Long-term disability and return to work among patients who have a herniated lumbar disc: The effect of disability compensation

Background Low-back problems are one of the most frequent reasons for disab ility compensation claims by workers. However, the effect of Workers' Compe nsation status on the long-term outcome for workers with sciatica has not b een studied in detail, to our knowledge. Therefore, we believe that it is i mportant to describe the long-term outcomes for patients who have herniatio n of a lumbar disc and sciatica according to the Workers' Compensation stat us at the time of the preoperative consultation, Methods: We conducted a prospective, observational study of patients who ha d sciatica and were seeking care from specialist physicians in community-ba sed practices throughout Maine. Among 440 eligible patients, 199,were recei ving Workers' Compensation at the time of entry into the study (baseline) a nd 241,were not, Three hundred and twenty-six patients (74 percent) complet ed questionnaires at the time of a four-year follow-up. The outcomes that w e assessed included disability compensation and work status as well as reli ef from symptoms, functional status, and quality of life. Results: Patients who were receiving Workers' Compensation at baseline were more likely to be young, male, and employed as laborers, They reported wor se functional status; however, the clinical findings for these patients wer e similar to those for patients who,were not receiving Workers' Compensatio n, Patients who had been receiving Workers' Compensation at baseline,were m ore likely to be receiving disability benefits at the time of the four-year follow-up compared,vith those,who had not (27 percent of 133 compared with 7 percent of 189; p < 0.001); however, they were only slightly less likely to be,working at the time of the four-year followup (80 percent of 133 com pared,vith 87 percent of 190; p = 0.09), Operative management did not influ ence these comparisons, but it decreased symptoms and improved functional s tatus, Patients who had been receiving Workers' Compensation at baseline al so had significantly less relief from symptoms and improvement in quality o f life than patients who had not been receiving Workers' Compensation (all p < 0.001), In multivariate models, Workers' Compensation status at baselin e was an independent predictor of wether the patient would be receiving dis ability benefits after four years (odds ratio, 3.5; 95 percent confidence i nterval, 1.7 to 7.6) but was not an independent predictor of whether the pa tient,would be working on a job for pay at the time of the four-year follow -up (odds ratio, 0.6; 95 percent confidence interval, 0.3 to 1.2), Conclusions: Even after adjustment for the initial treatment of the sciatic a and for other clinical factors, patients who had been receiving Workers' Compensation at baseline were more likely to be receiving disability benefi ts and were less likely to report relief from symptoms and improvement in q uality of life at the time of the four-year follow up than patients who had not been receiving Workers' Compensation at baseline, Nonetheless, most pa tients returned to work regardless of their initial disability status, and those who had been receiving Workers' Compensation at baseline were only sl ightly less likely to be working after four years. Whether or not they had been receiving Workers' Compensation at baseline, patients who had been man aged,vith an operation reported greater relief from symptoms and improvemen t in functional status at the time of the four-year follow-up compared,with patients who had been managed nonoperatively, even though the outcomes,vit h regard to disability and work status in these two groups were comparable.