Listening to injured workers: how recovery expectations predict outcomes--a prospective study

Abstract

Background: Rigorous evidence on factors affecting the prognosis of work-related soft-tissue injuries remains limited. Although shown to be important for a wide variety of clinical conditions, recovery expectations have rarely been assessed as prognostic factors for workers with soft-tissue injuries. We examined the predictive role of various measures of recovery expectations among workers with injuries resulting in time off work.

Methods: We identified a prospective cohort of 1566 injured workers shortly after they filed a claim for their injury with the Ontario Workers' Compensation Board (OWCB). They had soft-tissue injuries to the back or upper or lower extremities, had new, lost-time claims from May to November 1993 and were still off work at the time of the first interview. We interviewed participants by telephone within 3 weeks after the injury and measured their recovery expectations (perceptions regarding progress, expected change in condition, expected time until return to usual activities and expectations regarding return to usual job) along with other, potentially important prognostic factors. The primary outcome was total time receiving 100% wage-replacement benefits during the year following injury, obtained from OWCB administrative files. Self-reported measures of pain, health-related quality of life and functional status, obtained up to 4 times during the year following injury, were both independent predictors and secondary outcomes.

Results: The 4 measures of recovery expectations together explained one-sixth of the variation in time receiving benefits. All but expectations regarding return to usual job were individually predictive of time receiving benefits. Judging one's recovery as much better than expected resulted in a 30% (95% confidence interval [CI] 9%-46%) faster rate of stopping receiving benefits (and likely returning to work) compared with judging one's recovery as much worse than expected. Similarly, participants who expected to return to usual activities within 3 weeks had a 37% (95% CI 26%-47%) faster rate of stopping receiving benefits than those who responded "Don't know" to this question, and participants who stated that they were fully recovered or would get better soon had a 25% (CI 5%-40%) faster rate than those who thought they would never get or stay better. Positive recovery expectations were also associated with reductions in pain grade and improvement in functional status outcomes.

Interpretation: Expectations regarding recovery may provide useful information on the complex process of recovering from work-related soft-tissue injuries. For clinicians, patients' negative or uncertain expectations may indicate the need for further probing and intervention on psychosocial factors to facilitate recovery.

Fig. 1: Mean pain grade at baseline and during the year following injury for workers with soft-tissue injuries, as a function of expected time until return to usual activities (measured at baseline). Error bars represent 95% confidence intervals.