Nontreatment variables affecting return-to-work in Tennessee-based employees with complaints of low back pain

Disability and health care-related costs continue to rise as a result of work-related low back injury. Our investigation examined treatment-independent variables that influenced return-to-work outcome in a sample of workers employed in Northeast Tennessee.

The review collected 11 variables from two different outpatient physical therapy clinics utilizing a balanced quota sampling design. The patients were enrolled if the documented complaint was low back pain and was an employment-related injury. The patients were grouped according to whether or not they returned to full-time pre-injury work. Twenty-five patients were enrolled in the positive outcome group, those who returned to full-time pre-injury work. Twenty-two patients who did not achieve this goal were enrolled in a separate group.

Return-to-work for these patients was not dependent upon age, gender, insurer, number of physical therapy treatments attended, or previously reported low back injury. Those who returned to work had (1) a higher percentage of patients working full-time at their pre-injury position during the rehabilitation process (28% vs. 0%); (2) a higher compliance with the treatment schedule (97% vs. 93%); (3) a lower cancellation rate (0.5 vs. 2.4); (4) a shorter interval in days between reporting the injury and initiation of physical therapy rehabilitation (27 vs. 58); and (5) a lower percentage of previous surgeries resulting from low back injuries (12% vs. 36%), than those who did not. A relationship was also demonstrated between previous surgery and the interval prior to beginning treatments (P < or = 0.0001). However, no relationship was observed between previous surgery and compliance, or between the interval prior to beginning treatments and compliance.

These results document two variables representing independent factors affecting return-to-work in this population. The first was previous injury influencing the current injury, as documented by both previous surgery and the interval between the current injury and beginning of treatments. The second was compliance with the treatment schedule for the current injury. The psychosocioeconomic aspects of these results are discussed.