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Title: The influence of no fault compensation on functional outcomes after lumbar spine fusion.
Epworth Authors: Cunningham, John
Other Authors: Montgomery, Alexander
Robertson, Peter
Keywords: Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Workers' Compensation
Research Design
Scoring Methods
Data Reporting
Matched Groups
Disability Evaluation
Compensation and Redress
Spinal Fusion
Return to Work
Spinal Stenosis
Back Pain
Quality of Life
Follow-Up Studies
Literature Review
Issue Date: Jul-2015
Publisher: Wolters Kluwer
Citation: Spine 2015 Jul 15;40(14):1140-7
Abstract: STUDY DESIGN: Prospective cohort study and systematic literature review. OBJECTIVE: To compare the functional outcomes for lumbar spinal fusion in both compensation and non- compensation patients in an environment of universal no fault compensation and then to compare these outcomes with those in worker's compensation and non-workers compensation cohorts from other countries. SUMMARY OF BACKGROUND DATA: Compensation has an adverse effect on outcomes in spine fusion possibly based on adversarial environment, delayed resolution of claims and care, and increased compensation associated with prolonged disability. It is unclear whether a universal no fault compensation system would provide different outcomes for these patients. New Zealand's Accident Compensation Corporation (ACC) provides universal no fault compensation for personal injury secondary to accident and offers an opportunity to compare results with differing provision of compensation. METHODS: A total of 169 patients undergoing lumbar spinal fusion were assessed preoperatively, at 1 year, and at long-term follow-up out to 14 years, using functional outcome measures and health-related quality-of-life measures. Comparison was made between those covered and not covered by ACC for 3 distinct diagnostic categories. A systematic literature review comparing outcomes in Worker's Compensation and non-Compensation cohorts was also performed. RESULTS: The functional outcomes for both ACC and non-ACC cohorts were similar, with significant and comparable improvements over the first year that were then sustained out to long-term follow-up for both cohorts. At long-term follow-up, the health-related quality-of-life measures were the same between the 2 cohorts. The literature review revealed a marked difference in outcomes between worker's compensation and non-worker's compensation cohorts with a near universal inferior outcome for the compensation group. CONCLUSION: The similarities in outcomes of patients undergoing lumbar spine fusion under New Zealand's universal no fault compensation system, when compared with the dramatically inferior outcomes for these patients under other worker's compensation systems, suggest that the system of compensation has a major influence on patient outcomes, and that change of compensation to a universal no fault system is beneficial for patients undergoing lumbar fusion surgery. LEVEL OF EVIDENCE: 2.
DOI: 10.1097/BRS.0000000000000966
PubMed URL:
ISSN: 0362-2436
Journal Title: Spine
Type: Journal Article
Affiliated Organisations: St Bartholomews Hospital, London, England
The Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
The Royal London Hospital, London, England
Type of Clinical Study or Trial: Prospective Cohort Study
Appears in Collections:Neurosciences

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