Risk Factors For Functional Restoration Non-completion

Abstract

Previous studies have shown that the one-year outcomes after an interdisciplinary functional restoration program for patients with chronic disabling occupational disorders vary significantly between those who complete the program and those who prematurely drop-out. Non-completers are 9.7 times less likely to return-to-work at any time, and are 7 times less likely to retain work at one year, relative to those who complete the program. Non-completers are also 7 times more likely to have post-rehabilitation surgery to the original injured area, while also displaying higher levels of healthcare utilization. The present study focuses on identifying the risk factors for non-completion of a functional restoration program for these chronic patients. This was a prospective cohort study of consecutive patients undergoing functional restoration treatment in a regional rehabilitation referral center. The sample consisted of 3,052 consecutive patients, classified as either completers (C group, N= 2,367) or non-completers (NC group, N= 685), who entered a functional restoration program. The measures used included medical evaluations, demographic data, DSM psychiatric diagnoses, the MMPI, and validated questionnaires evaluating pain, depression and occupational factors. Patients were admitted to a comprehensive interdisciplinary functional restoration program which provides medical and psychosocial support, along with quantitatively-directed exercise and disability management. A logistic regression analysis was utilized to further assess the significant univariate factors found to be associated with non-completion status. The findings revealed that patients who did not complete the program had a longer duration between injury and admission to treatment, a higher score on the MVAS, and were less likely to be working at the time of admission to treatment. Furthermore, patients who were opioid dependent were 1.5 times more likely to drop out of rehabilitation, and patients diagnosed with a socially problematic cluster B Personality Disorder, especially Borderline, were 1.6 times more likely to drop out. Although some risk factors associated with program non-completion may be addressed in treatment, socially maladaptive personality disorders, long-neglected disability and chronic opioid dependence are major barriers to successful treatment completion and social re-integration.