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