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Integrated Case Management for Work-Related Upper-Extremity Disorders: Impact of Patient Satisfaction on Health and Work Status

Feuerstein, Michael PhD, MPH; Huang, Grant D. MPH, PhD; Ortiz, Jose M. MD, MPH; Shaw, William S. PhD; Miller, Virginia I. MD; Wood, Patricia M. RN, COHN-S, CCM

Journal of Occupational and Environmental Medicine: August 2003 - Volume 45 - Issue 8 - p 803-812
doi: 10.1097/01.jom.0000079091.95532.92

Compare the effects of integrated case management and usual care on patient satisfaction in employees with work-related upper extremity disorder (WRUED), and consider the implications of higher levels of satisfaction.Describe those patient-related and work-related factors that predict the severity of upper limb symptoms and the degree of functional limitation 6 and 12 months after intervention.Enumerate the factors influencing the interval before return to work in employees with WRUED who are managed by traditional or integrated case management. An integrated case management (ICM) approach (ergonomic and problem-solving intervention) to work-related upper-extremity disorders was examined in relation to patient satisfaction, future symptom severity, function, and return to work (RTW). Federal workers with work-related upper-extremity disorder workers’ compensation claims (n = 205) were randomly assigned to usual care or ICM intervention. Patient satisfaction was assessed after the 4-month intervention period. Questionnaires on clinical outcomes and ergonomic exposure were administered at baseline and at 6- and 12-months postintervention. Time from intervention to RTW was obtained from an administrative database. ICM group assignment was significantly associated with greater patient satisfaction. Regression analyses found higher patient satisfaction levels predicted decreased symptom severity and functional limitations at 6 months and a shorter RTW. At 12 months, predictors of positive outcomes included male gender, lower distress, lower levels of reported ergonomic exposure, and receipt of ICM. Findings highlight the utility of targeting workplace ergonomic and problem solving skills.

From the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Feuerstein, Dr Huang); Department of Preventive Medicine & Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Feuerstein, Dr Huang, Dr Ortiz); Georgetown University Medical Center, Washington, DC (Dr Feuerstein); Liberty Mutual Center for Disability Research, Hopkinton, Massachusetts (Dr Shaw); and Office of Workers Compensation Programs, US Department of Labor, Washington, DC (Dr Miller, Ms Wood).

Address correspondence to: Michael Feuerstein, PhD, MPH., Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814; e-mail address:

The opinions and assertions contained herein are the private views of the authors and are not to be construed as being official or as reflecting the views of the Uniformed Services University of the Health Sciences, the Department of Defense, or the Department of Labor.

Michael Feuerstein has no commercial interest related to this article.

©2003The American College of Occupational and Environmental Medicine