Abstract
Introduction There is a perception in the orthopaedic community that patients with workers’ compensation claims have a poorer outcome than non-compensation patients. This review aims to identify and quantify the effect of workers’ compensation claims on the outcome of orthopaedic treatment.
Methods A systematic review of the literature was performed. Studies of any language published between 1966 and 2002 that compared the outcomes of compensation against a non-compensation group for any orthopaedic treatment were included. Articles with any group less than 20 patients were excluded. Literature searching and data extraction were performed independently by both reviewers and then compared. Differences between reviewers’ findings were resolved by discussion. Measures of region specific objective outcome, where available, were pooled into satisfactory and unsatisfactory groups for comparison. The raw data was used for a meta-analysis. The total number of articles that met the search criteria was 63. Within these articles there were 7,279 patients with workers’ compensation claim and 14,368 patients with no compensation claim.
Results No articles found that the workers’ compensation group had better outcomes. Fourteen found no difference between the two groups while 49 articles described a worse outcome in the compensation group. In the 41 papers which had outcome scores available for comparison there were 3,608 compensation patients with outcome scores and the outcome was unsatisfactory in 33.7%. There were 6,607 non-compensation patients with outcome scores and the outcome was unsatisfactory in 15.1% of non-compensation patients. The difference was significant (p< 0.01). The Relative Risk (RR) of an unsatisfactory outcome in workers’ compensation patients is 2.2. The Attributable Risk (AR), which gives the percentage of poor outcomes in the compensation group directly attributable to their compensation status, was 55.1%. Subgroup analysis of the major groups (spine: n=7,815, carpal tunnel: n=743, and shoulder n=379) revealed similar findings for each group (spine: RR=2.1, carpal tunnel: RR=2.2, shoulder: RR=5.1).
Conclusions From reviewing the literature, workers’ compensation patients have a poorer outcome compared to non-compensation patients for the same orthopaedic conditions. A workers’ compensation patient has more than double the risk of having a poor outcome in comparison to the non-compensation patient. More than half of the poor results in the compensation group can be attributed to their compensation status.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
