Predicting subsequent employment status of SSA disability applicants with chronic pain.
OBJECTIVE
The study assessed the predictive ability of the standardized Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). An assessment tool that predicts return to work with chronic pain patients is needed, as increasing numbers of disability applications are adjudicated in the courts.


METHODS
National randomized validation sample of disability applicants. Each MMPAP consisted of physical examinations by two physiatrists and the participant's subjective assessment. Criterion standards were Multidimensional Pain Inventory and McGill Pain Questionnaire. There was phone follow-up 6 months postdecision.


METHODS
Six clinical sites were ambulatory referral centers, both public and private.


METHODS
Population-based random national sample of 710 Social Security disability applicants claiming chronic pain related to their disability, stratified by national Social Security Administration (SSA) applicant demographics. Seventy-eight were lost to follow-up, and 688 initially refused.


METHODS
No interventions were continued or initiated by the research team between assessment and follow-up.


METHODS
Claimant employment status 6 months after disability decision was primary outcome, change in pain intensity, and change in employment situation.


RESULTS
The MMPAP predicted with 90% accuracy employment status of SSA disability applicants with chronic pain 6 months postdecision when assessed at application by two physicians trained in Physical Medicine and Rehabilitation (physiatry). Accuracy of employment situation change was 93%, and pain intensity change was 65%. Self-report measures, physical examination results, psychological status, functional limitations, and physician's subjective appraisal predict future employment.


CONCLUSIONS
The MMPAP accurately predicts future employment of disability applicants claiming chronic pain. The introduction of this standardized protocol will assist in standardizing disability determination for claimants with chronic pain.
Rucker
K S
KS
Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University/Medical College of Virginia, Richmond 23298, USA.
Metzler
H M
HM
D002908:Chronic Disease; D004185:Disability Evaluation; D006233:Persons with Disabilities; D004651:Employment; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement; D011237:Predictive Value of Tests; D012943:Social Security