Psychiatric comorbidity in chronic disabling occupational spinal disorders has minimal impact on functional restoration socioeconomic outcomes.
METHODS
A prospective study conducted at a tertiary functional restoration center for patients with chronic disabling occupational spinal disorders (CDOSDs), comparing treatment outcome status 1-year posttreatment of patients with specific diagnosed psychiatric disorders to those without.


OBJECTIVE
To evaluate if diagnosed psychopathology is a significant limiting factor in the successful interdisciplinary rehabilitation of CDOSD patients.


BACKGROUND
Research has demonstrated high prevalence rates of psychiatric disorders in patients with CDOSDs. Little is known about whether these disorders are associated with less successful treatment outcomes.


METHODS
A consecutive group of CDOSD patients (n = 1323) averaging 19 months of prerehabilitation disability were evaluated for psychiatric disorders with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Patients participated in a functional restoration program. A structured clinical interview addressing work status, recurrent injury, healthcare utilization, and financial claims closure was administered 1 year after discharge. Logistic regression analyses were conducted to determine the unique contribution of the specific DSM-IV disorders that were significantly associated with the outcomes.


RESULTS
Patients with panic disorder, antisocial personality disorder (PD) and dependent PD were >2 times more likely to be program noncompleters. For successful program completers, those with opioid dependence disorder (ODD) were 2.7 times less likely to return to work and 2.6 times less likely to retain work. Patients with ODD were also 2.1 times more likely to seek postrehabilitation treatment from a new provider.


CONCLUSIONS
Despite intensive management of psychiatric disorders during interdisciplinary functional restoration for CDOSD, several disorders were found to be associated with less successful outcomes. Poorer work outcomes were more common with specific (and comorbid) Axis I psychiatric disorders. Opioid dependence was the single disorder associated most often with less successful outcomes. Despite these findings, the large majority of patients demonstrated successful outcomes. Depression did not independently link to less successful outcomes.
Dersh
Jeffrey
J
PRIDE Research Foundation, Dallas, TX, USA.
Mayer
Tom
T
Gatchel
Robert J
RJ
Towns
Ben
B
Theodore
Brian
B
Polatin
Peter
P
D000328:Adult; D000987:Antisocial Personality Disorder / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003859:Dependent Personality Disorder / Q000453:epidemiology; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D016017:Odds Ratio; D009293:Opioid-Related Disorders / Q000453:epidemiology; D016584:Panic Disorder / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D020127:Recovery of Function; D012008:Recurrence; D012959:Socioeconomic Factors; D013122:Spinal Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome