PSYCHOSOCIAL FACTORS AND THE REHABILITATION OF PATIENTS WITH CHRONIC WORK-RELATED UPPER EXTREMITY DISORDERS

This prospective cohort study investigated the effects of psychosocial factors on long-term employment outcome of a sample of chronic work-r elated upper-extremity pain disorder patients who had completed an int erdisciplinary functional restoration program. Factors examined includ ed the following: DSM-III-R Axis I and Axis II diagnoses, derived from the Structured Clinical Interview for DSM-III-R (SCID); history of ch ildhood abuse experienced as elicited by the SCID; the Quantitated Pai n Drawing, which evaluated perceived pain intensity; Million Visual An alog Scale, which measures perceived level of disability; and the Beck Depression Inventory, which assessed the level of depression. Results fi om univariate analyses demonstrated that return-to-work status I y ear following rehabilitation was predicted by the following psychosoci al variables: The number of Axis I disorders, a past diagnosis of subs tance abuse, a past and/or current diagnosis of an anxiety disorder a diagnosis of borderline personality disorder a history of childhood ab use, self-report of depressed mood, and a moderate to high level of pe rceived disability. Additionally, age, race, length of disability, and prior surgical treatment predicted return-to-work races. A multiple l ogistic regression further revealed that upper extremity patients who were older; Caucasian, had a current diagnosis of an anxiety disorder and whose perception of their disability deteriorated from pre-to post -program were significantly less likely to return to work at one-year follow-lip. Overall, the findings indicate that psychosocial variables influence the successful rehabilitation of patients with upper extrem ity disability, suggesting that these patients should be assessed and treated for psychosocial dysfunctions in conjunction with their rehabi litation so as to optimize favorable outcomes after treatment.