5207.0: Wednesday, November 15, 2000 - 3:30 PM

Abstract #4516

Long-term disability and return to work among patients with sciatica: The effect of disability compensation at baseline

Steven J. Atlas, MD, MPH1, Robert B. Keller, MD2, Richard A. Deyo, MD, MPH3, and Daniel E. Singer, MD1. (1) Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114, 617 724-4736, satlas@partners.org, (2) Maine Medical Assessment Foundation, Manchester, ME, (3) Center for Cost and Outcomes Research, University of Washington, Seattle, WA

Methods: The effect of workers’ compensation (WC) on long-term outcomes of patients with sciatica has not been studied in detail. A prospective observational study of patients with sciatica treated in community-based practices throughout Maine included 440 eligible patients; 199 were receiving WC at baseline evaluation and 241 were not. 326 patients (74%) completed 4-year follow-up. Outcomes included disability compensation and work status, symptom relief, and functional status.

Results: At 4 years, patients initially receiving WC were more likely to be receiving disability benefits (27% versus 7%, p=0.001) but were only slightly less likely to be working (80% versus 87%, p=0.09) than patients not receiving WC. Treatment, either surgical or nonsurgical, did not influence these comparisons, although surgery was associated with improved symptoms and function. Patients initially receiving WC demonstrated significantly less improvement in symptoms and function than patients not receiving WC (all p<0.001). In multivariate models, baseline WC status was an independent predictor of receiving disability benefits at 4 years (OR 3.3, 95% CI 1.6-7.1), but not of working on a job for pay (OR 0.6, 95% CI 0.3-1.3).

Conclusion: Patients receiving WC at baseline evaluation were more likely to be receiving disability benefits, and less likely to report improvement in symptoms and function after 4 years. A majority returned to work regardless of initial WC status, and those receiving WC were only slightly less likely to be working. Though patients treated surgically reported improved symptoms and functional status compared to nonsurgically treated patients, disability and work outcomes were similar.

Learning Objectives: At the end of the presentation, the participant should understand the influence of workers' compensation on outcomes of care for patients with sciatica due to a herniated lumbar disc

Keywords: Workers' Compensation, Outcomes Research

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA