Differences in Clinically Important Physical Function Improvement in Workers' Compensation Population

Overview

Journal Int J Spine Surg

Date 2022 Feb 18

PMID 35177529

Authors

Elliot D K Cha

Conor P Lynch

Caroline N Jadczak

Shruthi Mohan

Cara E Geoghegan

Kern Singh

Affiliations

Soon will be listed here.

Abstract

Background: Patients receiving workers' compensation demonstrate a propensity for poorer postoperative outcomes. This study aims to determine rates of minimum clinically important difference (MCID) achievement in patients receiving workers' compensation following transforaminal lumbar interbody fusion (TLIF).

Methods: We retrospectively reviewed a prospective surgical database from 2015 to 2020 for primary, single-level TLIFs with posterior instrumentation for degenerative spinal pathologies. Visual analog scale (VAS) for back and leg, Oswestry Disability Index (ODI), 12-Item Short Form Physical Component Summary (SF-12 PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were collected pre- and postoperatively. Patients were separated by workers' compensation (WC) status. Propensity score matching was performed to account for differences in demographic characteristics. Postoperative improvements in patient-reported outcome measures (PROMs) were calculated using paired Student's test, and intergroup differences were determined by Mann-Whitney test. Achievement of MCID was determined using established values, and intergroup differences were assessed using analysis.

Results: A total of 121 patients were included in this study with 29 WC and 92 non-WC patients. The mean age was 53.5 years with the majority being men (63.6%) and nonobese (54.5%). WC patients demonstrated significantly poorer PROM values at all timepoints except for preoperative VAS back ( = 0.297) and leg ( = 0.475). Overall achievement of MCID was significantly lower for WC patients for VAS back ( = 0.040), ODI ( = 0.001), SF-12 PCS ( = 0.010), and PROMIS-PF ( = 0.039).

Conclusion: WC patients demonstrated poorer postoperative outcomes at multiple timepoints. Additionally, a significantly lower rate of MCID achievement for back pain, disability, and physical function was observed for WC patients.

Clinical Relevance: These results suggest that WC patients may require alternative preoperative counseling about realistic expectations for improvement following lumbar fusion.

Level Of Evidence: 3:

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