title: The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain.
abstract: METHODS
  In this prospective, observational, cohort study of 192 individuals with chronic low back pain, the group of individuals was divided based on compensation involvement, and their presentation pain and disability, treatment recommendations, and compliance were compared. For 85 of these individuals who completed a spine rehabilitation program, their pain and disability at 3 and 12 months were compared.
  
  
  OBJECTIVE
  To test the theory that individuals with compensation involvement presented with greater pain and disability and would report less change of pain and disability after rehabilitation efforts.
  
  
  BACKGROUND
  Previous studies have produced conflicting results concerning this issue.
  
  
  METHODS
  Individuals were recruited as consecutive patients referred for consultation at a spine rehabilitation center. Pain, depression, and disability were assessed using self-report questionnaires at evaluation and at 3 and 12 months. Rehabilitation services consisted of aggressive, quota-based exercises aimed at correcting impairments in flexibility, strength, endurance, and lifting capacity, identified through quantification of back function. Multifactoral analysis of variance models were used to control for baseline differences between compensation and noncompensation patients during analysis of target variables.
  
  
  RESULTS
  The compensation group included 96 patients; these patients reported more pain, depression, and disability than the 96 patients without compensation involvement. These differences persisted when baseline differences were controlled for with multifactoral analysis of variance models. Treatment recommendations and compliance were not affected by compensation. For patients completing the spine rehabilitation program, length of treatment, flexibility, strength, lifting ability, and lower extremity work performance before and after treatment and patient satisfaction ratings were similar for the compensation and noncompensation groups. At 3 and 12 months, improvements in depression and disability were noted for both groups, but were statistically and clinically less substantial for the compensation group. At the 12 month follow-up visit, pain scores improved for the noncompensation group, but not for the compensation group.
  
  
  CONCLUSIONS
  In chronic low back pain, compensation involvement may have an adverse effect on self-reported pain, depression, and disability before and after rehabilitation interventions.
authors.affiliation: New England Spine Care Center, Chestnut Hill, Massachusetts, USA.
authors.forename: J
authors.initials: J
authors.lastname: Rainville
authors.forename: J B
authors.initials: JB
authors.lastname: Sobel
authors.forename: C
authors.initials: C
authors.lastname: Hartigan
authors.forename: A
authors.initials: A
authors.lastname: Wright
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D010349:Patient Compliance; D011446:Prospective Studies; D012017:Referral and Consultation; D013997:Time Factors; D016896:Treatment Outcome; D014942:Workers' Compensation / Q000191:economics / Q000331:legislation & jurisprudence