title: Does the economy affect functional restoration outcomes for patients with chronic disabling occupational musculoskeletal disorders?
abstract: OBJECTIVE
  To determine how the economy affects psychosocial and socioeconomic treatment outcomes in a cohort of chronic disabling occupational musculoskeletal disorder (CDOMD) patients who completed a functional restoration program (FRP).
  
  
  METHODS
  A cohort of 969 CDOMD patients with active workers' compensation claims completed an FRP (a medically-supervised, quantitatively-directed exercise progression program, with multi-modal disability management). A good economy (GE) group (n = 532) was released to work during a low unemployment period (2005-2007), and a poor economy (PE) group (n = 437) was released during a higher unemployment period (2008-2010). Patients were evaluated upon admission for demographic and psychosocial variables, and were reassessed at discharge. Socioeconomic outcomes, including work return and work retention 1 year post-discharge, were collected.
  
  
  RESULTS
  Some significant differences in psychosocial self-report data were found, but most of the effect sizes were small, so caution should be made when interpreting the data. Compared to the PE group, the GE group reported more depressive symptoms and disability at admission, but demonstrated a larger decrease in depressive symptoms and disability and increase in self-reported quality of life at discharge. The PE group had lower rates of work return and retention 1-year after discharge, even after controlling for other factors such as length of disability and admission work status.
  
  
  CONCLUSIONS
  CDOMD patients who completed an FRP in a PE year were less likely to return to, or retain, work 1-year after discharge, demonstrating that a PE can be an additional barrier to post-discharge work outcomes. A difference in State unemployment rates of <3% (7 vs. 5%) had a disproportionate effect on patients' failure to return to (19 vs. 6%) or retain (28 vs. 15%) work.
authors.affiliation: PRIDE Research Foundation, 5701 Maple Ave. #100, Dallas, TX, 75235, USA.
authors.forename: Meredith M
authors.initials: MM
authors.lastname: Hartzell
authors.forename: Tom G
authors.initials: TG
authors.lastname: Mayer
authors.forename: Randy
authors.initials: R
authors.lastname: Neblett
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Marquardt
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gatchel
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004467:Economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000191:economics / Q000534:rehabilitation*; D009784:Occupational Diseases / Q000175:diagnosis / Q000191:economics / Q000534:rehabilitation*; D011584:Psychology; D020127:Recovery of Function; D012050:Rehabilitation, Vocational / Q000191:economics / Q000379:methods; D062707:Return to Work / Q000191:economics / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014478:Unemployment / Q000706:statistics & numerical data; D014481:United States; D014942:Workers' Compensation / Q000191:economics*