Abstract
Return to work is used routinely to define successful back pain treatment. This study examined how the patient and three professional groups defined success for each of five categories of patients: not sponsored and working, sponsored and working, sponsored on modified duty, sponsored and off work for less than 10 weeks, and sponsored and off work for more than 10 weeks. The groups sampled were treating staff (n = 98), referring physicians (n = 98), third-party sponsors (n = 133), and patients (n = 648) representing all five patient categories. Each group provided a priority ranking for six objectives of treatment: Return to Work, Pain Control, Functional Improvement, Increased Strength and Range of Movement, Positive Attitude Shift, and Acquired Knowledge. The results indicated that the work status of the patient had a significant effect on the ranking of objectives by the treating staff and third-party sponsors. Physicians and patients considered pain control most important regardless of the patient category. Success in back pain rehabilitation is defined by different criteria. The determination of successful outcome must consider the patient's circumstances and acknowledge the perspective of the individual who is defining success.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Frymoyer JW, Cats-Baril WL. An overview of the incidence and costs of low back pain.Orthop Clin North Am 1991; 22: 263–271.
Frymoyer JW. Medical progress. Back pain and sciatica.New Eng J Med 1988; 318: 291–300.
Kelsey JL, White AA. Epidemiology and impact of low back pain.Spine 1980; 5: 133–142.
Spitzer WO, LeBlanc Fe, Dupuis M. Scientific approach to the assessment and management of activity-related spinal disorders.Spine 1987; 12(Suppl): S1–59.
Turk DC, Rudy TE, Sorkin BA. Neglected topics in chronic pain treatment outcome studies: Determination of success.Pain 1993; 53: 3–16.
Fredrickson BE, Triel PM, VanBeveren P, Yuan HA, Baum G. Rehabilitation of the patient with chronic back pain: A search for outcome predictors.Spine 1988; 13: 351–353.
Guck TP, Skultety FM, Meilman PW, Dowd ET. Multidisciplinary pain center follow up study: Evaluation with a no-treatment control group.Pain 1985; 21: 295–306.
Malec J, Cayner JJ, Harvey RF, Timming RC. Pain management: Long term follow up of an inpatient program.Arch Phys Med Rehabil 1981; 62: 369–372.
Mayer TG, Gatchel RJ, Kishino N, Keeley J, Mooney V. Objective assessment of spine function following industrial injury: A prospective study with comparison group and one year follow up.Spine 1985; 10: 482–493.
Mayer TG, Gatchel RJ, Mayer H, Kishino N, Keeley J, Mooney V. A prospective two year study of functional restoration in industrial low back injury: An objective assessment procedure.JAMA 1987; 258: 1763–1767.
Parris WCV, Jamison RN, Vasterling JJ. Follow up study of a multidisciplinary pain center.J Pain Sympt Manag 1987; 2: 145–151.
Roberts AH, Reinhardt L. The behavioral management of chronic pain: Long term follow up with comparison groups.Pain 1980; 8: 151–162.
Harvey JT, Chong JP, Neufeld VR, Sackett AL, Oates MJ. Ranking clinical problems and ocular diseases in ophthamology: An innovative approach to curriculum design.Can J Ophthamol 1988; 23: 255–258.
Brattberg G. Priority setting with regard to placement on waiting list to a pain clinic.Scand J Soc Med 1988; 16: 173–178.
Dixon J, Welch HG. Priority setting: Lessons from Oregon.Lancet 1991; 337: 891–894.
Naylor CD, Baigrie RS, Goldman BS, Cairns JA, Beanlands DS, Berman N, Borts D, Fitchett DH, Hao A, Hess A, Hughes W, Swain J, Tinmouth A, Gunstensen J, Lichtenstein SV, Salter D, Weisel RD, Anderson GM, Basinski A, Lomas J. Assigning priority to patients requiring coronary revascularization: Consensus principles from a panel of cardiologists and cardiac surgeons.Can J Cardiol 1991; 7: 207–213.
McMahon LF. A critique of the harvard resource-based relative value scale.Am J Pub Health 1990; 80: 793–809.
Rudy TE, Turk DC, Brena SF. Differential utility of medical procedures in the assessment of chronic pain patients.Pain 1988; 34: 53–60.
Hazard RG, Haugh LD, Green PA, Jones PL. Chronic low back pain: The relationship between patient satisfaction and pain, impairment, and disability outcomes.Spine 1994; 19: 881–887.
Strupp HH, Hadley SW. A tripartite model of mental health and therapeutic outcome.Am Psychol 1977; 32: 187–196.
Colvin DF, Bettinger R, Knapp R, Pawlicki R, Zimmerman J. Characteristics of patients with chronic pain.South Med J 1980; 73: 1020–1023.
Fitzpatrick RM Bury M, Frank AO, Donnelly T. Problems in the assessment of outcome in a back pain clinic.Int Disabil Stud 1987; 9: 161–165.
Carosella AM, Lackner JM, Feuerstein M. Factors associated with early discharge from a multidisciplinary work rehabilitation program for chronic low back pain.Pain 1994; 57: 69–76.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Melles, T., McIntosh, G. & Hall, H. Provider, payor, and patient outcome expectations in back pain rehabilitation. J Occup Rehab 5, 57–69 (1995). https://doi.org/10.1007/BF02109910
Issue Date:
DOI: https://doi.org/10.1007/BF02109910