Predicting Clinical Outcomes and Lost Work in Patients with Work - Related Upper Extremity Disorders

Ti~leofThesis: Predicting Clinical Outcomes and Lost Work in Patients With Work-Related Upper Extremity Disorders. Julie Kay Mil1er~ Doctor of Philosophy~ 1998 Thesis directed by: Michael Feuerstein, Ph.D. Professor Department ofMedical and Clinical Psychology Department ofPreventive Medicine and Biometrics Althougb past research bas suggested that a wide range ofcIemograpbic, occupational, physiological., biomecbanical, aud psychosocial factors may be important in work-disabled low back pain patients, the influence ofa combination ofthese factors on clinical outcomes aoo lost work in patients with work...reJated upper extremity disordel'S has rarely been studied. The present study utilized a prospective multifilctorial approach to predict cliuical and work outcomes in a recently diagnosed sample ofwork-related upper extremity patients. The objectives were twO""fold: First, to develop and validate a comprehensive assessment instrument to be utilized by health care professionals to assess and predict clinical outcomes in patients at increased risk for chronic long-term disability. Second, the study attempted. to de.termine whether a multivariate model wbidl CORSiders demographics aad ocx:upational status., mediea.l status, painlsymptoms, aetivity/fimctioo, work. demandslwork characteristics, work environment/work perceptions, support, and mental health measures determined in the early stages ofa work-related upper extremity disorder is predictive ofclinical and work outcomes at one month post initial diagnosis. Fony-eight subjects were assessed via questionnaire and pincblgrip straJgth measurements no IDOl'e tban six weeks aft« their initial diagnncsis with a workrelated upper extremity disorder. Outcome measures ofdays lost work, paiolsymptonfi, aetivity/fimctioo, and meotaJ. health were complered one month after' baseline. MuItiwriate hierarchical repessioo. analyses were used to detamiDe tile relatioasbip ofpredictor variables to each oftile four outcomes. Results n,ticAted that IIUIIlbeI' oflost WGl'kdays was predicted by attmney c:omnltatioo, days missed work in the previous mootb, symptom severity, and high work support. PaiDlSymptoms were predicted by prior healtbcare trea1ment history, baseline symptom severity aDd fimctioo scores, and ergooomic sarcssors. Functioaal impairmeat was prectietal by prior health:are trea1ment history. SFbaseline fimctioo, and job stress. MCIJIa1 Health (distress) was predicted by badine meotaJ. health scores and symptom severity. Results support multidimeosioDal models ofwork-rdated upper extremity disordcn and associated work disability.