PREDICTING RETURN TO WORK - A LONG-TERM FOLLOW-UP-STUDY OF RAILROAD WORKERS AFTER LOW-BACK INJURIES

Study Design. Evaluation of the long-term outcomes of 178 railroad emp loyees with low back injury who had completed a multidisciplinary reha bilitation program, Objectives. To study two major areas: 1) outcomes of the rehabilitation program in terms of the patient's improvement in function and rate of return to work and 2) factors that predict long- term retention at work, both at the railroad and elsewhere. Summary of Background Data. Several studies have been published examining rehabi litation outcomes of individuals covered under workers' compensation l aw, but few exist that have examined railroad workers covered by the F ederal Employers Liability Act, and few studies exist with follow-up p eriods longer than 3 years. Methods. Physical/medical, self-reported, and employment/financial data were collected on each patient from medi cal and employment records. Follow-up data regarding employment status were obtained either from he employer or from the patient by telephon e interview. Results. On average, the patients improved in all objecti ve and subjective measures after rehabilitation. Improvements in these measures were not predictive of return to work. At follow-up examinat ion, 89% of the contacted patients were employed-61% still at the rail road. The employment factors of lost work days and length of employmen t and the financial factor of wage rate were the most predictive of lo ng-term work status. Conclusions. The multidisciplinary program in the current study was found to improve patient physical functioning and r educe pain. However, success in these measures was not predictive of l ong-term work status, suggesting that other factors have an impact on work status. Clinicians must be aware that employment nad financial fa ctors may have a strong influence on return-to-work outcomes.