Disability and functional status in patients with low back pain receiving workers' compensation: a descriptive study with implications for the efficacy of physical therapy.
OBJECTIVE
The efficacy of a physical therapy outpatient program with multiple interventions to treat low back pain in subjects receiving workers' compensation was examined. The primary purpose of the study was to describe the level of disability, physical impairment, and rate of return to work for compensated patients.


METHODS
One hundred thirty-eight patients (84 male, 54 female), aged 17 to 63 years (mean = 38, SD = 10), were evaluated prospectively.


METHODS
Subjects were assessed initially (INA) and were reevaluated 1 month later (1MO) and again at the time of discharge (DC). The Oswestry disability score, fingertip-to-floor distance during forward bending, maximal isometric lift, and work status were described as outcomes. Subjects were grouped based on compliance, chronicity, and leg symptoms. Each disability/impairment outcome was analyzed with paired t tests (INA versus 1MO and INA versus DC). The frequency of subjects returning to work across groups was evaluated with a chi-square analysis corrected for unequal group sizes.


RESULTS
Overall, there was improvement in each dependent measure at 1MO and DC compared with the INA. Subjects with high compliance had a 10% reduction in mean disability at 1MO and a 12% reduction in mean disability at DC compared with the INA. The low-compliance group, in contrast, showed less than a 5% reduction in mean disability at both the 1MO and DC assessments compared with the INA. The magnitude of improvement in disability status, forward bending, and maximal lift was approximately two to three times greater for subjects with acute symptoms compared with those with chronic symptoms. The increase in mean forward bending for subjects without leg symptoms was over twice as large as the increase in forward bending for subjects with leg symptoms. Seventy-five percent of the subjects followed at DC (30 out of 40) were released to work in some capacity. There was no association between compliance or presence of leg symptoms and work status at DC. Eighty percent of the subjects with acute symptoms, however, were working at the time of DC compared with 44% of those with chronic symptoms.


CONCLUSIONS
Compliance, chronicity, and leg symptoms are all factors that can affect the outcome of physical therapy. The positive outcomes for subjects who complied with therapy suggest that a physical therapy program with multiple interventions may decrease disability and impairment.
Di Fabio
R P
RP
Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis 55455.
Mackey
G
G
Holte
J B
JB
D000293:Adolescent; D000328:Adult; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007537:Isometric Contraction; D017770:Lifting; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000534:rehabilitation*; D010349:Patient Compliance; D026741:Physical Therapy Modalities; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014938:Work Capacity Evaluation; D014942:Workers' Compensation