Development of a Screen for Predicting Clinical Outcomes in Patients With Work-Related Upper Extremity Disorders

• Published in: Journal of occupational and environmental medicine Vol. 42; no. 7; pp. 749 - 761
• Main Authors: Feuerstein, Michael, Huang, Grant D., Haufler, Amy J., Miller, Julie K.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-07-2000; Lippincott Williams & Wilkins, Inc
• Subjects: Adult; Analysis of Variance; Arm; Biological and medical sciences; Disability Evaluation; Diseases of the osteoarticular system; District of Columbia; Female; Humans; Juxtaarticular diseases. Extraarticular rhumatism; Logistic Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Musculoskeletal Diseases - diagnosis; Occupational Diseases - diagnosis; ORIGINAL ARTICLES; Prognosis; Prospective Studies; Risk Factors; District of Columbia; Human; Juxtaarticular disease; Nervous system diseases; Prognosis; Diseases of the osteoarticular system; Prediction; Occupational exposure; Stress; Functional capacity; Workload; Occupational environment; Symptomatology; Pain; Ergonomics; Upper limb; Predictive factor; Occupational medicine; Social support
• ISSN: 1076-2752; 1536-5948
• DOI: 10.1097/00043764-200007000-00011

This study prospectively examined the extent to which a set of medical, physical, ergonomi occupational psychosocial, and individual psychosocial variables would predict clinical outcome associated with a diverse set of work-related upper extremity disorders in recently diagnosed individuals. This investigation was designed to develop a tool for use in a clinical setting to assist in identifying patients at risk for poorer outcome. Outcome was measured at 1, 3, and 12 months after completing a baseline questionnaire. Outcome status was based on a median split of a standardized composite index (symptoms, function, workdays lost, and mental health). Logistic regression indicated that predictors of poorer outcome at 1 month were: upper extrem comorbidity (nsk ratio [RR], 1.58), pain seventy (RR, 1.45), ergonomie nsk exposure (RR, 1.07), low job support (RR, 1.03), and pain coping style (RR, 1.54). At 3 months, poorer outcome was predicted by: symptom severity (RR, 10.46), job stress (RR, 1.20), and pain copin style (RR, 1.98). The number of prior treatments/providers (RR, 1.77), past recommendation for surgery (RR, 6.43), and pain coping style were found to predict poorer outcome at 12 months. Sensitivity and specificity, respectively, for the models were 77.4% and 71.8% at 1 month, 80.6% and 82.4% at 3 months, and 80.6% and 83.3% at 12 months. The results indicate that baseline measures of ergonomie and psychosocial stress, pain severity, and pain coping style predict clinical outcome at shorter intervals, whereas number of past treatments/ providers, recommendation for surgery and pain coping style predict longer-term outcome. The resulting prognostic screen provides a simple tool that assesses the multidimensional nature of work-related upper extremity disorders and predicts clinical outcome. Furthermore, the findings suggest the importance of early intervention that addresses both physical and psychosocial Stressors at work. Specific recommendations to reduce the impact of observed risk factors are discussed.