Development of a screen for predicting clinical outcomes in patients with work-related upper extremity disorders

This study prospectively examined the extent to which a set of medical, phy sical, ergonomic, occupational psychosocial, and individual psychosocial va riables would predict clinical outcome associated with a diverse set of wor k-related upper extremity disorders in recently diagnosed individuals. This investigation was designed to develop a tool for use in a clinical setting to assist in identifying patients at risk for poorer outcome. Outcome was measured at 1, 3, and 12 months apm completely a baseline questionnaire. Ou tcome status was based on a median split of a standardized composite index (symptoms, function, workdays lost, and mental health). Logistic regression indicated that predictors of poorer outcome at 1 month were: upper extremi ty comorbidity (risk ratio [RR], 1.58), pain severity (RR, 1.45), ergonomic risk exposure (RR, 1.07), four job support (RR 1.03), and pain coping styl e (RR, 1.54). At 3 months, poorer outcome was predicted by: symptom severit y (RR, 10.46), job stress (RR, 1.20), and pain coping style (RR, 1.98). The number of prior treatments/providers (RR, 1.77), past recommendation for s urgery (RR, 6.43), and pain coping style were found to predict poorer outco me at 12 months. Sensitivity and specificity, respectively for the models w ere 77.4% and 71.8% at 1 month, 80. 6% and 82.4 % at 3 months, and 80.6% an d 83.3% at 12 months. indicate that baseline measures of ergonomic and psyc hosocial stress, pain severity, and Pain coping style predict clinical outc ome at shorter. intervals, whereas number of past treatments/providers reco mmendation for surgery and pain coping style predict longer-term outcome. T he resulting prognostic screen providers a simple tool that assesses the mu ltidimensional nature of work-related upper extremity disorders and predict s clinical outcome. Furthermore, the findings suggest the importance of ear ly intervention that addresses both physical and psychosocial stressors at work. Specific recommendations to reduce the impact of observed risk factor s are discussed.