130 who were receiving workers' compensation had significantly lower SF-36 individual item and component summary scores than those patients having other sources of payment.
The findings add new light to the cause for the poor outcomes in this group of patients, say coauthors of scientific paper 261, which was presented Friday. They point out that it has been reported that active workers' compensation and litigation issues are associated with poor operative management results from chronic back pain in adults with low grade spondylolisthesis. The exact cause of the poor outcomes in this group of patients is unclear. One study suggested that in a workers' compensation venue, outmoded post-operative rehabilitation methods may be responsible for suboptimal outcomes after spinal surgery for degenerative conditions. Another study found that in chronic low back pain, compensation involvement may have an adverse effect on self-reported pain, depression and disability before and after rehabilitation.
"The physical and mental health status of workers' compensation cases evaluated for spinal problems receives little attention," the coauthors say. "The patient's perception of their health status is becoming increasingly important in outcomes research."
The relevance of the data in scientific paper 261 "has multiple implications in clinical practice," the coauthors say. "First of all, using the initial visit SF-36 scores, we can identify which worker's compensation patient is at risk of chronicity, absenteeism and poor treatment outcomes before any treatment is instituted.
"The criteria for successful outcome may have to be modified for this high-risk cohort group. A more realistic treatment goal may be required in managing these patients. At the same time, active rehabilitation intervention strategies designed to improve physical and mental well being should be promoted, as they could have an impact on enhancing positive health outcomes. "Stress management, psychological counseling and group therapy may help to improve the mental health of these patients.
Based on our study, physical factors are just as important in the overall functional status and well being of patients receiving workers' compensation. Special attention should be paid to reducing problems during work or other activities in these patients, due to physical health. Strategies to improve their Role Physical (RP) may involve work hardening and general physical fitness programs. Involvement of the immediate family members is helpful. Managing these patients usually involves a multidisciplinary approach."
Coauthors of the study, all of Tulane University Medical Center, New Orleans, are Hwan T. Hee, MD, clinical fellow; Thomas S. Whitecloud III, MD, professor and chairman; Jennifer Gaynor, research assistant; Leann Myers, PhD, statistician; Warren Roesch, RNFA, physician assistant; and James E. Ricciardi, MD, associate professor.
|2001 Academy News March 3 Index C|
Last modified 16/February/2001 by IS