The effectiveness of a comprehensive work hardening program as measured by lifting capacity, pain scales, and depression scores

Abstract

Objective: The purpose of this pilot study was to examine the effectiveness of a four-week work rehabilitation program.

Method: Investigators conducted a retrospective chart review of 312 clients participating in the Work Evaluation and Rehabilitation Clinic (WERC) Program from 1994-2000. Only 196 charts were sufficiently complete to be included in the study. Of these 196 prospective clients, 166 began the WERC program and 141 completed the program and were included in the database. Data were gathered from the initial history and evaluations conducted upon admission to the program and from the final evaluation conducted at the time of discharge. Demographic information was recorded. Data from the following assessments were collected: pre- and post-scores for subjective measures of pain using the Oswestry Back Pain Scale and a self-report of pain, the Beck Depression Inventory, the Waddell Sign, and pre- and post-scores of several physical performance tasks.

Results: Statistically significant post-test improvements were shown in all six outcome measures used in this study. A decrease in pain correlated with the Floor to Waist Lift test and with the Carrying An Object 20 Feet test. The percentage increase in Waddell's Sign correlated with a decrease in the Carrying An Object 20 Feet test. The Floor to Waist Lift test correlated with the Carrying an Object 20 Feet test. The Oswestry Test correlated with the Beck Depression Scale. There was no significant relationship found between diagnosis of back injury and Waddell's Sign, between either the Waddell's Sign and the Oswestry, or the Waddell's Sign and depression. A regression analysis revealed diagnosis, level of education, gender, and pre-injury work load as significant predictors of improvements made during the work program.

Conclusion: The program was shown to be effective as measured by the post-test improvements in all 6 performance tests. Although more research is warranted into the effectiveness of treatment for clients with chronic pain, it appears that there is a relationship between pain and physical performance and pain and depression in clients completing a work hardening program.