In the January 20, 2016 JBJS prognostic study by Gornet et al., patients with Workers’ Compensation (WC) insurance coverage were compared to a group not covered by that insurance mechanism in regard to outcomes after cervical disc arthroplasty. Multiple studies have been published looking at WC coverage in relation to outcomes after many orthopaedic interventions, including spinal disease, fractures, and soft tissue injuries. The findings have generally identified worse outcomes in terms of pain relief, return to work, and function among WC-covered cohorts.
That was not the case in this analysis by Gornet et al. Only the number of days off before returning to work was different (significantly higher) for WC patients. There were no significant between-group differences in patient-reported outcomes, reoperation rates, complications, or the proportion of patients who returned to work.
I think we can gain some insight into the generally poorer reported outcomes for WC patients by considering that patients with higher functional demand employment experience greater stressors on their musculoskeletal systems. They also often have lower levels of education, which in turn can translate into less control over the work environment. I believe that it is the combination of these two factors that lead some WC patients to emphasize their pain symptoms and functional disability.
Rather than look askance at patients with WC coverage, I think we need to factor in these physical and work-disempowerment issues into our decision making and recommendations. If we do that, we might go beyond making sound clinical recommendations to suggest job retraining or additional classroom education so that the mechanical loads can be lessened and more empowerment at work can be obtained.
Marc Swiontkowski, MD