Clinician-patient agreement about the work disability problem of patients having persistent pain: why it matters.

BACKGROUND

Studies from different fields documenting the differences between clinicians' and workers' representations have not elucidated where the differences exist or how they can be resolved.

PURPOSE

To define and describe scenarios depicting the differences between clinical judgment, workers' representations about their disability and clinicians' interpretations of these representations.

METHODS

A multiple case-study design was used. Semi-structured prospective interviews were conducted at four points in time, with five clinicians managing 12 cases of workers having persistent pain and participating in an evidence-based work rehabilitation program.

RESULTS

Four scenarios depicting differences in representations were found, but not all the differences necessarily had a negative impact on the program outcomes. For the clinicians, clear identification of the problem was important to allow for the use of concrete, pragmatic strategies. For the workers, congruence between the proposed strategy and their representations was crucial.

CONCLUSION

During rehabilitation, the objectives must be acceptable to both parties or the proposed strategy must, at least, make sense to the patient.