Employees with comp claims have worse outcomes after rotator cuff surgery

Injured employees with workers' compensation claims have worse outcomes after receiving rotator cuff surgery, according to a study.

The study, by researchers from The Warren Alpert Medical School of Brown University in Providence, R.I., examined 125 patients -- including 39 with workers' comp claims -- who underwent unilateral primary repair of a chronic rotator cuff tear. The individuals were studied and evaluated one year after the surgery, prior to the settlement of any claims.

According to the researchers, outcomes were assessed using different methods, including a simple shoulder test; the Disabilities of the Arm, Shoulder and Hand index; and three visual analog scales (shoulder pain, shoulder function, and quality of life).

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Researchers said that previous studies have demonstrated varying correlations between workers' comp status and the outcome of rotator cuff repair. However, according to the findings, none of those studies had accounted for potentially confounding factors with multivariable analysis.

The study, which was published in The Journal of Bone and Joint Surgery, found that individuals in the workers' comp group were significantly younger, had greater work demands, and had lower marital rates, education levels, and preoperative expectations for the outcome of treatment as compared with those in the non-workers' comp group. One year postoperatively, researchers said those patients reported worse performance on the simple shoulder test and had worse improvement on the Disabilities of the Arm, Shoulder and Hand index. According to the study, multivariable analysis controlling for age, sex, comorbidities, smoking, marital status, education, duration of symptoms, work demands, expectations, and tear size confirmed that workers' comp status was an independent predictor of worse Disabilities of the Arm, Shoulder and Hand index scores.

"The results of the present study support our hypothesis that patients with workers' compensation claims report worse outcomes, even after controlling for confounding factors," the researchers said.

Researchers said that although they don't yet know how a workers' comp claim affects the long-term outcome of rotator cuff repair, the findings have important societal implications.

"Shoulder disorders are very common and injuries are bound to occur at work," they said. "We strongly believe that the present study should not discourage clinicians from recommending indicated rotator cuff repair to workers' compensation patients. Rather, it should provide a framework for outcome evaluation for both patients and surgeons. In the future, our goal is to determine how to optimize the outcome of rotator cuff repair for all patients, including those with workers' compensation claims."

November 17, 2008

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