Psychosocial factors and the rehabilitation of patients with chronic work-related upper extremity disorders

This prospective cohort study investigated the effects of psychosocial factors on long-term employment outcome of a sample of chronic work-related upper-extremity pain disorder patients who had completed an interdisciplinary functional restoration program. Factors examined included the following: DSM-III-R Axis I and Axis II diagnoses, derived from the Structured Clinical Interview for DSM-III-R (SCID); history of childhood abuse experienced as elicited by the SCID; the Quantitated Pain Drawing, which evaluated perceived pain intensity; Million Visual Analog Scale, which measures perceived level of disability; and the Beck Depression Inventory, which assessed the level of depression. Results from univariate analyses demonstrated that return-to-work status 1 year following rehabilitation was predicted by the following psychosocial variables: The number of Axis I disorders, a past diagnosis of substance abuse, a past and/or current diagnosis of an anxiety disorder, a diagnosis of borderline personality disorder, a history of childhood abuse, self-report of depressed mood, and a moderate to high level of perceived disability. Additionally, age, race, length of disability, and prior surgical treatment predicted return-to-work rates. A multiple logistic regression further revealed that upper extremity patients who were older, Caucasian, had a current diagnosis of an anxiety disorder, and whose perception of their disability deteriorated from pre- to post-program were significantly less likely to return to work at one-year follow-up. Overall, the findings indicate that psychosocial variables influence the successful rehabilitation of patients with upper extremity disability, suggesting that these patients should be assessed and treated for psychosocial dysfunctions in conjunction with their rehabilitation so as to optimize favorable outcomes after treatment.