Predicting Future Loss of Work Capacity After Back SurgeryAbout one-quarter (25 per cent) of back patients who have a disc removed aren't able to go back to work -- even six months later. Who's at risk for this problem? If doctors can screen patients before surgery, they may be able to reduce this problem. Treatment early on might give patients what they need to avoid work loss.
To test for what are called predictive risk factors, researchers from the Netherlands studied adult workers who had a paid job before back surgery. All the patients had a problem called lumbrosacral radicular syndrome (LRS). This means a bulging disc was causing back and leg pain.
Patients were tested and took a survey one day before the operation. These measures were repeated three days after surgery and again six months later. Work-capacity (WC) was assessed using a self-report questionnaire. WC was calculated as a percentage of previous capacity before surgery. For example, a patient who worked 40 hours/week before the operation who can only work 20 hours now had a 50 per cent work capacity.
Results showed three factors that may predict reduced work capacity after surgery for LRS. The first is fear of movement or reinjury. The patients who are afraid to move because it might hurt or because they might reinjure themselves were less likely to return to work.
Second, patients with passive means of coping with pain had reduced work capacity. This includes patients who worry and avoid activity as their main ways of coping.
The third predictive risk factor for reduced work capacity was a higher physical work-load on the job and lower job satisfaction.
The authors conclude that most patients with LRS do get back to work full-time. Those who don't have cognitive-behavioral factors that keep them from doing so. These factors may be treatable.
Helping patients overcome their fears, improving fitness, and training them to handle different workloads may be the key. More studies are needed to find out what works best. The first step is the screening process to predict who might have these problems.
Jasper J. den Boer, et al. Reduced Work Capacity After Lumbar Disc Surgery: The Role of Cognitive-Behavioral and Work-Related Risk Factors. In Pain. December 2006. Vol. 126. No. 1-3. Pp. 72-78.
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