Provider, payor, and patient outcome expectations in back pain rehabilitation

Return to work is used routinely to define successful back pain treatment. This study examined how the patient and three professional groups defined success for each of five categories of patients: not sponsored and working, sponsored and working, sponsored on modified duty, sponsored and off work for less than 10 weeks, and sponsored and off work for more than 10 weeks. The groups sampled were treating staff (n = 98), referring physicians (n = 98), third-party sponsors (n = 133), and patients (n = 648) representing all five patient categories. Each group provided a priority ranking for six objectives of treatment: Return to Work, Pain Control, Functional Improvement, Increased Strength and Range of Movement, Positive Attitude Shift, and Acquired Knowledge. The results indicated that the work status of the patient had a significant effect on the ranking of objectives by the treating staff and third-party sponsors. Physicians and patients considered pain control most important regardless of the patient category. Success in back pain rehabilitation is defined by different criteria. The determination of successful outcome must consider the patient's circumstances and acknowledge the perspective of the individual who is defining success.