title: Does patient-reported insomnia improve in response to interdisciplinary functional restoration for chronic disabling occupational musculoskeletal disorders?
abstract: METHODS
  An analysis of prospectively collected data.
  
  
  OBJECTIVE
  To evaluate how patient-reported insomnia, in patients with chronic disabling occupational musculoskeletal disorders (CDOMDs), responds to a functional restoration program (FRP), and to investigate the relationships among insomnia, psychosocial factors, medication use, and post-FRP socioeconomic outcomes.
  
  
  BACKGROUND
  Insomnia is commonly reported by patients with chronic pain.
  
  
  METHODS
  A consecutive sample of 262 patients with predominant chronic spinal pain was assessed with the insomnia severity index (ISI) at program admission and discharge. Groups were formed on the basis of the ISI total scores, from no clinically significant insomnia to severe clinical insomnia (SCI). Patient-reported psychosocial measures were administered, medication information was collected, and ISI discharge score categories were compared with 1-year post-FRP socioeconomic outcomes. The Wilcoxon signed rank, repeated measures ANOVAs, ANOVAs and χ tests were performed.
  
  
  RESULTS
  The degree of clinical insomnia at admission significantly predicted program completion, P < 0.001. Mean ISI scores improved from admission (M = 17.2) to discharge (M = 10.6, P < 0.001), but a relatively high percentage of patients (36.6%) still reported moderate to severe insomnia symptoms at discharge. The prevalence of SCI decreased by 18.4%, but this remaining group still reported more pain, disability, and depressive symptoms, and demonstrated more use of opioids, sedatives, and antidepressants (P ≤ 0.01), compared with the other insomnia groups at discharge. One year later, only 56% of the patients with severe insomnia at discharge had retained work, whereas 71% to 93% of those with lesser sleep disturbance were still working (P < 0.001). Those with SCI at discharge were 10.4 times less likely to be working than those without clinically significant insomnia.
  
  
  CONCLUSIONS
  Although insomnia improved for the majority of patients with chronic disabling occupational musculoskeletal disorder, a relatively high percentage continued to report clinically significant insomnia at FRP discharge. Patients with SCI reported more pain, depression, and disability, used more medication, and had poorer work outcomes 1-year post-FRP.
  
  
  METHODS
  2.
authors.affiliation: *PRIDE Research Foundation, Dallas, TX †Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; and ‡Department of Psychology, College of Science, the University of Texas at Arlington, Arlington, TX.
authors.forename: Sali
authors.initials: S
authors.lastname: Asih
authors.forename: Randy
authors.initials: R
authors.lastname: Neblett
authors.forename: Tom G
authors.initials: TG
authors.lastname: Mayer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gatchel
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications / Q000534:rehabilitation*; D009784:Occupational Diseases / Q000453:epidemiology*; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014937:Work; D014942:Workers' Compensation / Q000706:statistics & numerical data