Abstract
Timely intervention and recovery is beneficial to patients with chronic disabling
occupational musculoskeletal disorders. Therefore, a surgical option process was developed
for use in a functional restoration program (FRP) to allow chronic disabling occupational
musculoskeletal disorder patients who were undecided about elective orthopedic surgery
to participate in interdisciplinary rehabilitation, rather than suspending treatment,
until the surgical option could be resolved. A consecutive cohort of 295 chronic disabling
occupational musculoskeletal disorder patients with an unresolved surgical option
was admitted to an FRP and their surgical preference at FRP midpoint was determined.
The majority of patients declined surgery (n = 164) and were invited to complete the
FRP. The remainder elected to pursue surgery and either underwent surgery (n = 43)
or had their surgical request denied (n = 38). In the post-FRP year, only .8% of patients
reversed their original decision and underwent surgery. Patients whose surgical preferences
were accommodated (ie, the declined-surgery/underwent-surgery groups) demonstrated
significant psychosocial improvement and excellent socioeconomic outcomes, which were
similar to those of FRP patients without a surgical option. Patients whose request
for surgery was denied had poorer outcomes than the other groups, but still outperformed
FRP dropouts. This suggests that the addition of a formal surgical option process
to an interdisciplinary FRP facilitated the surgical decision-making process and helped
prevent delayed recovery.
Perspective
This study introduces a surgical option process to improve outcomes for patients with
chronic disabling occupational musculoskeletal disorders who are undecided about elective
orthopedic surgery. The addition of a surgical option process to interdisciplinary
rehabilitation may resolve surgical indecision, improve outcomes, promote psychosocial
recovery, and facilitate progression to Maximum Medical Improvement.
Key words
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Article info
Publication history
Accepted:
September 20,
2013
Received in revised form:
August 9,
2013
Received:
May 15,
2013
Footnotes
The writing of this manuscript was supported in part by Grant 1K05-MH-71892 from the National Institutes of Health, which focuses on evidence-based assessment and treatment of musculoskeletal pain and the monitoring of valid outcomes.
No conflicts of interest were reported by any of the authors.
Identification
Copyright
© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
