title: Prediction of failure to retain work 1 year after interdisciplinary functional restoration in occupational injuries.
abstract: OBJECTIVE
  To identify risk factors for work retention (a patients' ability to both obtain and retain employment) at 1 year after treatment for a chronic disabling occupational musculoskeletal disorder (CDOMD).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Consecutive patients undergoing interdisciplinary functional restoration treatment in a regional rehabilitation referral center.
  
  
  METHODS
  A sample of 1850 consecutive CDOMD patients, who were admitted to and completed a functional restoration program, were subsequently classified as work retention or nonwork retention at a 1-year posttreatment evaluation.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Measures, including medical evaluations, demographic and occupational data, psychosocial diagnostic evaluation, and validated measures of pain, disability, and depressive symptoms, were obtained at admission to, and discharge from, the program.
  
  
  RESULTS
  Using a multivariate logistic regression analysis, the following variables were found to be significant predictors of failure to retain work: older age (odds ratio [OR]=1.84; 95% confidence interval [CI], 1.33-2.54), female sex (OR=1.46; 95% CI, 1.09-1.94), nonworking status at discharge (OR=1.65; 95% CI, 1.11-2.45), extreme disability at admission (OR=1.46; 95% CI, 1.06-2.00), antisocial personality disorder (OR=2.11; 95% CI, 1.09-4.08), receipt of government disability benefits at admission (OR=2.28; 95% CI, 1.06-4.89), and dependence on opiate pain medications (OR=1.43; 95% CI, 1.02-2.00). The final model improved prediction by 75% over assigning all patients to the larger (work retention) group.
  
  
  CONCLUSIONS
  This study identified demographic, psychosocial, and occupational factors that were predictive of failure to retain work. These risk factors may be used to individualize treatment plans for CDOMD patients in order to provide optimal functional restoration.
authors.affiliation: PRIDE Research Foundation, Dallas, TX, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Brede
authors.forename: Tom G
authors.initials: TG
authors.lastname: Mayer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gatchel
mesh_terms: D000367:Age Factors; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000987:Antisocial Personality Disorder / Q000453:epidemiology; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009140:Musculoskeletal Diseases / Q000534:rehabilitation*; D060051:Occupational Injuries / Q000534:rehabilitation*; D010147:Pain Measurement; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012943:Social Security / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid