Work hardening: past, present, and future--the work programs special interest section national work-hardening outcome study.
OBJECTIVES: A review of outcome research conducted between 1982 and 1992 revealed return-to-work rates for industrial rehabilitation programs that ranged from 50% to 88%. Variations in outcome statistics appeared to reflect discrepancies in factors such as type of research design, initial characteristics of the client sample, and clients excluded from the study group. METHOD: A work-hardening outcome study involving 36 programs was conducted by the Work Programs Special Interest Section to address questions left unanswered by existing studies regarding (a) rates of program nonacceptance or noncompletion, (b) basic client characteristics and outcome, (c) length of disability and outcome, (d) breakdown of client disposition after program completion, and (e) program characteristics and return to work. RESULTS: Findings included the following: (a) 11.5% of clients were not accepted into work hardening and 24.6% did not complete the program; (b) outcome was not related to client age, gender, area of injury, or physical demand level of job before injury; (c) as duration of disability increased, return to work decreased significantly; (d) at discharge, 48.2% of clients returned to the usual and customary job and 30.5% to alternate or modified work, whereas 13.6% were referred to a vocational counselor; and (e) there was no relationship between number of visits or number of professionals seen and return to work. CONCLUSION: The authors suggest a need for uniform standards in collection of outcome data to establish a basis for comparison of efficacy among programs. Recommendations include tracking comparison or control groups, grouping clients in terms of length of disability, computing success rate on the basis of number of clients who completed their program, using relevant subcategories when reporting return to work, and consistency of the postdischarge interval for follow-up.