title: Long-term adjustment to work-related low back pain: associations with socio-demographics, claim processes, and post-settlement adjustment.
abstract: OBJECTIVE
  Predict long-term adjustment (pain intensity, pain-related catastrophizing, and pain-related disability) from socio-demographic, claim process, and post-settlement adjustment variables in a cohort of 374 Workers' Compensation low back claimants.
  
  
  METHODS
  Age- and gender-matched subsamples of African Americans and Caucasians were randomly selected for long-term follow-up (6 years post-settlement) from a larger, existing cohort of Workers' Compensation low back claimants in Missouri. Computer-assisted telephone interviews were used to assess pain, catastrophizing, and disability. Path analysis and logistic regression analysis were used to predict long-term adjustment from socio-demographic variables (race, gender, age, and socioeconomic status), Workers' Compensation claim process variables (surgery, diagnosis, claim duration, treatment costs, settlement awards, and disability rating), and adjustment at baseline.
  
  
  RESULTS
  Poorer long-term adjustment (higher levels of pain, catastrophizing, and pain-related disability) was significantly predicted by relatively poorer adjustment at baseline, lower socioeconomic status, and African American race. African American race associations were also mediated through lower socioeconomic status. Higher levels of occupational disability, as measured by long-term rates of unemployment and social security disability, were also predicted by African American race (in addition to age and claim process factors).
  
  
  CONCLUSIONS
  Long-term adjustment to low back pain in this cohort of Workers' Compensation claimants was stable, relative to short-term adjustment soon after settlement. Long-term adjustment was worse for people of lower socioeconomic status, particularly for economically disadvantaged African Americans, suggesting the possibility of race- and class-based disparities in the Workers' Compensation system.
authors.affiliation: Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, MO 63104, USA. chibnajt@slu.edu
authors.forename: John T
authors.initials: JT
authors.lastname: Chibnall
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Tait
mesh_terms: D000041:Absenteeism; D000223:Adaptation, Psychological; D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends; D006304:Health Status; D006801:Humans; D007345:Insurance Claim Review; D007407:Interviews as Topic; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology*; D011584:Psychology; D011602:Psychophysiologic Disorders / Q000453:epidemiology / Q000208:ethnology; D011610:Psychosocial Deprivation; D018582:Sick Leave / Q000706:statistics & numerical data / Q000639:trends; D012959:Socioeconomic Factors; D013995:Time; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data; D014942:Workers' Compensation / Q000706:statistics & numerical data* / Q000639:trends