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Workers Compensation Patients Have Worse Pain, Function, and General Health after Rotator Cuff Repair

Authors: Ralph Frank Henn, MD New York NY

References: AAOS 2005

Abstract
A workers' compensation claim has a negative effect on the outcome of rotator cuff repair, even after controlling for confounding variables.

Previous studies have demonstrated varying correlations between workers' compensation (WC) status and the outcome of rotator cuff repair (RCR). However, no studies have formally accounted for potential confounding factors with multivariate analysis. We hypothesize that patients receiving WC have worse outcomes, even after controlling for confounding factors.

125 patients (39 WC) who underwent repair of a chronic rotator cuff tear by a single surgeon were studied prospectively and evaluated one year after surgery, prior to settlement of WC claims. Outcomes were assessed with the Simple Shoulder Test (SST), Disability of Arm Shoulder and Hand (DASH), three visual analogue scales (VAS) (shoulder pain, shoulder function, and quality of life) and the Short Form 36 (SF36).

WC patients were significantly younger and had lower marital rates, education level, preoperative SST scores, and SF36 physical function and social function scores (p ranges 0.002 to 0.04). One year postoperatively, WC patients reported worse performance on the SST, DASH, all VAS, and the SF36 (p ranges 0.007 to 0.05) and had worse improvement on the DASH, both shoulder VAS, and SF-36 pain (p ranges 0.006 to 0.038). Rigorous multivariate analysis controlling for age, sex, comorbidities, smoking, marital status, education, symptom duration, work demands, expectations, and tear size confirmed that WC was an independent predictor of worse SST, DASH, VAS, and SF-36 scores.

WC patients report worse outcomes, even after controlling for confounding factors. This study provides substantial further evidence that a WC claim can have a negative effect on the outcome of treatment.

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