This study prospectively examined the extent to which a set of medical, physical,
ergonomic, occupational
psychosocial, and individual
psychosocial variables would predict clinical outcome associated with a diverse set of work-related
upper extremity disorders in recently diagnosed individuals. This investigation was designed to develop a tool for use in a clinical setting to assist in identifying patients at risk for poorer outcome. Outcome was measured at 1, 3, and 12 months after completing a baseline questionnaire. Outcome status was based on a
median split of a standardized composite index (
symptoms, function, workdays lost, and mental health).
Logistic regression indicated that predictors of poorer outcome at 1 month were:
upper extremity comorbidity (
risk ratio [RR], 1.58),
pain severity (RR, 1.45),
ergonomic risk exposure (RR, 1.07), low job support (RR, 1.03), and
pain coping style (RR, 1.54). At 3 months, poorer outcome was predicted by:
symptom severity (RR, 10.46), job stress (RR, 1.20), and
pain coping style (RR, 1.98). The number of
prior treatments/providers (RR, 1.77), past recommendation for
surgery (RR, 6.43), and
pain coping style were found to predict poorer outcome at 12 months.
Sensitivity and specificity, respectively, for the models were 77.4% and 71.8% at 1 month, 80.6% and 82.4% at 3 months, and 80.6% and 83.3% at 12 months. The results indicate that baseline measures of
ergonomic and
psychosocial stress,
pain severity, and
pain coping style predict clinical outcome at shorter intervals, whereas number of past treatments/providers, recommendation for
surgery and
pain coping style predict longer-term outcome. The resulting
prognostic screen provides a simple tool that assesses the multidimensional nature of work-related
upper extremity disorders and predicts clinical outcome. Furthermore, the findings suggest the importance of early intervention that addresses both physical and
psychosocial stressors at work. Specific recommendations to reduce the impact of observed
risk factors are discussed.
