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Journal of Bone and Joint Surgery, 1972;54:1593-1611.
© 1972 by The Journal of Bone and Joint Surgery, Inc

Industrial Injuries of the Back and Extremities

COMPREHENSIVE EVALUATION-AN AID IN PROGNOSIS AND MANAGEMENT: A STUDY OF ONE HUNDRED AND EIGHTY PATIENTS

RODNEY K. BEALS M.D.1 and NORMAN W. HICKMAN PH.D.1

1 From the Division of Orthopedics, University of Oregon Medical School, and The Psychology Center, Portland

Comprehensive evaluation and follow-up of a group of 180 industrially injured patients and a group of non-injured workers were carried out to ascertain the extent to which psychological, vocational, physical and other factors influenced the return to work of the injured patients. Significant differences were demonstrated in the psychological posture of back-injured, extremity-injured, and non-injured industrial workers. This study indicated that physical and psychological disability play an important role in the return to work of both extremity-injured and back-injured patients. Although a significant number of patients returned to work two or more years after injury, there was a general relationship between the duration of non-employment and the probability of return to work. In predicting return to work of the back-injured patient, psychological ratings by psychologists were superior to those made by physicians.

These studies document the importance of psychological evaluation for optimum rehabilitation effort and suggest that the whole man concept is a useful, and perhaps necessary, consideration in the rehabilitation of the industrially injured workman. We believe that psychological evaluation is of value for patients who have failed to respond to usual therapy and in those being considered for spine fusion. Such evaluation is also useful in predicting the need for vocational retraining.

Although the population represented in this study is a distinctive group, it is not unique. There are a large number of patients who exhibit similar characteristics. It seems unlikely that the concepts illustrated in this study are confined to the industrially-injured worker on compensation. They undoubtedly apply to other patients as well. Additional studies of the various factors influencing return to work following injury are needed.


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