Prediction of Failure to Retain Work 1 Year After Interdisciplinary Functional Restoration in Occupational Injuries

Abstract Brede E, Mayer TG, Gatchel RJ. Prediction of failure to retain work 1 year after interdisciplinary functional restoration in occupational injuries. Objective To identify risk factors for work retention (a patients' ability to both obtain and retain employment) at 1 year after treatment for a chronic disabling occupational musculoskeletal disorder (CDOMD). Design Prospective cohort study. Setting Consecutive patients undergoing interdisciplinary functional restoration treatment in a regional rehabilitation referral center. Participants A sample of 1850 consecutive CDOMD patients, who were admitted to and completed a functional restoration program, were subsequently classified as work retention or nonwork retention at a 1-year posttreatment evaluation. Interventions Not applicable. Main Outcome Measures Measures, including medical evaluations, demographic and occupational data, psychosocial diagnostic evaluation, and validated measures of pain, disability, and depressive symptoms, were obtained at admission to, and discharge from, the program. Results Using a multivariate logistic regression analysis, the following variables were found to be significant predictors of failure to retain work: older age (odds ratio [OR]=1.84; 95% confidence interval [CI], 1.33–2.54), female sex (OR=1.46; 95% CI, 1.09–1.94), nonworking status at discharge (OR=1.65; 95% CI, 1.11–2.45), extreme disability at admission (OR=1.46; 95% CI, 1.06–2.00), antisocial personality disorder (OR=2.11; 95% CI, 1.09–4.08), receipt of government disability benefits at admission (OR=2.28; 95% CI, 1.06–4.89), and dependence on opiate pain medications (OR=1.43; 95% CI, 1.02–2.00). The final model improved prediction by 75% over assigning all patients to the larger (work retention) group. Conclusions This study identified demographic, psychosocial, and occupational factors that were predictive of failure to retain work. These risk factors may be used to individualize treatment plans for CDOMD patients in order to provide optimal functional restoration.