Article

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.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS