WHY DO PEOPLE WITH COMPENSABLE INJURIES HAVE POORER OUTCOMES THAN THOSE WITH NON COMPENSABLE INJURIES?

Transcription

1 WHY DO PEOPLE WITH COMPENSABLE INJURIES HAVE POORER OUTCOMES THAN THOSE WITH NON COMPENSABLE INJURIES? A Systematic Review Olufemi Adekeye Master of Public Health Medical College of Wisconsin Capstone Project May 2013

2 Abstract Compensable injuries have worse outcomes than non compensable injuries Psychological environment contributes to worse outcomes Multidisciplinary case management helps identify psychosocial factors Collaboration between professionals reduces disability

3 Introduction Claim closure faster for claimants seen by a physician than those seen by chiropractor Involvement of a lawyer in a case is associated with a delay in case closure and recovery time Claimants recover faster if compensation for pain and suffering is not available

4 Objectives Review literature on compensable and non compensable injuries Determine why compensable injuries have worse outcomes than non compensable injuries

5 Methods Literature Search PubMed Search Terms: Compensable and non compensable injuries 45 Articles returned Manual search for additional publications that did not appear in original search results

6 Literature Review:Results Patients receiving workers compensation reported worse functional status than the other patients, yet have similar clinical findings Receiving workers compensation linked to poor relief from symptoms and improvement in quality of life. Workers compensation patients reported longer duration of post operative pain and more days off work

7 Literature Review:Results Patients seeking or receiving compensation for chronic low back pain reported more pain, depression and disability Treatment recommendations and compliance not affected by compensation status Older age, female gender, and a diagnosis of carpal tunnel syndrome or back/neck sprain, predict longer duration of disability.

8 Literature Review:Results Compensable patients are more likely than non compensable patients to report moderate to severe disability Compensable patients less likely than non compensable patients to return to work or study Incidence of reported pain, disability, psychological disturbance, unemployment and length of time off work greater in compensable injuries

9 Literature Review:Results Workers compensation claims have worse outcomes following rotator cuff tears even after controlling for confounding factors Chronic pain patients receiving compensation reported more severe pain High abnormality and disability in patients with financial incentives despite less severe injuries

10 Literature Review:Results Social support has a protective health effect and assists people to recover from illness Unemployed people suffer worse physical and mental health and are unlikely to have strong support networks

11 Conclusion Limited data on why people with compensable injuries have poorer outcomes than those without compensation Most people with compensable injuries recover from their injuries and return to normal activities No single isolated cause has been identified for poorer health outcomes for compensable injuries A combination of factors leads to poorer health outcome

12 Conclusion Factors contributing to poor outcomes include: Psychosocial environment of the injured person Psychological vulnerability of the injured person Handling of case management by insurers Management of initial treatment. The type of compensation offered

13 Conclusion A multidisciplinary and early intervention approach to case management will help reduce long term disability Collaboration and cooperation between professionals of all fields involved in the case management (legal, medical etc) is essential Insurance companies should review their case management policies and procedures on case management.

14 References Compensable injuries and health outcomes. The Royal Australasian College of Physicians, Health Policy Unit Cassidy DJ, Carroll LJ, Cote P, et al. Effect of Eliminating Compensation for Pain and Suffering on the Outcome of insurance Claims for Whiplash Injury, New England Journal of Medicine, Vol.342, No.16, Apr 20, 2000,pp Butterfield PG, Spencer PS, Redmond N, Feldstein A, Perrin N. Low back pain: predictors of absenteeism, residual symptoms, functional impairment, and medical costs in Oregon workers' compensation recipients. Am J Ind Med 1998; 34: Auto injuries: claiming behavior and its impact on insurance costs. Oak Brook, Ill.: Insurance Research Council, September McKinney LA. Early mobilization and outcome in acute sprains of the neck. BMJ 1989; 299: Borchgrevink GE, Kaasa A, McDonagh D, Stiles TC, Haraldseth O, Lereim I. Acute treatment of whiplash neck sprain injuries: a randomized trial of treatment during the first 14 days after a car accident. Spine 1998; 23:25 31.

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16 References Rainville J, Sobel JB, Hartigan C, et al. The Effect of Compensation Involvement on the Reporting of Pain and Disability by Patients Referred for Rehabilitation of Chronic Low Back Pain, Spine, Vol. 22, No. 17, 1997, pp Cheadle A, Franklin G, Wolfhagen C, Savarino J, et al. Factors influencing the duration of work related disability: a population based study of Washington State workers' compensation. Am J Public Health February; 84(2): Gabbe BJ, Cameron PA, Willianson OD, Edwards ER, et al. The relationship between compensable status and long term patient outcomes following orthopaedic trauma. Med J Aust Jul 2; 187(1): Greenough CG, Fraser, RD. The effects of compensation on recovery from low back injury, Spine, Vol. 14, No. 9, 1989, pp Taylor VM, Deyo RA, Ciol M, et al. Surgical Treatment of Patients with Back Problems Covered by Workers compensation Versus Those with Other Sources of Payment, Spine, Vol. 21, No. 19, pp Henn RF, Kang L, Tashjian RZ, Green A. Patients with workers compensation claims have worse outcomes after rotator cuff repair. J Bone joint Surg Am Oct; 90(10):

17 References O Donnell ML, Creamer MC, McFarlane AC, Silove D, Bryant RA. Does access to compensation have an impact on recovery outcomes after injury? Med J Aust Mar 15;19 2(6): Turk DC, Okifuji A. Perception of Traumatic Onset, Compensation Status and Physical Findings: Impact on Pain Severity, Emotional Distress, and Disability in Chronic pain Patients, Journal of Behavioural Medicine, Vol. 19, No. 5, 1996, pp Mayou R. Accident Neurosis Revisited, British Journal of Psychiatry, Vol. 168, No. 4, April, 1996, pp McNaughton HK, Sims A, Taylor WJ. Prognosis for people with Back pain Under a No Fault 24 Hour Cover Compensation Scheme, Spine, Vol. 25, No. 10, 2000, pp Binder LM, Rohling ML. Money Matters: A Meta Analytic Review of the Effects of Financial Incentives on Recovery After Closed Head Injury, American Journal of Psychiatry, Vol. 153, No. 1, January 1996, pp Hirsch BT. Incentive Effects of Workers compensation, Clinical Orthopaedics and Related Research, Vol. 336, March 1997, pp

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