SF-36 health status of workers compensation cases with spinal disorders

Abstract

Background context: Poorer outcomes of treatment are reported in patients with spinal disorders who receive workers compensation. The reason for their suboptimal outcomes is unclear. No study has examined the relationship between workers compensation and the Short Form Health Survey (SF-36) health status of patients with spinal disorders.

Purpose: To compare the self-perceived health status of spinal disorder patients receiving workers compensation with those not receiving workers compensation.

Study design/setting: A cross-sectional study on 18,389 patients who were evaluated in the 28 centers comprising the National Spine Network.

Patient sample: The study data were derived from patients when first evaluated for back or neck pain between January 1998 and April 2000.

Outcome measures: The outcome measures used were the eight individual and two component scores of the SF-36.

Methods: All first-visit patients enrolled in the National Spine Network from January 1998 to April 2000 were reviewed. Eight individual scores and two component scores of the SF-36 were compared.

Results: Of the 18,389 patients, 1,535 (8%) were receiving workers compensation. Bivariate analyses showed all eight individual scores, and two summary scores of the SF-36 were significantly lower ( p<.0001) in patients receiving workers compensation. After controlling for confounding covariates, workers compensation status was a significant predictor of lower SF-36 scores for General Health ( p<.0001), Physical Functioning ( p<.0001), Role Physical ( p<.01), Social Functioning ( p<.05), and Mental Health ( p<.05).

Conclusions: Workers compensation status is associated with poorer physical and mental health of patients with spinal disorders. Because the workers compensation group is younger, has a shorter duration of symptoms, and fewer comorbid medical problems, the lower SF-36 scores most likely reflect psychological factors and not ill health per se. The lower SF-36 scores may also reflect premorbid personality differences in the workers compensation patients, compared with those not receiving workers compensation. SF-36 is a validated tool that can be used to objectively identify the patient at risk for delayed recovery. Future treatment protocols should pay special attention to improve the health-related quality of life, especially general health and physical functioning of spinal patients receiving workers compensation.

Introduction

Spinal disorders have a profound effect on the workforce and the health-care resources available 1, 2. The socioeconomic burden of spinal disorders is steadily increasing. Studies have indicated that 80% of the population experience back pain during their active lives [3]. Recovery from various spinal conditions depends not only on physical factors, but also on psychological factors [4]. Patients receiving compensation are more likely to be influenced by psychological factors [5], thus delaying recovery from back pain [6]. Workers compensation status may be associated with later return to work 5, 7, 8, 9, although this statement is disputed by some [10].

Workers compensation and litigation negatively affect the postrehabilitation prognosis for chronic back pain [11]. It has been reported that active workers compensation and litigation issues are associated with poor operative management results for chronic back pain in adults with low-grade spondylolisthesis [12].

The physical and mental health status of workers compensation patients evaluated for spinal problems have historically received little attention [13]. Patients' perception of their health status is becoming increasingly important in outcomes research [14]. Assessment of the health status of patients receiving workers compensation may allow identification of patients at higher risk of chronicity and absenteeism from work.

The Short Form Health Survey (SF-36) [15] measures health-related qualities of life. It has been recommended for spine research because of its brevity, psychometric properties, and wide clinical use with patients who have other chronic medical conditions 16, 17. The ease of use and interpretability of the SF-36 questionnaire shows that it can be a useful adjunct in the assessment of patients with low back pain [17].

The objective of our study is to compare the SF-36 health status of spinal disorder patients receiving workers compensation with those not receiving workers compensation. We hypothesize that workers compensation cases with spinal disorders have significantly lower SF-36 scores.