Spinal rehabilitation by work tolerance based on objective physical capacity assessment of dysfunction. A prospective study with control subjects and twelve-month review.

A work tolerance program was used for rehabilitation treatment of 45 patients with spinal dysfunction. Patients entering the treatment group were prospectively evaluated by objective physical capacity assessment (PCA). Treatment patients averaged 4 weeks of three, one half day sessions per week. These patients were compared with a control group of 33 patients who did not participate in the rehabilitation program but were evaluated by PCA. A telephone review of all patients in each group was carried out at 6- and 12-month follow-up. Results demonstrated that 78% of the rehabilitation treatment group were discharged with an improved functional work capacity. Most importantly, at 6-month follow-up, 73.0% of patients in the treatment group were productively working while only 38% of control group patients were actively employed. In addition, 84.4% showed an improvement in spinal range of motion. The subjective pain scale ratings of these treatment patients demonstrated only 44.4% decreased pain, while 51.1% stayed the same, and two patients increased discomfort. Further medical diagnostics or intervention was required in 24.4% of treatment patients. These findings definitely show that a spinal rehabilitation work-tolerance program based on objective measurement will enhance an increased rate of return to productive employment activity. There is poor correlation of subjective pain assessment when compared to objective PCAs. Therefore, recommendations of patients for return-to-productive work should be based pain ratings. When adjusted for nonselection patients, the authors community-based hospital program showed similar results to other programs. The work tolerance and rehabilitation program in Concord, New Hampshire, demonstrated a significant cost-effective approach; being less expensive, less time-consuming, and less psychologically oriented.