EFFECT OF DISCHARGE RECOMMENDATIONS ON OUTCOME

Study Design. The incidence of two common discharge recommendations, return to work unrestricted (RTWU) and restricted (RTWR) suggested that most restrictions were applied on the basis of patients' subjective reports of pain or therapists' unfounded fears that return to full duty would result in physical harm. Objectives. This prospective study compares the therapist's return to work recommendation to the patient's actual work status and analyzes the effect of that recommendation on outcome. Methods. There were 1438 consecutive patients reviewed by structured telephone interviews during the two halves of the study: the control group when pain was accepted as a reason for restriction and the study group when it was not. Summary of Background Data. In the control group, 44% of the patients were recommended to RTWU; for the study group, 81% received this recommendation. Compliance was 84% for the control subjects and 78% for the study group. Results. The absolute number of patients who returned to unrestricted work doubled in the study group. Conclusions. The probability of a successful return to normal duty increased with a recommendation of RTWU (P = 0.0001), whereas the probability of failure increased when restrictions were imposed (P = 0.0001).