DISABILITY AND FUNCTIONAL STATUS IN PATIENTS WITH LOW-BACK-PAIN RECEIVING WORKERS COMPENSATION - A DESCRIPTIVE STUDY WITH IMPLICATIONS FOR THE EFFICACY OF PHYSICAL THERAPY

Background and Purpose. The efficacy of a physical therapy outpatient program with multiple interventions to treat low back pain in subjects receiving workers' compensation was examined. The primary purpose of the study was to describe the level of disability, physical impairment , and rate of return to work for compensated patients. Subjects. One h undred thirty-eight patients (84 male, 54 female), aged 17 to 63 years (X = 38, SD = 10), were evaluated prospectively. Methods. Subjects we re assessed initially (INS) and were reevaluated 1 month later (1MO) a nd again at the time of discharge (DC). The Oswestry disability score, fingertip-to-floor distance during forward bending, maximal isometric lift, and work status were described as outcomes. Subjects were group ed based on compliance, chronicity, and leg symptoms. Each disability/ impairment outcome was analyzed with paired 1 tests (INA versus 1MO an d Ina versus DC). The frequency of subjects returning to work across g roups was evaluated with a chi-square analysis corrected for unequal g roup sizes. Results. Overall, there was improvement in each dependent measure at 1MO and DC compared with the INA. Subjects with high compli ance had a 10% reduction in mean disability at 1MO and 12% reduction i n mean disability at DC compared with the INA. The low-compliance grou p, in contrast, showed less than a 5% reduction in mean disability at both the 1MO and DC assessments compared with the INA. The magnitude o f improvement in disability status, forward bending, and maximal lift was approximately two to three times greater for subjects with acute s ymptoms compared with those with chronic symptoms. The increase in mea n forward bending for subjects without leg symptoms was over twice as large as the increase in forward bending for subjects with leg symptom s. Seventy-five percent of the subjects followed at DC (30 out of 40) were released to work in some capacity. There was no association betwe en compliance or presence of leg symptoms and work status at DC. Eight y percent of the subjects with acute symptoms, however, were working a t the time of DC compared with 44% of those with chronic symptoms. Con clusion and Discussion. Compliance, chronicity, and leg symptoms are a ll factors that can affect the outcome of physical therapy. The positi ve outcomes for subjects who complied with therapy suggest that a phys ical therapy program with multiple interventions may decrease disabili ty and impairment.