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Effect of discharge recommendations on outcome
1Canadian Back Institute, Toronto, Ontario.
Spine
|September 15, 1994
Summary
Recommending return to work unrestricted (RTWU) significantly increases the likelihood of successful patient outcomes. Imposing work restrictions based on fear or pain reports is less effective for return to normal duty.
Area of Science:
- Occupational health
- Rehabilitation medicine
- Clinical outcomes research
Background:
- Return to work recommendations often involve unrestricted (RTWU) or restricted (RTWR) guidelines.
- Restrictions were frequently based on patient-reported pain or unfounded therapist concerns about harm.
Purpose of the Study:
- To compare therapist recommendations for return to work with patient work status.
- To analyze the impact of these recommendations on patient outcomes.
Main Methods:
- A prospective study involving 1438 patients.
- Two groups: control (pain accepted for restriction) and study (pain not accepted for restriction).
- Structured telephone interviews were used for data collection.
Main Results:
- The study group received RTWU recommendations more frequently (81%) than the control group (44%).
- The absolute number of patients returning to unrestricted work doubled in the study group.
- Compliance rates were 84% for controls and 78% for the study group.
Conclusions:
- A recommendation for return to work unrestricted (RTWU) significantly increases the probability of successful return to normal duty.
- Imposing restrictions negatively impacts the probability of successful return to work.