Prediction of "intent," "discrepancy with intent," and "discrepancy with nonintent" for the patient with chronic pain to return to work after treatment at a pain facility

Objective: We previously determined that "intent" to return to work post pa in facility treatment is the strongest predictor for actual return to work. The purposes of the present study were the following: to identify variable s predicting "intent"; to predict membership in the "discrepant with intent " group [those chronic pain patients (CPPs) who do intend to return to work but do not]; and to predict membership in the "discrepant with nonintent" group (those CPPs who do not intend to return to work but do). Design: A total of 128 CPPs completed a series of rating scales and yes/no questions relating to their preinjury job perceptions and a question relati ng to "intent" to return to the same type of preinjury job post-pain facili ty treatment. These CPPs were part of a grant study for prediction of retur n to work, and therefore their work status was determined at 1, 3, 6, 12, 1 8, 24, and 30 months posttreatment. Preinjury job perceptions and other dem ographic variables were utilized using stepwise discriminant analysis to id entify variables predicting 'intent" and predicting membership in the "disc repant with intent" and "discrepant with nonintent" groups. Setting: Pain facility (multidisciplinary pain center). Patients: Consecutive low back pain CPPs, mean age 41.66 +/- 9.54 years, wi th the most frequent highest educational status being high school completio n (54.7%) and 60.2% being worker compensation CPPs. Results: "Intent" was predicted by tin decreasing order of probability) pos tinjury job availability variables, job characteristic variables, and a lit igation variable. "Discrepant with intent" was predicted by tin decreasing order of probability) for the 1-month follow-up time point, postinjury job availability variables, pain variables, a litigation variable, and a functi on perception variable, and for the final follow-up time point, pain variab les only. "Discrepant with nonintent" was predicted by tin order of decreas ing probability) for the I-month follow-up time point, a job availability v ariable, a demographic variable, and a functional perception variable, and for the final follow-up time point a pain variable and a job availability v ariable. The percentage of CPPs correctly classified by each of these analy ses was as follows: "intent" 81.25%, "discrepant with intent" 87.01% (at 1- month follow-up) and 74.03% (final follow-up), "discrepant with nonintent" 92.16% (at 1-month follow-up) and 75.00% (final follow-up). Conclusions: CPPs intentions of returning to their preinjury jobs are mainl y determined by job availability and job characteristic variables but supri singly not by pain variables. However, the results with "discrepant with in tent" and "discrepant with nonintent" groups indicate that actual return to work is determined by an interaction between job availability variables an d pain variables with pain variables predominating for long-term outcome.