EFFECT OF DISCHARGE RECOMMENDATIONS ON OUTCOME

Study Design. The incidence of two common discharge recommendations, r eturn to work unrestricted (RTWU) and restricted (RTWR) suggested that most restrictions were applied on the basis of patients' subjective r eports of pain or therapists' unfounded fears that return to full duty would result in physical harm.Objectives. This prospective study comp ares the therapist's return to work recommendation to the patient's ac tual work status and analyzes the effect of that recommendation on out come. Methods. There were 1438 consecutive patients reviewed by struct ured telephone interviews during the two halves of the study: the cont rol group when pain was accepted as a reason for restriction and the s tudy group when it was not. Summary of Background Data. In the control group, 44% of the patients were recommended to RTWU; for the study gr oup, 81% received this recommendation. Compliance was 84% for the cont rol subjects and 78% for the study group. Results. The absolute number of patients who returned to unrestricted work doubled in the study gr oup. Conclusions. The probability of a successful return to normal dut y increased with a recommendation of RTWU (P = 0.0001), whereas the pr obability of failure increased when restrictions were imposed (P = 0.0 001).