Work outcomes for female liver transplant recipients with alcohol-related liver disease.

The purpose of this retrospective survey was to describe post-liver transplant work outcomes for female liver transplant recipients with histories of alcohol-related liver disease. The theoretical framework guiding the study was Laffrey's conception of health. The Short Michigan Alcohol Screening Test was used to measure alcohol-related liver disease. Forty-seven female liver transplant recipients whose Short Michigan Alcohol Screening Test scores were indicative of alcohol-related liver disease comprised the convenience sample. Using a mailed questionnaire, post-transplant work and daily activities were assessed. Work was operationally defined as including either employment or household work. Results revealed that 59% of the female recipients were working post-transplant and that working recipients had higher conception of health scores than did non-working recipients.     

Effects of a rehabilitation programme on daily functioning,participation, health-related quality of life,anxiety and depression in liver transplant recipients

Purpose.?Fatigue is a chronic problem in liver transplant recipients and may influence daily functioning and health-related quality of life (HRQoL). This study aimed to evaluate the effects of a fatigue-reducing physical rehabilitation programme on daily functioning, participation, HRQoL, anxiety and depression among liver transplant recipients.

Method.?Eighteen fatigued liver transplant recipients (mean age 51 years, 10 men/8 women) participated in a 12-week rehabilitation programme, which included supervised exercise training and daily physical activity counselling. We assessed pre- and post-programme health-related daily functioning, participation, HRQoL, anxiety and depression using questionnaires.

Results.?After the programme, patients showed improvements in daily functioning (23.6%, p?=?0.007), the participation domain ‘autonomy outdoors’ (34.1%, p?=?0.001), and the HRQoL domains ‘physical functioning’ (11.5%, p?=?0.007) and ‘vitality’ (21.5%, p?=?0.022). Anxiety and depression were unchanged post-programme.

Conclusions.?Rehabilitation using supervised exercise training and daily physical activity counselling can positively influence daily functioning, participation and HRQoL among fatigued liver transplant recipients.     

Ethnic disparities in outcome from posttransplant infections

Black transplant recipients have decreased graft survival and increased rejection rates compared with whites. Because increased rejection rates may lead to more immunosuppression in black recipients, ethnic differences may exist for outcomes of posttransplant infectious complications. All episodes of infection between December 1996 and October 1998 on the transplant services at the University of Virginia Health Sciences Center were prospectively evaluated. Parameters recorded included self-designated ethnicity, demographics, APACHE II scores, laboratory and microbiologic data, immunosuppression, episodes of rejection, and outcome measures. Evaluation of 303 episodes of infection demonstrated an increased mortality rate for white compared with black recipients (19% vs. 3%, P = 0.0006) despite having a similar severity of illness (APACHE II score). Among renal transplant recipients, episodes of infection occurring in black recipients (n = 46) were also associated with a decreased mortality rate versus whites (n = 89) (0% vs. 15%, P = 0.006) and shorter mean length of stay (12 +/- 2 vs. 25 +/- 4 days, P = 0.002) despite similar severity of illness and rejection rates. For posttransplant infections in liver transplant recipients, blacks (n = 23) demonstrated a trend toward decreased mortality (9% vs. 26%, P = 0.07) but equal lengths of stay despite similar APACHE II scores, rejection rates, and age. White liver transplant recipients had an increased incidence of viral infections (15% vs. 0%, P = 0.03). All other infecting organisms were similar. The unexpected finding of a significantly decreased rate of mortality associated with posttransplant infections in black recipients remains largely unexplained but may be related to subtle differences in immune response between racial or ethnic groups.     

Comparison of the overall quality of life in 50 long-term survivors of autologous and allogeneic bone marrow transplantation

Fifty long-term survivors of bone marrow transplant (mean post-transplant time = 42 4 months) participated in a study examining their psychosocial adjustment and quality of life Differences between patients who received an autologous marrow transplant and those who received an allogeneic marrow transplant were identified Patients with an autologous transplant had mainly psychological difficulties in their post-transplant adaptation, whereas patients with allogeneic transplant developed more physical problems Overall, their psychosocial adjustment was similar and comparable with other medical groups of patients A quarter of both groups had failed to return to work/education and up to 9 5% had difficulty in carrying out daily tasks Twenty per cent of the patients with autologous transplant had clinical signs of anxiety and 10% clinical signs of depression, whereas there was an incidence of 10% of patients with allogeneic transplant with anxiety, but no cases with clinical depression Family relationships were found to be more integrated and lower in conflict compared with normal families Quality of life has been described as good to excellent in most of the patients Multiple regression analysis showed that physical symptomatology, vocational adjustment and depression are predictors of the degree of the patients' quality of life     

Effect of atorvastatin on cyclosporine pharmacokinetics in liver transplant recipients

BACKGROUND: The development of hyperlipidemia after liver transplant is frequently treated with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) such as atorvastatin. As atorvastatin and the primary immunosuppressant drug, cyclosporine, are metabolized by the same pathway, there is the potential for an interaction. OBJECTIVE: To determine the effect of atorvastatin on cyclosporine pharmacokinetics in liver transplant recipients. METHODS: Six stable, long-term adult liver transplant recipients from a single center who developed posttransplant dyslipidemia were recruited to participate in a 14-day, open-label study of atorvastatin 10 mg/d coadministered with standard posttransplant immunosuppression using constant oral doses of cyclosporine and corticosteroids. A 10-point pharmacokinetic profile was performed prior to and on day 14 after commencement of atorvastatin therapy. Cyclosporine concentrations were measured by HPLC-electrospray-tandem mass spectrometry. The AUC was calculated by the linear trapezoidal rule, with other parameters determined by visual inspection. RESULTS: Atorvastatin coadministration increased the cyclosporine AUC by 9% (range 0-20.6%; 3018 vs 3290 ng.h/mL; p = 0.04). No significant change was evident for other cyclosporine pharmacokinetic parameters. Total cholesterol and low-density lipoprotein cholesterol levels were significantly lower on day 14 than at baseline (p < 0.02). One patient developed a twofold increase in transaminases after 2 weeks of atorvastatin therapy, but no other clinical or biochemical adverse events were recorded. CONCLUSIONS: Atorvastatin coadministration increases the cyclosporine AUC by approximately 10% in stable liver transplant recipients. This change in systemic exposure to cyclosporine is of questionable clinical significance. Atorvastatin is effective in reducing cholesterol levels in liver transplant recipients.     

Relationships between oral mucositis and treatment variables in bone marrow transplant patients.

The pattern of oral mucositis and related treatment variables was studied in 20 bone marrow transplant patients. Patients received either total body irradiation (TBI) or busulfan in combination with cyclophosphamide and etoposide as pretransplant conditioning. Daily oral assessment scores were analyzed. Mucosal changes began approximately 2 days before transplant and peaked approximately 8 days after transplant. There was a trend for patients receiving TBI to have slightly higher oral scores during the first week posttransplant than patients receiving busulfan. The TBI patients averaged almost twice the number of days of continuous intravenous morphine infusion for oral pain and 6 additional days of total parenteral nutrition when compared with patients receiving busulfan. Subjects who died during aplasia manifested mucositis that gradually worsened and did not return to baseline. Differences in oral status based on type of transplant, either autologous or allogeneic, were not shown in this study.     

Functional outcome after liver transplantation: a preliminary report

Although the number of patients undergoing successful liver transplants each year has increased dramatically, little information is available on the functional outcome of such patients. A survey was conducted to determine the functional and vocational outcome of patients three years after orthotopic liver transplantation. Questionnaires were sent to 45 patients who had liver transplants in 1985, of whom 31 responded. Fourteen patients (47%) reported abnormal function in at least one limb; four patients (13%) reported developing gout. All patients were independent in ADLs and mobility; assistive devices were used by four patients. Nineteen patients (61%) reported severe impairment in endurance before transplant; 15 (48%) were unable to ambulate outside the house. After transplant only two patients (6%) reported severely impaired endurance, and all but two were able to walk at least three blocks. Three years after transplant, 12 patients (39%) were working full time and eight patients (26%) were homemakers. Work performance was most commonly limited by fractures (12 patients) and lack of concentration (seven patients). Thus, despite frequent limitations in limb function, patients after liver transplant are largely independent in ADLs and mobility, have improved endurance, and can often return to work despite physical limitations.     

The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy

In a prospective controlled trial on 46 patients undergoing lumbar discectomy, three classes of variables (medical data including MRI-identified morphological abnormalities, general psychological factors and psychosocial aspects of work) were analyzed with regard to their predictive value for the outcome of lumbar disc surgery at 2 year follow-up. Multiple regression analyses were used to identify the best predictor variables of four different outcome measures (i.e. pain relief, reduction of disability in daily activities, return to work and surgical outcome). MRI-identified nerve root compromise and social support from the spouse were independent predictors of pain relief 2 years after surgery (R2 = 0.40, P < 0.01). Return to work 2 years after surgery was best predicted by depression and occupational mental stress (R2 = 0.36, P < 0.001). MRI-identified extent of herniation and depression were significant predictors of a good surgical outcome after lumbar discectomy (R2 = 0.61, P < 0.001). This study has demonstrated that the outcome of discectomy is critically dependent on which outcome variables are selected and that different sorts of predictor variables have a distinct influence on the various outcome variables. Obvious morphological alterations (i.e. disc extrusions, nerve root compromise) proved to be significant predictors of postoperative pain relief and improvement of disability in daily activities justifying a surgical treatment approach in these cases. The most important finding of this study was that return to work was not influenced by any clinical findings or MR-identified morphological alterations, but solely by psychological factors (i.e. depression) and psychological aspects of work (i.e. occupational mental stress).     

An evidence-based pilot study exploring relationships between psychologic and physiologic factors in post-lung-transplant adolescents with cystic fibrosis

After using an evidence-based approach to address clinical practice questions, a pilot study was designed to explore the relationships among anxiety and depression self-report data, cyclosporine (CSA) trough values, and biopsy rejection grades within a posttransplant sample of adolescents with cystic fibrosis. Thirteen study participants completed the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI), and had CSA trough levels and biopsy data collected. There was a statistically significant correlation between depression and inflammatory rejection levels. Adolescents with benign rejection scores had lower depression scores than adolescents with higher levels of rejection scores. The data also showed a statistically significant inverse correlation between CSA trough levels and inflammatory rejection levels. Posttransplant success depends on compliance with a strict, antirejection regimen. Adolescence is a turbulent time when many stressors can result in risk-taking behavior such as medication noncompliance and anxiety and depression. Regular psychologic monitoring of posttransplant adolescent patients may be warranted to identify increasing psychologic distress and proactive opportunities for health care intervention. This pilot study is an example of a clinical research question that evolved from a practice situation in which nurses caring for posttransplant adolescents with cystic fibrosis surmised that there were many psychologic issues influencing successful transplant outcomes. Nursing observations suggested a strong connection between poorer medication control, greater risk for rejection, and signs of depression and/or anxiety. The nurse researchers were interested in identifying significant relationships between psychologic factors and physiologic factors, and in discovering objective ways to better assess the psychologic needs of this patient population. A thorough search was conducted of the research literature, and the best clinical practices of other institutions were investigated. There was a lack of transplant research literature on adolescents, and although excellent ideas were generated from inquiries to other institutions, there was a lack of best evidence to answer the clinical questions about this group of patients. The initial clinical question became a research question to determine more about this specific patient population. This article is an example of a clinical research pilot study that resulted from an evidence-based practice process. Pilot studies are springboards for other, more refined research: They help to point the way, or to clarify what the real issues may be. For nurses, they serve as an opportunity to hone critical thinking skills and to contribute to the scientific foundation of our profession.     

Permanent pacing for late-onset atrioventricular block in patients with heart transplantation: a single center experience

Introduction: The incidence, mechanisms, clinical associations, and outcomes in patients with late‐onset (>3 months) atrioventricular (AV) block following heart transplantation are not well known. This study will characterize late‐onset AV block following cardiac transplantation. Methods: We retrospectively reviewed our databases to identify patients who required pacemakers for late‐onset AV block postheart and heart‐lung transplantation from January 1990 to December 2007. Orthotopic heart and heart‐lung transplantation were separately analyzed. Results: This study included 588 adults who received cardiac transplants over a 17‐year period at our center (519 orthotopic, 64 heart‐lung transplants, and five heterotopic heart transplants). Of the 519 patients with orthotopic heart transplant, 39 required pacing (7.5%), 17 (3.3%) within 3 months posttransplant, 11 (2.1%) for late‐onset sinus node dysfunction (SND), 11 (2.1%) for late‐onset AV block. Also, five patients (7.8%) out of 64 heart‐lung transplants required pacemakers, two (3.1%) for late‐onset SND, three (4.7%) for late‐onset AV block. None of the five patients who underwent heterotopic transplant required cardiac pacing prior to or posttransplant. Conclusions: Late‐onset AV block occurs in 2.4% of patients with orthotopic heart transplant or heart‐lung transplant. AV block is predominantly intermittent and, often, does not progress to permanent AV block. There are no predictable factors for its onset. (PACE 2011; 72–75)     

Depression and anxiety in the heart transplant patient: a case study

Depression and anxiety are potential psychological problems that a heart transplant patient may face both before and after transplant. In addition, there is the potential for difficulty in adjusting to life after transplantation. Anxiety and depression and their effects, both pretransplant and posttransplant, are explored. A case study is used to illustrate the psychological effects of trans plantation.     

肝移植受者疲乏状况与焦虑抑郁情绪的相关性研究

目的了解肝移植受者疲乏状况与焦虑抑郁情绪的关系。方法使用一般资料调查表、中文版多维度疲乏症状量表-简表、医院焦虑抑郁量表对北京市某三级甲等医院肝移植随访中心进行随访的270例肝移植受者进行问卷调查。结果肝移植术后移植受者存在一定程度的疲乏、焦虑和抑郁情绪,且疲乏焦虑、抑郁密切相关;其中焦虑、抑郁总分均与疲乏总分、一般疲乏、身体疲乏、情绪疲乏、心理疲乏得分呈正相关(P0.01),与活力维度得分呈负相关(P0.01)。回归分析显示焦虑、抑郁能影响肝移植受者的疲乏状况。结论肝移植受者的疲乏与焦虑、抑郁密切相关,医护人员应注重肝移植受者的心理问题,并教授受者一些调节情绪的方法,从而改善疲乏。     

Care for the organ transplant recipient on the intensive care unit

All transplant recipients receive tacrolimus, mycophenolate and glucocorticoids and these drugs have many side-effects and drug-drug interactions. Common complications include surgical complications, infections, rejection and acute kidney injury. Infections as CMV and PJP can be prevented with prophylactic treatment. Given the complexity of organ transplant recipients a multi-disciplinary team of intensivists, surgeons, pharmacists and transplant specialists is essential.After heart transplantation a temporary pacemaker is required until the conduction system recovers. Stiffening of the heart and increased cardiac markers indicate rejection. An endomyocardial biopsy is performed via the right jugular vein, necessitating its preservation.For lung transplant patients, early intervention for aspiration is warranted to prevent chronic rejection. Risk of any infection is high, requiring active surveillance and intensive treatment, mainly of fungal infections.The liver is immunotolerant requiring lower immunosuppression. Transplantation surgery is often accompanied by massive blood loss and coagulopathy. Other complications include portal vein or hepatic artery thrombosis and biliary leakage or stenosis.Kidney transplant recipients have a high risk of cardiovascular disease and posttransplant anemia should be treated liberally. After postmortal transplantation, delayed graft function is common and dialysis is continued. Ureteral anastomosis complications can be diagnosed with ultrasound.     

Care of the kidney transplant recipient. Vigilant monitoring creates the best outcome

Kidney transplant recipients require careful follow-up in both the early (< 6 months) and late posttransplant periods. Monitoring should focus on graft function and the most common complications of immunosuppression therapy. Infections, especially CMV infection, require particular attention in the first few months after transplantation, when immunosuppression is most intense. In both the early and the late posttransplant periods, an emphasis should be placed on intensive management of CVD risk factors (e.g., hypertension, hyperlipidemia, cigarette smoking). Screening for malignancies known to occur with a high incidence after transplantation is also important. With the improved short-term survival rates brought about by new, potent immunosuppressive agents, emphasis has now shifted to the prevention and treatment of posttransplant complications in kidney transplant recipients. A heightened awareness of these complications, along with a cooperative effort between primary care physicians and transplant programs, offers the best hope for further improvement in outcomes after kidney transplantation.     

Quality of life, coping and concerns in Chinese patients after renal transplantation.

This study aims to identify the coping methods used by patients to deal with stress after renal transplantation and to assess patients' perceived quality of life at two different time intervals after the transplant. The study conducted in one transplant centre in Hong Kong and 101 survivors participated. The Chinese Coping Scale (CCS) and the Hong Kong Chinese version of the WHOQOL scale were used together with an open question inquiring about stressors or concerns experienced by patients posttransplant. The results revealed that the main stressors identified were fear of rejection, compliance with medication and side-effects of medication, uncertainty about the future, fear of infection and the cost factor. Not statistically significant differences were found in all the CCS subscales measuring internal coping or external coping between patients within one year posttransplant (n = 23) and patients more than one year posttransplant (n = 78). Overall, patients used more internal locus of coping to deal with stress. Not statistically significant differences were also found in all the quality of life subscales between the two groups of patients. The results showed that quality of life was moderate in the Chinese renal transplant patients in Hong Kong. The findings of this study would enable renal nurses to design interventions to help transplant recipients to cope with the demands of life with a renal graft.     

Telomere length changes after umbilical cord blood transplant

BACKGROUND: The establishment of donor-derived hematopoiesis in the recipients of hematopoietic stem cell (HSC) transplants involves extensive proliferation and differentiation of HSCs. Data from long-term survivors of HSC transplants suggest that these transplanted HSCs may experience a debilitating replicative senescence. A significant posttransplant shortening of peripheral blood mononuclear cell (PBMNC) telomeres has been observed in both marrow transplant and peripheral blood progenitor cell transplant recipients. Similar studies have not been performed for umbilical cord blood (UCB) HSC transplants, which might be expected to exhibit increased posttransplant replicative potential due to their inherently greater telomere length. STUDY DESIGN AND METHODS: Blood was obtained from donor-recipient pairs of allogeneic PBHSC transplant and UCB HSC transplant, both before transplant and at follow-up treatments (minimum 1 year after transplant) after engraftment. Telomere restriction fragment length (TRFL) analysis was performed on the blood samples. The mean TRFL and posttransplant changes in the mean TRFL were analyzed. RESULTS: Measurements of telomere lengths in the PBMNCs of transplant patients revealed a significant net decrease in telomere length in all transplant recipients compared with their respective donors. Our results also revealed that the PBMNCs of umbilical cord stem cell transplant patients retain a significantly longer posttransplant telomere length. CONCLUSION: The significantly longer telomeres observed in the allogeneic UCB HSC transplant recipients compared to the allogeneic PBHSC transplant recipients in our study may be indicative of a replicative advantage inherent in the use of UCB HSC for transplant.     

Mycophenolate pharmacokinetics in early period following lung or heart transplantation

BACKGROUND: The available pharmacokinetic and pharmacodynamic data on mycophenolic acid (MPA), the pharmacologically active metabolite of mycophenolate mofetil (MMF), are derived largely from renal transplant patients, not thoracic transplant recipients.OBJECTIVE: To evaluate, in a pilot study, the pharmacokinetics of MPA at 3 different times in the early period (up to the first 9 mo) following lung or heart transplantation.METHODS: Nine patients were entered into this open-label study. Upon administration of a steady-state morning MMF dose, blood samples were collected at 0, 20, 40, 60, and 90 minutes and at 2, 4, 6, 8, 10, and 12 hours after the dose at 3 times (denoted as sampling periods 1, 2, and 3) in the early posttransplant period. Total MPA concentrations were measured by a validated HPLC method with ultraviolet detection and followed by ultrafiltration of pooled samples for unbound MPA concentrations. Pharmacokinetic parameters (maximal concentration [C(max)], dose-normalized C(max), time to C(max), minimum concentration, predose concentration, AUC, dose-normalized AUC, free fraction, free AUC) were calculated by traditional noncompartmental methods.RESULTS: Patient characteristics included 7 men and 2 women, 5 lung and 4 heart transplant recipients, mean +/- SD age 53 +/- 11 years, and weight 77 +/- 14 kg. All patients were receiving prednisone and cyclosporine (with the exception of 2 pts. on tacrolimus during sampling periods 2 and 3). Sampling periods 1, 2, and 3 occurred on posttransplant days 15 +/- 13, 56 +/- 33, and 125 +/- 73, respectively. No significant differences were found between sampling periods in any pharmacokinetic parameter. Drug exposure as evaluated by AUC was 39.95 +/- 44.86, 25.24 +/- 25.68, and 43.96 +/- 38.67 micro g*h/mL during sampling periods 1, 2, and 3, respectively, (p > 0.05).CONCLUSIONS: As of September 26, 2003, this is the first study to systematically evaluate MPA pharmacokinetics in thoracic transplant recipients at 3 different time points during the early posttransplant period. Wide interpatient variability in MPA pharmacokinetics was observed, thus emphasizing the need to individualize dosing of MMF and to further evaluate important pharmacokinetic/pharmacodynamic parameters and endpoints that impact on clinical outcomes. Further studies involving more patients and pharmacodynamic outcomes are underway to help identify optimal MMF strategies.     

Factors influencing cyclosporine blood concentration-dose ratio

OBJECTIVE: To analyze the trough cyclosporine concentration-dose ratio (CDR) and its relationship to some commonly available factors such as cyclosporine dosage, patient age, grade of obesity, posttransplant days, serum creatinine, serum bilirubin, and serum cholesterol by multiple linear regression. METHODS: The study was performed on 866 samples from 90 transplant recipients (25 kidney, 25 heart, 17 bone marrow, 13 liver, 10 simultaneous pancreas-kidney). RESULTS: The results show differences between transplants both in cyclosporine CDR variability (expressed by the coefficients of variation) and in the capability of those factors to explain this variability (expressed by the coefficient of determination). Coefficients of variation were 41% for the 866 samples (from 34% in heart to 55% in pancreas-kidney transplantation) and 28% for the 90 patients' CDR mean values (from 24% in heart to 32% in pancreas-kidney transplantation). All factors, except for the grade of obesity, were related to the cyclosporine CDR for all transplants as a whole. However, differences in the influence of each factor on each transplant were observed. The coefficient of determination based on significant factors was R2 = 0.25 for all samples (from 0.18 in pancreas-kidney to 0.52 in liver transplantation) and R2 = 0.53 for the patients' CDR means (from 0.39 in heart to 0.83 in kidney transplantation). CONCLUSIONS: We have quantified the cyclosporine CDR, its variability, and its relationship with some commonly available factors and found significant differences between transplant types. The equations of regression obtained might improve trough cyclosporine CDR estimation as a first step in cyclosporine dosage adjustment in kidney and liver transplant recipients.     

An application of the Occupation Competence Model to organizing factors associated with return to work

The variations in return to work outcomes for ill or injured persons experiencing health leaves are complex. However, it is important to comprehend these variations in order to develop evidenced-based practice in work rehabilitation. Currently, a plethora of studies exist in the literature that have attempted to explain the variations in work outcomes. A 20-year review of the literature on work outcomes has revealed several limitations in using this knowledge in occupational therapy. The study of return to work outcomes is, for the most part, atheoretical and the knowledge base is fragmented and disorganized. In addition, the literature does not reflect a consistent understanding of the multidimensional nature of either work disability or the facilitators for return to work. In this paper, the Occupational Competence Model is presented as a framework for filling this gap. This model is used here to organize and synthesize the factors previously studied on work outcomes to foster an understanding of this literature from an occupational therapy perspective and the future study of work outcomes and work rehabilitation.     

Failure to complete a functional restoration program for chronic musculoskeletal disorders: a prospective 1-year outcome study

OBJECTIVE: To compare comprehensively the likelihood of various socioeconomically relevant outcomes between functional restoration completers and noncompleters, while simultaneously identifying risk factors for noncompletion. DESIGN: A prospective cohort study of patients with chronic disabling occupational musculoskeletal disorders (CDOMD). SETTING: Chronic pain management facility. PARTICIPANTS: A total of 1440 patients with CDOMD were consecutively divided into 2 groups-one with 303 patients who did not complete the prescribed treatment program (noncompleters [NC]) and a second with 1137 patients who did (completers). INTERVENTION: The Interdisciplinary Functional Restoration: Rehabilitation program. MAIN OUTCOME MEASURES: Validated questionnaires about pain, disability, and depression were added to results of a structured 1-year posttreatment telephone interview on socioeconomic outcomes covering work status, health utilization, recurrent injury claims, and resolution of financial disputes. RESULTS: The 1-year posttreatment socioeconomic outcomes were most striking. The NC group was 7 times more likely to have postrehabilitation surgery in the same area, and nearly 7 times more likely to have more than 30 visits to a new health provider in persistent health care-seeking efforts. The NC group also had only half the rates of work return and work retention, being 9.7 times less likely to have returned to any type of work, and 7 times less likely to have retained work at the end of the year. Regression analysis also revealed that work return, surgery in a compensable injured area, more health care utilization from a new provider, and more overall health care utilization (>30 visits) were most reliably predicted by whether the rehabilitation program was completed. CONCLUSIONS: This large prospective study determined that noncompleters of interdisciplinary tertiary rehabilitation for CDOMDs had comparatively poor socioeconomic outcomes in the year after discharge from treatment, especially on work status and health utilization outcomes. These outcomes are of great relevance to societal, medical, and indemnity costs and future worker productivity. Several risk factors of possible importance in identifying potential noncompleters early in the treatment program were identified that may yield more effective interventions tailored to maintain compliance and decrease the percentage of drop-outs.