Return-to-Work
Many studies reporting on changes in physical activities have relied on patients’
self-reports. A more objective measure of function is RTW. There are a number of
caveats that need to be taken into consideration, however, when considering rates
of RTW. RTW may have little to do with the readiness of an individual to resume jobrelated
activities (85). For example, the mean duration of pain for patients treated at
MPRPs is 7 years (34), and someone who has been off of work for such a long period
may not have a job to which to return. Additionally, their skills may be outdated,
making return to their previous job difficult. Economic factors (e.g., the job market)
will also influence whether someone returns to gainful employment following treatment.
Finally, administrative decisions regarding appropriateness of RTW may be
primary, with little consideration given to the presence of the patients’ symptoms or
physical capacities. Furthermore, research does not report whether individuals are
returning to a full-time status or regular work duties versus more limited job functions.
These limitations, however, apply equally to all treatments; therefore, even
though there are significant limitations, RTW rates can be used to compare different
treatments.
RTW rates following lumbar surgery have been reported to be as low as 20%
(51). Examination of outcomes of lumbar surgery for worker compensation patients
reveal that none of the patients in the sample actually returned to work (86).
One recent study reported 50% RTW following radiofrequency facet joint denervation
for the treatment of low back pain (86). At first, this outcome seems quite
impressive; however, the group of patients treated with sham therapy showed almost
the identical rate of RTW. These sobering results underscore the necessity of developing
and using appropriate placebo treatments.
Studies of patients who have been implanted with SCSs suggest that from
5% to 40% eventually returned to work (51,53,87,88). One of the few studies of the
results of IDDS on RTW indicates that none of the patients (n =16) returned to gainful
employment (65). These outcomes can be compared to the RTW rates reported
for patients treated at MPRPs, which range from 48% to 65% (34).
The outcomes following treatment at MPRPs are quite impressive given the
long pain duration (mean =7 years) for treated patients (34). Two meta-analyses
(34,69) confirmed that the long-term effects on RTW for pain patients treated at
MPRPs were very positive and the results were superior to other active treatments.
Once again, using the cost-effectiveness formula mentioned earlier, it becomes
apparent that MPRPs are substantially more cost-effective if the criteria is RTW,
with MPRPs being 12 times more cost-effective than conventional medical care,