Multidisciplinary treatment for a chronic pain patient returning to work: a case report.
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Supported employment was used to place 41 persons into competitive employment during 30 months. All individuals had experienced severe head injuries; almost 70% of injuries were due to motor vehicle accidents. A mean of seven years had passed since injury for all referred clients, who had been unconscious a mean of 53 days. Only 36% of referred clients had achieved any competitive postinjury employment, compared with 91% of the same group who were competitively employed before injury. A job retention rate of 71% was reported, with most jobs in warehouse, clerical, and service-related occupations. A mean of 291 hours of job coaching was required to place and maintain all clients in supported employment.
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Three case studies illustrating the use of supported employment methods to help individuals with severe head injury are presented. Before supported employment intervention, these individuals were unable either to obtain or maintain employment. Neuropsychologic evaluation revealed many intellectual impairments which contributed to diminished employment potential. Through intervention, all three persons were able to obtain and maintain employment. Consecutive number of months employed ranged from 17.5 to 35, and hours worked per week ranged from 30 to 40. Current hourly earnings exceed the minimum wage, ranging from +5.00 to +5.16 per hour. These cases represent a subset within a larger supported employment program, which assists patients with severe traumatic brain injury to reenter the labor force and maintain employment.
A prospective study of patients with chronic low-back pain was made to determine the significance of the patient's own prediction of the outcome of a vocational rehabilitation program. Fifty-two patients were screened, and their work situation determined one and 4 years after the rehabilitation program was started. The patients predicted the outcome correctly in 69%, with a sensitivity of 68% and a specificity of 71%. A statistically significant correlation was found between the patient's prediction and the recommendations given by the rehabilitation unit.
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