Nonphysical factors that affect work hardening success: a retrospective study.

The high cost of health care and limited information regarding the effects of work hardening have prompted a need to further study work hardening programs. The purpose of this study was to determine the success of a work hardening program that included physical, occupational, and psychological therapies, and to determine if there are nonphysical factors associated with successful work hardening. One hundred medical records of injured workers with low back pain and other musculoskeletal disorders were retrospectively reviewed. Factors examined included months of injury, education level, sex, race, presence of an attorney, prior surgery, pain behaviors, smoking, medication use, and diagnosis severity. Seventy-six percent of the subjects successfully completed the program, and 50% of the subjects were returned to work at discharge. Nonphysical factors that limited successful work hardening were presence of pain behaviors (p < .01), attorney representation (p < .01), McAndrews score above 70 (p < .05), and education less than high school (p < .05). The author concludes that the return to work rate for injured workers in this study is comparable to rates of previous studies and that there are nonphysical factors associated with the success of work hardening.