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Predictors of Vocational Prognosis After Herniated Lumbar Disc: A Two-Year Follow-Up Study of 2039 Patients Diagnosed at Hospital

Jensen, Lone Donbæk, MD*; Frost, Poul, MD, PhD*; Schiøttz-Christensen, Berit, MD, PhD; Maribo, Thomas, PT, MHS; Christensen, Michael Victor, MA*; Svendsen, Susanne Wulff, MD, PhD§

doi: 10.1097/BRS.0b013e3181ef6243
Health Services Research
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Study Design. A register study with 2 years of follow up.

Objective. To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD).

Summary of Background Data. There is sparse information about vocational prognosis among HLD patients diagnosed at hospital.

Methods. We followed all in- and outpatients diagnosed with HLD at a Danish University Hospital 2001 to 2005 eligible for the labor market in the Danish National Register on Public Transfer Payments (n = 2039). Clinical data were obtained from the Danish National Patient Register. The outcome measure was unfavorable vocational prognosis defined as less than 40 weeks of employment within the second year after hospital contact. Cox proportional hazards models were used.

Results. Altogether 41.8% had an unfavorable vocational prognosis. The outcome was associated with unskilled work Hazard Ratio (HR) 2.1 (95% confidence interval [CI] = 1.5–2.8), skilled work HR 1.9 (CI = 1.3–2.7), and semi academic work HR 1.5 (CI = 1.1–2.0) as compared with academic work and less than 40 weeks of employment within year two before hospital contact HR 2.1 (CI = 1.9–2.5). Further negative prognostic factors were lumbar fusion alone HR 1.4 (CI = 1.1–1.8) and in combination with discectomy HR 1.6 (CI = 1.2–2.2) as compared with nonsurgical treatment, ethnicity other than Danish HR 1.55 (CI = 1.2–1.8), and female gender HR 1.2 (CI = 1.1–1.4). Discectomy, age, and year of inclusion were not associated with the outcome.

Conclusion. The risk of an unfavorable vocational prognosis after hospital contact for HLD was substantial. Nonacademic work and less than 40 weeks of employment within year two before hospital contact were the strongest prognostic factors, but also lumbar fusion alone and in combination with discectomy, ethnicity, and gender had a negative influence. There seems to be a need for actions addressing these patient categories to avoid long-term sick leave and premature withdrawal from the labor market.

In a register study with 2 years of follow up including 2039 herniated lumbar disc patients, we found a substantial risk of an unfavorable vocational prognosis. Nonacademic work, less than 40 weeks of employment within year two before hospital contact, lumbar fusion alone or in combination with discectomy, ethnicity, and female gender were negative prognostic factors.

*From the Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Denmark

Aarhus Rheumatology Clinic, Denmark;

Department of Physical Therapy and Occupational Therapy, Aarhus University Hospital, Denmark; and

§Department of Occupational Medicine, Danish Ramazzini Center, Herning Hospital, Denmark

Address correspondence and reprint requests to Lone Donbæk Jensen, MD, Danish Ramazzini Center, Department of Occupational Medicine, Aarhus University Hospital, Noerrebrogade 42, Building 2C, DK-8000 Aarhus C, Denmark; E-mail: lonjesen@rm.dk

Acknowledgement date: February 5, 2010. First revision date: May 14, 2010. Second revision date: June 18, 2010. Accepted date: June 21, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.