title: The impact of disability compensation on long-term treatment outcomes of patients with sciatica due to a lumbar disc herniation.
abstract: METHODS
  Prospective, observational study.
  
  
  OBJECTIVE
  To compare long-term disability and health-related quality of life outcomes of individuals receiving or not receiving workers' compensation at baseline evaluation.
  
  
  BACKGROUND
  Disability compensation has long been associated with poor clinical outcomes. However, most studies have assessed outcomes over short time periods using unvalidated measures without controlling for potential confounders.
  
  
  METHODS
  Patients with sciatica due to a herniated lumbar disc were treated by physicians in community based orthopedic, neurosurgical, and occupational medicine practices throughout Maine. Outcomes assessed included disability compensation and work status, and health-related quality of life, controlling for initial treatment received and factors predicting initial workers' compensation status.
  
  
  RESULTS
  Among 440 eligible patients, 172 (86%) receiving workers' compensation and 222 (92%) not receiving workers' compensation at baseline evaluation completed at least one follow-up between 5 and 10 years (80% completed 10-year). Baseline demographics, past back history, imaging findings, symptoms, functional status, and expectations significantly differed according to the patient's baseline workers' compensation status. After 5-10 years, most patients, regardless of baseline workers' compensation status (yes or no), were not receiving disability compensation (83% vs. 96%, respectively) and were employed (78% for both groups). However, workers' compensation patients were significantly more likely to be receiving disability compensation and had worse symptoms, functional status, and satisfaction outcomes. Outcome differences diminished in magnitude after controlling for baseline differences among patients receiving workers' compensation or not but continued to favor those not initially receiving workers' compensation. Initial treatment received, either surgical or nonsurgical, did not influence these findings.
  
  
  CONCLUSIONS
  Long-term employment and disability outcomes were favorable for most patients with a disc herniation, regardless of initial workers' compensation status. However, individuals initially receiving workers' compensation had worse disability and quality of life outcomes compared to individuals not receiving workers' compensation. Despite these differences, long-term work outcomes were similarly favorable.
authors.affiliation: General Medicine Division, Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. satlas@partners.org
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Robert B
authors.initials: RB
authors.lastname: Keller
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Singer
authors.forename: Yen A
authors.initials: YA
authors.lastname: Wu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
mesh_terms: D000328:Adult; D006233:Persons with Disabilities / Q000534:rehabilitation; D004651:Employment; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications*; D008159:Lumbar Vertebrae; D008281:Maine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012585:Sciatica / Q000209:etiology / Q000534:rehabilitation*; D016896:Treatment Outcome; D014942:Workers' Compensation