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The Rehabilitation of the industrially injured meniscectomy patient : an evaluation

University of British Columbia

The rehabilitation center of the Workers' Compensation Board (WCB) of British Columbia provides a centralized, multidisciplinary, time-intensive approach to the treatment of the industrially-injured patient. In order to evaluate the effectiveness of this system, rehabilitation outcomes measured by the number of days postoperative before return to work were compared for three groups of meniscectomy patients. The first group comprised those patients treated at the WCB rehabilitation center (commonly referred to as "the Clinic"). The second group were those WCB patients rehabilitated in community facilities, and the third group were those WCB cases who received no formal postoperative physical therapy. The population studied, 454 cases, was a total sample of all cases from the Lower Mainland for whom the WCB paid surgeons medical aid for the performance of a meniscectomy in 1976 and 1977. Data was obtained through an examination of the records. The variables examined were type of postoperative rehabilitation and of preoperative rehabilitation, age, occupation, income, degenerative changes of the knee, latency period, history of previous knee injury, medial or lateral excision of the meniscus and presence of a posterior incision. The method of analysis was a multifactor analysis of variance. Chi square was also used to understand the differences in the population. One hundred forty cases with complicated pathology or circumstances which might have influenced the results, and all 29 women in the initial sample, were excluded from the study. The final sample consisted of 285 cases: 85 Clinic cases, 110 Community cases, and 90 non-treated cases. The three populations were found to differ significantly in three characteristics: the frequency of degenerative changes of the knee, occupation, and the presence of a posterior incision. There was a higher incidence of degenerative changes in the Clinic group, and fewer cases with sedentary occupations in the group treated in the Community, The occurrence of posterior incision was greater in the Community than in the other populations. Four men who took over 300 days return to work were removed from the later analyses. The mean return to work time for the Clinic group was found to be 105.0 days, for the Community group 86.4 days, and for non-treated patients 67.5 days. These differences were significant at the .05 level. Within each postoperative rehabilitation group, the subgroup preoperatlvely treated at the Clinic was found to have returned to work the latest. With the exception of occupation, the other study variables were not found to be significant. With the Community-treated group only, the intensity of treatment was not found to affect return to work. It is suggested that the Clinic environment may encourage attitudes of disability and dependency. Intensive therapy and a multidisciplinary approach to treatment may also encourage unrealistic expectations of ultimate "cure". Centralization of treatment may heighten a litigious atmosphere, It is stressed that since return to work was the only criterion of outcome, other functional and pathophysiological outcomes remain unknown and long-term results were not studied.

Text

2010-03-18

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http://hdl.handle.net/2429/22103

Health Care and Epidemiology

University of British Columbia

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