Atlas Steven J, Tosteson Tor D, Hanscom Brett, Blood Emily A, Pransky Glenn S, Abdu William A, Andersson Gunnar B, Weinstein James N
General Medicine Division, Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Spine (Phila Pa 1976). 2007 Aug 15;32(18):2019-26. doi: 10.1097/BRS.0b013e318133d69b.
Combined analysis of 2 prospective clinical studies.
To identify socioeconomic characteristics associated with workers' compensation in patients with an intervertebral disc herniation (IDH) or spinal stenosis (SpS).
Few studies have compared socioeconomic differences between those receiving or not receiving workers' compensation with the same underlying clinical conditions.
Patients were identified from the Spine Patient Outcomes Research Trial (SPORT) and the National Spine Network (NSN) practice-based outcomes study. Patients with IDH and SpS within NSN were identified satisfying SPORT eligibility criteria. Information on disability and work status at baseline evaluation was used to categorize patients into 3 groups: workers' compensation, other disability compensation, or work-eligible controls. Enrollment rates of patients with disability in a clinical efficacy trial (SPORT) and practice-based network (NSN) were compared. Independent socioeconomic predictors of baseline workers' compensation status were identified in multivariate logistic regression models controlling for clinical condition, study cohort, and initial treatment designation.
Among 3759 eligible patients (1480 in SPORT and 2279 in NSN), 564 (15%) were receiving workers' compensation, 317 (8%) were receiving other disability compensation, and 2878 (77%) were controls. Patients receiving workers' compensation were less common in SPORT than NSN (9.2% vs. 18.8%, P < 0.001), but patients receiving other disability compensation were similarly represented (8.9% vs. 7.7%, P = 0.19). In univariate analyses, many socioeconomic characteristics significantly differed according to baseline workers' compensation status. In multiple logistic regression analyses, gender, educational level, work characteristics, legal action, and expectations about ability to work without surgery were independently associated with receiving workers' compensation.
Clinical trials involving conditions commonly seen in patients with workers' compensation may need special efforts to ensure adequate representation. Socioeconomic characteristics markedly differed between patients receiving and not receiving workers' compensation. Identifying the independent effects of workers' compensation on outcomes will require controlling for these baseline characteristics and other clinical features associated with disability status.
两项前瞻性临床研究的联合分析。
确定与椎间盘突出症（IDH）或椎管狭窄症（SpS）患者获得工伤赔偿相关的社会经济特征。
很少有研究比较患有相同基础临床疾病的工伤赔偿接受者和非接受者之间的社会经济差异。
从脊柱患者预后研究试验（SPORT）和基于国家脊柱网络（NSN）实践的预后研究中确定患者。在NSN中符合SPORT纳入标准的IDH和SpS患者被确定。在基线评估时关于残疾和工作状态的信息被用于将患者分为三组：工伤赔偿组、其他残疾赔偿组或工作合格对照组。比较了临床疗效试验（SPORT）和基于实践的网络（NSN）中残疾患者的入组率。在控制临床状况、研究队列和初始治疗指定的多因素逻辑回归模型中确定基线工伤赔偿状态的独立社会经济预测因素。
在3759名符合条件的患者中（SPORT组1480名，NSN组2279名），564名（15%）接受工伤赔偿，317名（8%）接受其他残疾赔偿，2878名（77%）为对照组。接受工伤赔偿的患者在SPORT中比在NSN中更少见（9.2%对18.8%，P<0.001），但接受其他残疾赔偿的患者比例相似（8.9%对7.7%，P = 0.19）。在单因素分析中，许多社会经济特征根据基线工伤赔偿状态有显著差异。在多因素逻辑回归分析中，性别、教育水平、工作特征、法律行动以及对非手术工作能力的期望与获得工伤赔偿独立相关。
涉及工伤赔偿患者常见疾病的临床试验可能需要特别努力以确保有足够的代表性。接受和未接受工伤赔偿的患者之间社会经济特征明显不同。确定工伤赔偿对预后的独立影响将需要控制这些基线特征以及与残疾状态相关的其他临床特征。
