(629) The Prediction of Chronic Pain Patient Intent, Discrepancy With Intent, And Discrepancy with Nonintent for Return to Work Following Pain Facility Treatment

Authors: DA Fishbain, University of Miami School of Medicine; H L Rosomoff, University of Miami School of Medicine; R B Cutler, University of Miami School of Medicine; T Khalil, Dept. of Industrial Engineering, University of Miami and Comprehensive Pain and Rehabilitation Center at South Shore Hospital; R Steele‐Rosomoff, University of Miami School of Medicine Objective: We have previously determined that intent to return to work following pain facility treatment is the strongest predictor for actual return to work. The purposes of this study were then the following: to identify variables predicting intent; to predict membership in the discrepant‐with‐intent group (those chronic pain patients (CPPs) who do intend to return to work but do not); and to predict membership in the discrepant‐with‐nonintent group (those CPPs who do not intend to return to work but do). Design: A total of 128 CPPs completed a series of rating scales and yes/no questions relating to their preinjury job perceptions and a question relating to intent to return to the same type of preinjury job following pain facility treatment. These CPPs were part of a grant study for prediction of return to work and therefore their work status was determined at 1, 3, 6, 12, 18, 24, and 30 months posttreatment. Preinjury job perceptions and other demographic variables were utilized using stepwise discriminant analysis to identify variables predicting intent, and predicting membership in the discrepant‐with‐intent and discrepant‐with‐nonintent groups. Results: Intent was predicted by (in decreasing order of probability): postinjury job availability variables, job characteristic variables, and a litigation variable. Discrepant with intent was predicted by (in decreasing order of probability): for the 1 month follow‐up time point, postinjury job availability variables, pain variables, a litigation variable, and a function perception variable and; for the final follow‐up time point, pain variables only. Discrepant with nonintent was predicted by (in order of decreasing probability): for the 1 month follow‐up time point, a job availability variable, a demographic variable, and a functional perception variable; and for the final follow‐up time point, a pain variable and a job availability variable. The percentage of CPPs correctly classified by each of these analyses was as follows: Intent 81.25%; discrepant with intent 87.01% (at 1 month follow‐up and 74.03% (final follow‐up); discrepant with nonintent 92.16% (at 1 month follow‐up) and 75.00% (final follow‐up). Conclusions: CPPs intentions of returning to their preinjury jobs are mainly determined by job availability and job characteristic variables, but surprisingly not by pain variables. However, the results with discrepant‐with‐intent and discrepant‐with‐nonintent groups indicate that actual return to work is determined by an interaction between job availability variables and pain variables, with pain variables predominating for long term outcome.