Biomedical subjects

R J Gatchel

Publications and source records attributed to R J Gatchel.

At least 37 records · Page 2Linked to original sources

PubMed1999

Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study.

CONTEXT: Low back pain (LBP) contributes to considerable disability and lost wages in the United States. Commonly used opioid and nonopioid analgesic drugs produce adverse effects and are of limited long-term benefit in the management of this patient population. OBJECTIVE: To compare the effectiveness of a novel nonpharmacologic pain therapy, percutaneous electrical nerve stimulation (PENS), with transcutaneous electrical nerve stimulation (TENS) and flexion-extension exercise therapies in patients with long-term LBP. DESIGN: A randomized, single-blinded, sham-controlled, crossover study from March 1997 to December 1997. SETTING: An ambulatory pain management center at a university medical center. PATIENTS: Twenty-nine men and 31 women with LBP secondary to degenerative disk disease. INTERVENTIONS: Four therapeutic modalities (sham-PENS, PENS, TENS, and exercise therapies) were each administered for a period of 30 minutes 3 times a week for 3 weeks. MAIN OUTCOME MEASURES: Pretreatment and posttreatment visual analog scale (VAS) scores for pain, physical activity, and quality of sleep; daily analgesic medication usage; a global patient assessment questionnaire; and Health Status Survey Short Form (SF-36). RESULTS: PENS was significantly more effective in decreasing VAS pain scores after each treatment than sham-PENS, TENS, and exercise therapies (after-treatment mean +/- SD VAS for pain, 3.4+/-1.4 cm, 5.5+/-1.9 cm, 5.6+/-1.9 cm, and 6.4+/-1.9 cm, respectively). The average +/- SD daily oral intake of nonopioid analgesics (2.6+/-1.4 pills per day) was decreased to 1.3+/-1.0 pills per day with PENS (P<.008) compared with 2.5+/-1.1, 2.2+/-1.0, and 2.6+/-1.2 pills per day with sham-PENS, TENS, and exercise, respectively. Compared with the other 3 modalities, 91 % of the patients reported that PENS was the most effective in decreasing their LBP. The PENS therapy was also significantly more effective in improving physical activity, quality of sleep, and sense of well-being (P<.05 for each). The SF-36 survey confirmed that PENS improved posttreatment function more than sham-PENS, TENS, and exercise. CONCLUSIONS: In this sham-controlled study, PENS was more effective than TENS or exercise therapy in providing short-term pain relief and improved physical function in patients with long-term LBP.

Adult↗

PubMed1999

Outcomes of disabling cervical spine disorders in compensation injuries. A prospective comparison to tertiary rehabilitation response for chronic lumbar spinal disorders.

STUDY DESIGN: A prospective, longitudinal cohort study assessing quantitative socioeconomic outcomes of tertiary rehabilitation for chronically disabled patients with cervical spinal disorders compared with those with more common chronic lumbar spinal disorders. OBJECTIVES: To assess 1-year socioeconomic outcomes of a worst-case cohort of consecutive patients with chronic cervical spinal disorders compared with those of patients with lumbar spinal disorders and to assess differences in an array of variables between those patients who reported any period of work during the posttreatment year and those who did not. SUMMARY OF BACKGROUND DATA: Few investigators have evaluated outcomes in patients with cervical spinal disorders. None have specifically studied distinctions in socioeconomic outcomes in patients with chronic cervical spinal disorders and in patients with other spinal disorders. Reports of pain are noted to persist in a high percentage of patients with whiplash receiving compensation even 10 years after injury, but the status of work, use of health care resources, financial disputes, or recurrent injury are unknown. METHODS: A cohort of consecutive chronically disabled patients with spinal disorders (N = 1198) was assessed for prospectively collected demographic, self-report, and physical performance data. A subset of patients (n = 421) with work-related cervical spinal disorders was compared with a group with various lumbar spinal disorders (n = 777). A structured clinical interview was administered 1 year after patients entered an interdisciplinary functional restoration program. RESULTS: High rates of return to work and continuation of work were recorded in the cervical and lumbar spinal disorder groups, with low rates of recurrent injury, new surgery in the injured area, and use of health care resources. There were no statistically significant differences between the groups. Multivariate analyses showed several variables that differentiated between those patients who had any reported period of work during the post-treatment year versus those who did not in the cervical and the lumbar spinal disorder groups. CONCLUSIONS: This first large cohort study of outcomes in chronically disabled patients with work-related cervical spinal disorder produced results similar to those found in tertiary functional restoration rehabilitation in chronic lumbar spinal disorders. In spite of poor outcomes reported in the literature for similar cervical and lumbar spinal disorders in patients receiving workers' compensation for disability, successful outcomes can be anticipated after effective rehabilitation, regardless of response to prerehabilitation treatment.

Activities of Daily Living↗

PubMed1999

Psychosocial issues: their importance in predicting disability, response to treatment, and search for compensation.

The conceptualization of pain and its progression into chronic disability has evolved from unidimensional models to more integrative, biopsychosocial models that take into account the many biological, psychosocial, social, and economic factors that may significantly contribute to the low back pain experience. This chapter reviews various studies that have demonstrated our growing understanding of these complex, interactive processes in helping to predict those who develop chronic disability as well as those who respond best to treatment attempts. Further, we examine the issue of compensation and how it too is intricately intertwined with the other variables contributing to lower back pain disability.

Disability Evaluation↗

PubMed1999

Temporomandibular disorders: evidence for significant overlap with psychopathology.

Data were analyzed for 277 acute and chronic temporomandibular disorder (TMD) patients to determine if there was a relationship between psychological and physical diagnoses. A significant (p < .01) relationship existed among the following: combined past or current mood disorder-personality disorder and muscle disorder; combined current mood, anxiety, or substance use disorder-personality disorder and muscle disorder; and combined current anxiety disorder-personality disorder and muscle disorder. This study further confirmed other research that has found that significant psychopathology exists in TMD. More important, this psychopathology appears to be linked primarily to muscle disorders, as opposed to disc or joint disorders, within the rubric of TMD.

Adult↗

PubMed1999

Toward more accurate use of the Beck Depression Inventory with chronic back pain patients.

OBJECTIVE: To improve the accuracy of the Beck Depression Inventory (BDI) in assessing depression in chronic back pain (CBP) patients, the pattern of depression symptomatology was evaluated. DESIGN: Analyses of BDI data obtained from nondepressed and depressed CBP patients were conducted to identify the major factors that differentiated among the patient groups. SETTING: CBP patients were recruited from a tertiary rehabilitation center. PATIENTS: One hundred one nondepressed and 99 depressed CBP patients from the tertiary treatment center. OUTCOME MEASURES AND RESULTS: Analyses of the BDI data revealed a general factor of depression severity that excluded items reflecting weight loss, sleep disturbance, and work inhibition. In addition, these analyses yielded a second factor reflecting somatic concerns and disability. Weight loss, sleep disturbance, and work inhibition failed to differentiate the depressed from the nondepressed CBP subjects, suggesting that these symptoms have poor diagnostic potential for CBP patients. CONCLUSIONS: This study demonstrated that the BDI can be used to generate important information about the severity of interference posed by pain on the functioning of an individual, while allowing for an independent evaluation of subjective indices of depression and somatic disturbances that need to be attended to by clinicians.

Adult↗

PubMed1999

Outcomes comparison of treatment for chronic disabling work-related upper-extremity disorders and spinal disorders.

Since 1986, the percentage of upper-extremity musculoskeletal disorders (UEMSDs) has increased from 1% to 4% of all occupational injury claims, while the average total medical and compensation cost is 80% higher than the average of all other claims. Because chronic disability leads to the highest cost, systematic evaluation of this growing occupational condition is needed. We performed a prospective case-series cohort study of patients (n = 163) with UEMSDs, compared with a matched group of spinal disorder (SD) patients (n = 163) treated with the same protocol. UEMSD patients were subclassified as those with one or more neuropathic diagnoses or those with non-neuropathic diagnoses. The neuropathic UEMSD subgroup had the poorest outcomes, with significantly higher surgery rates, higher health care utilization rates, and lower work retention when compared with the SD group. Rehabilitation outcomes for UEMSDs are similar to those for SDs. However, neuropathic-diagnosis patients are at risk for high-cost injuries and/or poorer prognoses.

Adult↗

PubMed1999

Diagnostic change and personality stability following functional restoration treatment in chronic low back pain patients.

This study examined personality pathology in a group of patients with chronic low back pain (CLBP) using both diagnostic interviews and dimensional self-report instruments. A group of CLBP patients (N = 125) was assessed before functional restoration treatment and compared with a matched normal comparison group (N = 75). The CLBP group evidenced broad personality pathology in all assessment modes pretreatment relative to the normal comparison sample. In addition, two subsamples of CLBP patients (n = 49 and n = 56) were assessed after treatment. Reductions in personality pathology between pre- and posttreatment assessments were more pronounced for diagnostic interview than dimensional self-report assessments. These results are discussed in the context of personality assessment and CLBP.

Adolescent↗

PubMed1999

A model for predicting chronic TMD: practical application in clinical settings.

BACKGROUND: Substantial cost is associated with the treatment of chronic temporomandibular disorders, or TMDs, and patients with TMDs often experience significant psychosocial distress. Early intervention based on identified risk factors has potential financial and functional benefits. METHODS: Two hundred four patients with acute TMD were evaluated via an assessment battery that included physical, psychological and social measures. All participants were diagnosed as having TMD on the basis of the research diagnostic criteria for TMD, Axis I. At the six-month follow-up assessment, patients were considered to have chronic TMD if they continued to have TMD pain. This resulted in 144 of the patients being classified in the chronic group and 60 being classified in the nonchronic group. RESULTS: A comparison of the acute TMD data demonstrated that the group that went on to develop chronic TMD and the group that did not differed significantly in their scores on numerous biopsychosocial indexes. Although several biopsychosocial measures were found to differentiate these two groups before the onset of chronic TMD, logistic regression analysis demonstrated that a two-variable predictive model consisting of the presence of a muscle disorder and characteristic pain intensity (that is, the mean of these three ratings: patient's report of current pain, worst pain in the last three months and mean pain in the last three months) accurately classified 91 percent of the subjects who went on to develop chronic TMD. CONCLUSIONS: During the acute phase of TMD, two variables allowed for an accurate prediction rate of 91 percent among patients who went on to develop chronic TMD. CLINICAL IMPLICATIONS: This model provides clinicians with the opportunity to identify at-risk patients early and initiate adjunctive or alternative treatments, thus reducing the likelihood of the development of TMD chronicity.

Acute Disease↗

PubMed1998

Should extended disability be an exclusion criterion for tertiary rehabilitation? Socioeconomic outcomes of early versus late functional restoration in compensation spinal disorders.

STUDY DESIGN: A prospective cohort design with two groups of patients representing short-term or long-term disability (n = 497) who were selected from a larger cohort (n = 938) of consecutively treated spinal disorder patients with chronic compensation injuries. OBJECTIVES: To prospectively evaluate the impact of length of spinal disability on socioeconomic outcomes of medically directed rehabilitation. SUMMARY OF BACKGROUND DATA: Despite an increasing tendency of managed care organizations to limit rehabilitation services for disabled workers with chronic spinal disorders, there has been a surprising lack of prospective research evaluating the impact of length of disability on objective socioeconomic treatment outcomes. Although only approximately 10% of all patients with spinal disorders are disabled beyond 4 months, they account for nearly 80% of all workers' compensation expenditures. Little is known about whether relatively early intervention improves outcomes after chronicity has been established or whether any predictors distinguish between these groups. METHODS: Two comparison groups of functional restoration tertiary treatment graduates were identified from the same community referral pool. The "long-term disabled" group involved a minimum of 18 months of disability (n = 252). This group was compared with a "short-term disabled" group (n = 245), no more than 8 months since injury, but chronic based on a minimum of 4 months after injury. The long-term disabled group showed significantly higher rates of pretreatment surgery than the short-term disabled group (P < 0.001). All patients were evaluated prospectively with specific physical, psychological, and occupational measurements. They also underwent a structured interview 1 year after treatment evaluating work status, health care use, and recurrent injury. RESULTS: The short-term disabled group showed statistically higher return to work (P < 0.001) and work retention (P < 0.05) relative to the long-term disabled group. However, health care use and recurrent lost time injury claims were low in both groups and did not differ significantly. No predictors of outcome were found among the prospectively collected physical performance or psychosocial variables. CONCLUSIONS: This study suggests that early tertiary nonoperative care, once patients with chronic spinal disorders are identified as having potentially high-cost chronic pain and disability, is efficacious in achieving goals of better work return and work retention. Such early rehabilitation may also prevent significant indemnity expense, as well as some late surgical interventions sought by progressively more desperate patients. However, individuals with long-term disability achieve respectable work return and retention rates, while faring no worse on other socioeconomic outcomes that represent major "cost drivers" to the workers' compensation system. Early intervention is not a panacea or a necessary condition for the successful rehabilitation of workers with disabling chronic spinal disorders.

Adult↗

PubMed1998

Socioeconomic outcomes of combined spine surgery and functional restoration in workers' compensation spinal disorders with matched controls.

STUDY DESIGN: A longitudinal cohort study (n = 448) comparing functionally restored discectomy (n = 123) and fusion (n = 101) workers' compensation patients to matched, unoperated control patients (n = 123 and n = 101, respectively). OBJECTIVES: To determine successful treatment outcomes uniquely important in a workers' compensation environment when spine surgery is combined with comprehensive tertiary rehabilitation, to optimize anatomic and social sequelae. SUMMARY OF BACKGROUND DATA: Multiple recent studies confirm suboptimal socioeconomic outcomes for spinal surgery for degenerative conditions in a workers' compensation venue. In other musculoskeletal regions, there is a clear relationship between the quality of postsurgical rehabilitation and the impact on disability, recurrent injury, and future health care use. It is hypothesized that poor surgical outcomes in compensation injuries may result from outmoded postoperative methods, rather than failures of patient selection or surgical technique. No previous combination of surgery plus rehabilitation has been carefully evaluated with disabled workers undergoing spine surgery. Functional restoration is an individualized medically directed, interdisciplinary program using quantitatively directed exercise progression, psychotherapeutic interventions, and monitoring of specific socioeconomic outcomes for chronically disabled workers. METHODS: This study prospectively evaluated a cohort of consecutive functional restoration program graduates (n = 1202). Two surgical groups, discectomy (n = 123) and fusion (n = 101) were matched to two groups of unoperated control patients, control/discectomy and control/fusion, selected from the same cohort of patients with chronic spinal disorders based on age, gender, race, length of disability, and workers' compensation jurisdiction. A structured clinical interview was administered 12 months after program completion, with a contact rate of 95% to 98%. RESULTS: Socioeconomic outcomes for work return, health care use, and recurrent lost-time injury were assessed. All groups demonstrated a return-to-work incidence of more than 85%, but work retention at 1 year was higher for the fusion group than for the discectomy or control/fusion groups. Health care use was significantly higher for the discectomy group than the control/discectomy or fusion groups for reoperation (8% vs. 4%/ 2%), as well as other factors. All groups showed comparable recurrent lost-time injury rates (2-3.3%), and made comparable improvements in prospectively collected physical and psychological measures. CONCLUSIONS: Discectomy patients had work, health care utilization, and recurrent injury outcomes comparable with those for unoperated control patients. Fusion patients had better outcomes of work retention, reoperation, and health care use compared with the unoperated control patients and even with discectomy patients, in spite of more cases of previous surgery and greater duration of disability. The discectomy and fusion cohorts of operated chronic spinal disorder compensation patients with subsequent functional restoration had the best documented outcomes found in the literature for this population. In spite of the common presumption that spine surgery patients fare poorly in a workers' compensation environment, these results demonstrate that such patients can show remarkably successful objective outcomes if accompanied by effective rehabilitation, documenting efficacy and clinical utility. A new clinical approach is required to evaluate prospectively the combination of surgery and rehabilitation in chronic pain/disability workers' compensation patients, in which the surgical role is to correct an anatomic lesion, but the socioeconomic outcomes either occur spontaneously or are effected through some form of rehabilitation.

Adult↗

PubMed1998

Cognitive predictors of depression in chronic low back pain: toward an inclusive model.

Previous research has linked cognitive distortion, perceived interference with instrumental activities, and self-control to depression in chronic pain patients, though to date no study has examined all three variables concurrently. The present study investigated these three cognitive mediators in a comprehensive model to determine whether each variable represented an independent dimension in the pain-depression relationship. Results in a sample of 74 chronic low back pain patients revealed that a regression model containing all three cognitive variables had the strongest association with depressive symptoms. Consistent with a cognitive mediational model of the pain-depression relation, when self-control, cognitive distortion, and interference were held constant, pain and disability did not have a significant association with self-reported depression. These findings indicate that a comprehensive cognitive model of depression and chronic pain will need to incorporate all three cognitive variables.

Activities of Daily Living↗

PubMed1998

Predicting chronicity in acute temporomandibular joint disorders using the research diagnostic criteria.

The authors describe a prospective study designed to examine the clinical utility of the Research Diagnostic Criteria for Temporomandibular Disorders, or RDC/TMD, in evaluating physical and psychological differences between patients with acute TMD that does not become chronic and patients with chronic TMD. A total of 153 patients with acute TMD participated in the study; the researchers deemed the condition of 87 of these patients to be chronic after a six-month follow-up period, and that of 66 patients to be nonchronic. Using a multiple logistic regression model, the authors found that a number of physical and psychological variables differed significantly between the two groups. These results highlight the importance of the physical-psychosocial interface that affects the development of chronic TMD.

Acute Disease↗

PubMed1998

Clinical outcome research in complementary and alternative medicine: an overview of experimental design and analysis.

This article serves as a primer for those beginning clinical research in complementary and alternative medicine. The authors provide a basic overview of important experimental design and statistical issues, of which clinical researchers in the area of complementary and alternative medicine must be aware when attempting to demonstrate the effectiveness of particular treatment modalities. As the article suggests, science is an inferential process, and experimental investigations can vary greatly in methodological integrity. Key concepts in clinical outcome research such as internal validity, statistical conclusion validity, and the appropriate measurement and operational definitions of outcomes are discussed. New scientific approaches that are evolving because of paradigm shifts in science (e.g., chaos theory) are also reviewed. Suggestions are provided to further develop an understanding of clinical outcome research methodology.

Complementary Therapies↗

PubMed1997

Early childhood abuse in chronic spinal disorder patients. A major barrier to treatment success.

STUDY DESIGN: Prevalence rates of childhood abuse, socioeconomic outcome data, and levels of psychopathology were evaluated for graduates of a functional restoration program for chronically disabled spinal disorder patients in a workers' compensation environment. OBJECTIVES: To describe psychological profiles and evaluate treatment outcomes for chronic spinal disorder patients with a history of childhood abuse. SUMMARY OF BACKGROUND DATA: There is increasing evidence to indicate that traumatic childhood events may leave adult survivors psychologically distressed. It is possible that because of this level of psychological distress, chronic spinal disorder patients may be unable to return to a productive life-style after completing a rehabilitation program. METHODS: Two hundred ninety-nine male and 174 female patients from a cohort (N = 473) of consecutive graduates of a functional restoration program were assessed for the presence of childhood abuse by structured interview. Prevalence rates were compared with a comparison group of subjects without a history of chronic spinal disorder disability. In addition, the 79 chronic spinal disorder patients with a history of childhood abuse were compared on several socioeconomic outcomes with a matched group of workers with chronic spinal disorders without a history of childhood abuse. Psychopathology in the two groups of chronic spinal disorder patients was evaluated using Diagnostic and Statistical Manual of Mental Disorders criteria, the Minnesota Multiphasic Personality Inventory, and Symptom Checklist-90-Revised. RESULTS: A history of childhood abuse was found to be related to a higher level of psychological distress in chronic spinal disorder patients. In addition, poorer socioeconomic outcomes, such as lower work retention rates and higher postrehabilitation operations to the same area of injury, were found in the chronic spinal disorder patients with a history of childhood abuse compared with workers without a history of childhood abuse in whom chronic spinal disorders developed. CONCLUSIONS: These results demonstrate that although a history of childhood abuse is associated with greater psychosocial disturbances in chronically disabled spinal disorder patients, such disturbances do not interfere with an initial positive response to an effective tertiary rehabilitation program such as functional restoration. However, a history of childhood abuse may be related to poorer socioeconomic outcomes after discharge from rehabilitation programs. Additional treatment options may be needed for these patients.

Adolescent↗

PubMed1997

Spinal range of motion. Accuracy and sources of error with inclinometric measurement.

STUDY DESIGN: A quantitative construct assessing accuracy and component analysis of sources of error rather than reliability coefficients was tested prospectively in human performance measurements of lumbar spine motion using a cohort of healthy individuals. OBJECTIVES: To evaluate the accuracy of lumbar spine sagittal motion measurements using a computerized inclinometer, which involved progressive analysis of sources of error to identify the most problematic sub-components of the measurement process and device. SUMMARY OF BACKGROUND DATA: Many previous studies have described the reliability of inclinometric lumbar motion measurement techniques, but with inconsistent analysis about sources of error to explain identified variability. Similar deficiencies exist in identifying sources of error leading to variability for other human performance measurements (e.g., strength, endurance. lifting capacity, etc.). Yet, range of motion has important clinical applications in monitoring progress and assessing temporary and/or permanent impairment. This makes it especially important for clinicians to be able to recognize and correct factors that limit accurate measurements affecting clinical utility. METHODS: A computerized inclinometer was used for measuring the sagittal lumbar mobility of 38 healthy individuals after bench testing the device itself for device error. The human performance test conditions were: 1) initial test on study participants by untrained test administrators with no control of human performance or procedural variables, 2) identical tests by procedurally trained test administrators controlling human performance variability by monitoring and controlling total motion, and 3) test by procedurally trained test administrators without controlling for human performance variability. RESULTS: The accuracy of the methodology progressively was degraded by the various sources of error. Device error was negligible relative to error associated with the test process itself. Lack of test administrator training and the magnitude of the measured quantity were the major factors in test degradation. Combined (gross) lumbar flexion was the most accurate measure (worst case > 95% accuracy for overall test conditions), whereas pelvic extension was the least accurate (worst case > 36%). CONCLUSIONS: Clinical utility of lumbar spine sagittal motion measurement is highly sensitive to test administrator training to bridge pitfalls to measurement accuracy (bony landmarks, "rocking" of inclinometer on sacrum, etc.). Magnitude of the measurement is another important accuracy factor because absolute error tends to remain relatively constant. Device accuracy is usually an insignificant component of overall test accuracy. Analysis of human performance measurements, such as spinal range of motion, may be facilitated by physics-based assessment of accuracy and procedural error in providing more sophisticated analysis than is customarily accessible through reliability coefficients. Previous studies often failed to recognize correctable procedural errors, rarely addressed them, and almost never quantitated them.

Adult↗

PubMed1997

A prospective study of Waddell signs in patients with chronic low back pain. When they may not be predictive.

STUDY DESIGN: Analysis of the treatment-outcome predictive power of Waddell signs by evaluating them before and after functional restoration, with assessment of 1-year socioeconomic outcomes. OBJECTIVE: To evaluate the presence of Waddell nonorganic signs in a group of patients with chronic low back pain presenting for functional restoration, and to determine whether they were predictive of treatment success of failure. SUMMARY OF BACKGROUND DATA: Waddell has described "nonorganic" physical signs in patients with chronic low back pain indicative of somatization. Other researchers have correlated high Waddell scores with psychosocial barriers that required additional consultation, and have suggested that diminution of a Waddell score during physical rehabilitation is predictive of subsequent therapeutic success. METHODS: Total positive Waddell signs score and individual sign scores were assessed at initial presentation for functional restoration treatment and at discharge in a group of 50 patients with chronic low back pain (average length of disability = 17.9 months; average age = 38.5 years). Patients were then tracked and assessed with a 1-year follow-up structured interview to evaluate outcome variables such as return to work, work retention, re-injury rate, health utilization, and subsequent surgery. RESULTS: Statistical analyses of these data revealed no significant associations between Waddell total positive score or changes in score and therapeutic success as measured by any of the behavioral outcomes such as return to work. Also, no predictive value was found for the individual positive signs of their changes and therapeutic success. CONCLUSIONS: Although positive Waddell signs have been found to be predictive in patients with short-term chronic low back pain, the current results suggest that, in patients who have longer duration of pain and who undergo a comprehensive functional restoration program, these signs are not significantly prognostic. Because functional restoration is an interdiscipilinary approach that effectively manages somatization complaints in a consistent manner by all treatment personnel, such complaints do not create any major barriers to recovery. Therefore, although Waddell signs may be predictive of treatment outcome in less intensive rehabilitation programs, they do not provide any predictive power in a comprehensive functional restoration program, which has a basic goal of managing barriers to recovery in a clinically efficacious manner.

Adult↗

PubMed1997

Objectification of functional improvement after nonoperative care.

STUDY DESIGN: In this article, the authors review the three broad categories of measures that have been used to objectify functional improvement after nonoperative care of painful spinal disorder patients-physical, psychological, and socioeconomic. For each of the three categories, the major measures used are discussed, as well as research relating to the efficacy of the measures. OBJECTIVE: To point out the many differences that still exist among research studies regarding which functional outcome measures to use and when to use them. SUMMARY OF BACKGROUND DATA: During the past few decades, it has been made abundantly clear that painful spinal disorders, particularly when associated with work disability and/or financial benefits, result from a complex interaction of medical, psychological, and social factors. This has resulted in frequent confusion regarding what constitutes the primary roots of the disabling process. Currently, a more comprehensive biopsychosocial perspective of chronic pain and disability has emerged that has significant implications for diagnostic and treatment philosophies of practitioners. METHODS: Identifying the measures frequently used to address the important biopsychosocial factors, and evaluating their relative benefits and drawbacks. RESULTS AND CONCLUSIONS: It is demonstrated that there has been an overall trend in recent years toward using more objective, quantifiable instruments, encompassing the physical, psychological, and socioeconomic parameters of outcomes research in painful spinal disorders. These changes will certainly improve the ability of researchers to tease out which factors tap more directly into such tissue as physical impairment, as well as create greater uniformity of measures that will permit direct comparisons between studies.

Activities of Daily Living↗

PubMed1996

Recurrent or new injury outcomes after return to work in chronic disabling spinal disorders. Tertiary prevention efficacy of functional restoration treatment.

STUDY DESIGN: A large prospective longitudinal cohort study (n = 1204) to identify prevalence of new or recurrent injury and risk factors in a rehabilitated chronic disabling spinal disorder patient group with matched control subjects. OBJECTIVES: To evaluate prevalence and risk factors for new or recurrent injury on a chronic disabling spinal disorder population. SUMMARY OF BACKGROUND DATA: The rate of symptom recurrence after acute low back pain, like the rate of initial back pain episodes, is extremely high (40-70%). However, although the incidence of recurrent back pain after chronic disabling spinal disorder represents a small subcomponent of these cases, there is a large socioeconomic impact. An individual attempting to return to work after a chronic disabling spinal disorder episode usually bears a stigma of "high risk" for recurrent injury and related work disability that may result in barriers to reemployment or work retention. Before the present research, no large scale studies had been conducted to evaluate whether recurrent spine injuries or new injuries to other musculoskeletal areas could be prevented by medical treatment. In addition, no studies had emerged to evaluate physical and psychologic risk factors of injury recurrence in this context to facilitate design of prevention programs. METHODS: The present study assessed the incidence of claimed recurrent spinal and new musculoskeletal injuries in a population of 1204 workers. A subgroup of 5.3% (n = 64) of treated patients with a new injury claim in the ensuing 12 months was matched for gender, age, race, length of disability, workers' compensation venue, previous surgery, and litigation status to an identically sized control group who did not report new or recurrent injuries. Demographic, physical, and psychologic measures were obtained prospectively on all patients, before and after treatment, to be analyzed as risk factors. RESULTS: During the year after treatment, 1.3% (n = 16) of patients reported another injury to the same spinal area, with only a 0.9% (n = 11) recurrent disability rate. A new injury to a different musculoskeletal area was reported by 4.0% (n = 48) of patients. Only 3.4% of the whole cohort, or 64.1% (n = 41) of the sample reporting reinjuries after returning to work, experienced lost work time (i.e., disability) after the reinjury. Only a modest predictive association was found between risk for new or recurrent injury and two self-report indices. CONCLUSIONS: The present study suggests that even a sample of the most severe chronic disabling spinal disorder workers' compensation patients who complete a tertiary functional restoration program are at relatively low risk for either a recurrent spinal disorder or new musculoskeletal injury claim (with or without disability). No major physical or psychologic risk factors for recurrent injury could be identified in this large cohort. These findings argue powerfully against employer bias in not rehiring employees with previous chronic disabling spinal disorder or discriminating in pre- or reemployment on the basis of putative reinjury risk factors after an appropriate rehabilitation program. Literature review documents a surprising paucity of quality studies examining variables predictive of this important socioeconomic outcome variable.

Adult↗