The impact of disability compensation on long-term treatment outcomes of patients with sciatica due to a lumbar disc herniation

被引:66
作者
Atlas, Steven J.
Chang, Yuchiao
Keller, Robert B.
Singer, Daniel E.
Wu, Yen A.
Deyo, Richard A.
机构
[1] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Med Serv,Gen Med Div, Boston, MA USA
[2] Dartmouth Coll Sch Med, Ctr Evaluat Clin Sci, Hanover, NH USA
[3] Univ Washington, Ctr Cost & Outcomes Res, Seattle, WA 98195 USA
[4] Univ Washington, Dept Med, Seattle, WA 98195 USA
[5] Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA
关键词
workers' compensation; disability; employment; lumbar disc herniation; sciatica; cohort study; outcomes research; lumbar disc surgery; natural history;
D O I
10.1097/01.brs.0000250325.87083.8d
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. Prospective, observational study. Objective. To compare long-term disability and health-related quality of life outcomes of individuals receiving or not receiving workers' compensation at baseline evaluation. Summary of Background Data. Disability compensation has long been associated with poor clinical outcomes. However, most studies have assessed outcomes over short time periods using unvalidated measures without controlling for potential confounders. Method. Patients with sciatica due to a herniated lumbar disc were treated by physicians in community based orthopedic, neurosurgical, and occupational medicine practices throughout Maine. Outcomes assessed included disability compensation and work status, and health-related quality of life, controlling for initial treatment received and factors predicting initial workers' compensation status. Results. Among 440 eligible patients, 172 (86%) receiving workers' compensation and 222 (92%) not receiving workers' compensation at baseline evaluation completed at least one follow-up between 5 and 10 years (80% completed 10-year). Baseline demographics, past back history, imaging findings, symptoms, functional status, and expectations significantly differed according to the patient's baseline workers' compensation status. After 5-10 years, most patients, regardless of baseline workers' compensation status (yes or no), were not receiving disability compensation (83% vs. 96%, respectively) and were employed (78% for both groups). However, workers' compensation patients were significantly more likely to be receiving disability compensation and had worse symptoms, functional status, and satisfaction outcomes. Outcome differences diminished in magnitude after controlling for baseline differences among patients receiving workers' compensation or not but continued to favor those not initially receiving workers' compensation. Initial treatment received, either surgical or nonsurgical, did not influence these findings. Conclusions. Long-term employment and disability outcomes were favorable for most patients with a disc herniation, regardless of initial workers' compensation status. However, individuals initially receiving workers' compensation had worse disability and quality of life outcomes compared to individuals not receiving workers' compensation. Despite these differences, long-term work outcomes were, similarly favorable.
引用
收藏
页码:3061 / 3069
页数:9
相关论文
共 36 条
[1]   The Maine Lumbar Spine Study .2. 1-year outcomes of surgical and nonsurgical management of sciatica [J].
Atlas, SJ ;
Deyo, RA ;
Keller, RB ;
Chapin, AM ;
Patrick, DL ;
Long, JM ;
Singer, DE .
SPINE, 1996, 21 (15) :1777-1786
[2]   Surgical and nonsurgical management of lumbar spinal stenosis - Four-year outcomes from the Maine lumbar spine study [J].
Atlas, SJ ;
Keller, RB ;
Robson, D ;
Deyo, RA ;
Singer, DE .
SPINE, 2000, 25 (05) :556-562
[3]   The Quebec Task Force classification for spinal disorders and the severity, treatment, and outcomes of sciatica and lumbar spinal stenosis [J].
Atlas, SJ ;
Deyo, RA ;
Patrick, DL ;
Convery, K ;
Keller, RB ;
Singer, DE .
SPINE, 1996, 21 (24) :2885-2892
[4]   Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine Lumbar Spine Study [J].
Atlas, SJ ;
Keller, RB ;
Wu, YA ;
Deyo, RA ;
Singer, DE .
SPINE, 2005, 30 (08) :927-935
[5]   Ten years' experience using an integrated workers' compensation management system to control workers' compensation costs [J].
Bernacki, EJ ;
Tsai, SP .
JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, 2003, 45 (05) :508-516
[6]  
BIGOS SJ, 1994, J MUSCULOSKELETAL ME, V11, P17
[7]  
Bombardier C, 2001, J RHEUMATOL, V28, P431
[9]   Determinants of occupational disability following a low back injury: A critical review of the literature [J].
Crook, J ;
Milner, R ;
Schultz, IZ ;
Stringer, B .
JOURNAL OF OCCUPATIONAL REHABILITATION, 2002, 12 (04) :277-295
[10]  
D'Agostino RB, 1998, STAT MED, V17, P2265, DOI 10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO