Does gender significantly affect treatment outcomes in work-related chronic spinal disorders?

Abstract

Robert J. Gatchel, PhD, Tom Mayer, MD, Christopher Anagnostes, PhD Candidate, Timothy Proctor, PhD Candidate, Dallas, TX, USAIntroduction: Clinicians have long hypothesized that gender may be a risk factor in treatment outcomes of chronically disabled spinal disorder (CDSD) patients. Although the scientific literature shows a higher prevalence of occupational low back injury in males, and a higher rate of repetitive motion and neck injuries in females, few studies have comprehensively investigated the role of gender regarding cost-related outcome variables of significance after work-related injuries. This study was designed to examine the relationship between gender and biopsychosocial treatment outcomes in a CDSD workers compensation cohort undergoing a tertiary-level functional restoration program.Methods: A large cohort of 1,827 consecutively treated CDSD patients were placed into two gender-based groups: males (M), n = 1,158, average age, 40.7 ± 10 years) and females (F), n = 669, average age, 42.5 ± 10 years). All patients underwent a 3-week medically directed functional restoration program combining quantitatively guided exercise progression with a multimodal disability management approach using psychological and case management techniques. Preprogram preparation included drug detoxification, psychotropic medication management and preparatory aerobic and mobilization training. Before the start of the program, and again upon completion of the program, all patients received a standard psychosocial assessment battery that included the Dallas Pain and Disability Questionnaire, a visual analog scale that measures subjective disability; and the Beck Depression Inventory, which quantifies depressive symptomology. Additionally, patients were assessed on a variety of physical factors, and a cumulative score was calculated that aggregates and averages these physical measures. A structural clinical interview examining socioeconomic outcomes was conducted at 1 year after program completion, and at least partial information was obtained from this interview on all patients in the present study.Results: As expected, men had a significantly higher rate of lumbar injury than women (64% to 53%), whereas women had a higher rate of cervical injury (15% to 10%) than men (p<.001). Men returned to work at a higher rate at 1 year follow-up than women (87% to 81%; p<.01). Men also had a higher rate of work retention to a 40 hour/week job at 1 year follow-up (68% to 61%, p<.01). Women evidenced a higher rate of health-care-seeking behaviors from new providers (31% to 25%, p<.01). Men had a significantly higher cumulative physical score (gender normalized) at both pretreatment (M=41) and postreatment (M=75) than women (F=34 and 67, respectively; p<.001). Men exhibited fewer depressive symptoms, as evidenced by lower pretreatment (M=16; F=18) and posttreatment (M=8; F=10) Beck Depression Inventory scores than women (p<.001). Men also evidenced lower pretreatment disability scores (M=90 versus F=94; p<.01).Conclusion: The present study represents the first large-scale examination of the relationship between gender and treatment outcomes for a CDSD population after work injuries. There is a pattern of moderately improved socioeconomic outcome for men. On psychosocial measures, men showed lower subjective disability scores than women. Men also showed lower levels of depression, with higher levels of physical functioning both before and after treatment. Overall, chronically disabled male spinal patients appeared to show somewhat better biopsychosocial outcomes. This leaves the question of identifying gender-specific risk factors to explain these differences.