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A-1139 The Effect of Workers' Compensation on Outcome after Upper Extremity Surgery
Kevin Chung, USA
Thursday, June 14, 2018 · 10:58 a.m. · 14m 04s
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well enjoy your presentation very much and uh we're gonna save the questions was the end but i
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like to pose a question to you sick and think about it and uh anyone where
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the common comment at being elegy studies in clinical trials is that you compare one tree men
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to the other in the conclusion is that this treatment is better than that treatment
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for the for the situation is that if if one tree men it both stream and has some some problems
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would not be doing them at all in the future and in opinion he studies
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the uh the traditional way is gonna say okay we have this much exposure
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thence you have this kind of um condition couple tall and i think this indisputable some some
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uh activities because that but the real question is that you have twenty three job descriptions
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i wonder whether we can move to more personalised medicine phase uh precision madison
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facing which we anticipate those patients oneness suitable for so the task
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and give them the opportunity to engage in other task rather than a repetitive type
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when you're is that because i mean that s. a. painters somebody has okay
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but many of them can do it very well even with high stress situations by some body type may not be suitable
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and i wonder whether as we move along at b. b. r. g. whether we can actually identify them way before
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they get those conditions imposition them in the situation they can be successful anyway that's aside from my workers compensation
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talk anyway my my yeah my passes talk by the fact the workers compensation how comes
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after op extremity surgery i think that is the answer is actually very clear
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workers compensation is at the for god comes a measure because traditionally they have was all cops we all know that
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but that's true trace workers compensation understand little bit about
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the context of workers compensation in the outcomes assessment
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you know that's what 'cause compositions aware of form of insurance that require employees to
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protect the workers and we actually started really start in the german system
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you know changed employees relinquish the rights to their employee or no no
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faults but the many variations of these no for things and
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in america i think that many of these become ever so real relationship or that surely no fault
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workers compensation basically i can believe actually a long long time ago there's some type
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of a workers compensation flavour in two hundred to two thousand b. c.
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but many countries industrial countries we have some form of what 'cause protection
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in the u. s. workers compensation is changes state by state by state also changes every year
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for example in michigan where worker unison michigan the compensation for loss of
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arms so much more fifty thousand dollars more than the national average
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so there's really no you know for workers compensation laws across given the us as
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the unify conch in the us the uh state or federal government pay
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six point five trillion dollars in total wages a couple workers
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this is a huge problem in the us of course i'm sure that it's across the board in europe and also the asian countries
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the the person all carpal tunnel syndrome cases that management ugly i'll work related in some way
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try to establish what related to this based on previous presentation can be
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very difficult and swatted at have injuries has a high crime rate
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so let's go through this study's about workers compensation truly is workers compensation of this
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factor when you look at all comes the traditionally have was all comes
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i met analysis actually supplement analysis by the one that's most prominence publishing gem is seven years ago
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found the workers complication across all surgical mask a scale the conditions are three to four times greater to
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have i said especially all cops and this is based on very rigorous math analysis publishing gem
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maybe study show the workers compensation status was the most significant predictor all comes when you look at any kind
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of how come the treatment which means that we look at moscow seller conditions that we all interested in
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you have to adjust for workers compensation and many times we live in a workers compensation
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as one the study population because invariably they ought the friends thence the traditional patience
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another math analysis on the workers compensation patience to have was all comes after stratified by conditional diseases
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for all kinds of stuff including lumbar surgery op extremely so
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be traumatic injuries ends mine surgery this is p.
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hapless wind publication by regress buys stratified basin diseases
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and couple has syndrome is a perfect opportunity to study workers compensation outcomes one year after surgery
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it's amazing that seventy seven percent of workers compensation patients are you able to return to pretty internally
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a vocation versus ninety three percent for most of us so there is a twenty percent difference
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and we all kind of know the answer but you have to have evidence to demonstrate these was all comes
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well this was all cops i think that when unit ever saw
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relationship workers compensation you generally have was expectations about your recovery
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i mean if you look at some of the patients who actually goes repetitive work
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and putting one not one not not into machine eight hours a day
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the satisfaction for that job is not great which means that when they start having
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problems the ever saw relationship make them to have low expectations regarding recovery
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so that that that's really a key factor with a patient want to return to work
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uh with a secondary k. it would help my secondary gain the secondary gains obvious
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i mean with a with a hard work they don't want to go back the same environment
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to produce those injuries and furthermore where they're in the ever saw relationship in the workforce
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well with people want to go back to those environment which means that the second again is
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help me put me in another job in other environments so that can be productive
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less educated maybe lesser support maybe higher what the man patted job definitely
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more likely to smoke and psychological because maybe these patients have it
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difficulties coping with a a stereo environment that they go into
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why should we care well we care because we treat them becomes what kind it just because
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there were good conversation patients to the mean that they don't have a real disease
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made them do have brought disease i have a problem when we label workers compensation patients as a psychological
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problem okay that's secondary gain so that's treated differently now have a problem would have to have
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a a yeah i'm a corny the approach not just based on hand surgeons approach but based on
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psychology is based on ergonomics base aunt people who actually look at uni work for us
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we have a team approach manages patients so that the recovery
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expectations can be enhance within forty percent of workers compensation
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patients was to experiencing difficulties with eighty or twenty eight month after initial claims and i think
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that we can remedy that tray in decision making to identify factors that influence prognosis
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we cannot just look at surgery itself with the committee couple holler syndrome i think that we
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have to understand i think it's difficult for hand surgeon to know everything about psychological
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makeup of patient but when they come in with a carrying case manager that isn't ally
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doesn't really helpful many of my patients come with a ally in the case manager
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i think those patients we cover so much better because the case manager i would you
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know my therapist to share with me the kind exposure to have at work and
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then my goal was not only to the social problem post a system to place
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them in different kinds of job and maybe indifference environment they they can thrive
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their ability now comes measures also hampered outcomes assessment
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this way the for courts to use a traditional all kinds measure for these workers compensation patients
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because we already know that when the ever saw relationship they're not gonna be i will say truthful that's gonna
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be difficult for them to answer those question there is the standard question there in a particular form
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maybe you know when you're on the litigation why would you even tell anyone that you get a better most the time you want
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to milk as long as possible and to the litigation goes away so one important factors we look at how calm says that
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is your case to another location the cases and of the location those all kinds parameters are
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are not useful when the off litigation then maybe maybe they
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will have eight different types expectations and responses the questionnaires
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so challenging to establish all kinds of workers compensation patients because the so call standardised tests
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such as questionnaires may not be applicable even worse track record of standardised tests well people can
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can manipulate how much they can squeeze those um corny amateurs and so forth so those things need to be considered
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if there but it all comes measure some of the papers that we have
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looked that's even on the uh on the shore nasty out i mean
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when you look at compensated versus non come say the patients the um the bees response
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is a very different even for the same kinds of conditions even for wrote
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it have injuries the same kind of conditions you look at them is on to
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say how come you're the responses to the question yours are starkly different
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so one of my actually both my uh my at japanese fellows from um
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for the other universes sitting there so like the ticket liberty of i'm presenting their data they did this is my review to
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determine what kind of outcomes measure are most affected by receiving workers
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compensation hand surgery patients actually went through the entire literature
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for twenty years over her articles on hand surgery
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sixty two articles some math analysis some of them as a summer use
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does not randomised control trials also clinical trials and we process
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data to understand exactly how do you measure workers compensation outcomes and
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this was published in plastic reconstructive surgery that look at
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satisfactory outcome such as we'd use pain such as paying
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patient report outcomes satisfaction nerve conduction studies assortment things
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and there was no change a worsening symptoms it consider as as say and says we
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all come make it easy for analysis to consider as satisfactory versus and satisfactory
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so i just went charming to the results section because it just work actually to over here
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the encompass that patients are three times more likely to experience improvement after surgery don't
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compensated patients so workers compensation patients for any kind of happy extremity injuries
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tend to have three times was ah comes then those one that and
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this was publishing p. r. s. passing reconstructive surgery just slash sure
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this is a lease a it recently busy slide but if you look at some of
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the so called the and not objective measures patient radar come such a satisfaction pain
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you know the other things workers compensation patients has a how much much greater arts then now workers compensation
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patients in affecting the outcomes assessment which means that this is very similar to what we talk about
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questionnaires can be difficult to measure if you use cross sectional
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studies if you compare what discount to not workers comp
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invariably have the control for these three times the arts of differences
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so is that the way we do what do we need to do cross sectional studies i
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think that we also discovered that even with joint tendon and nerve problems more objective
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kind of findings electorate honestly studies and ten the motion enjoy emotion and so forth the asses still
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more the and that he uh non compensated patients so we got a so what you do or
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what was compensated patients penned how was all comes
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across all spectrums of topics remedy a measurements
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and do you think that different countries have different findings rashes satisfied because we have
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the data from the entire world so stratified the country's based on the us and europe and asia
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the answers are the same regardless of what the laws you guys what the nuances of compensation
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workers compensation patients the hat was all comes then and compensated patients
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and this was found in another study that showed the same thing two point zero
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here in the us when compared to the rest the war smaller studies
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but regardless workers compensation patients even though the loss at the front
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the difference they see us in different countries and different religions in different continents is still a risk factor
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so how can i reduce l. workers compensation bias in the studies if one is have workers compensation patients your studies
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i think that we found out that it's really important that you have a comparison without
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a free operative measurement is very difficult to know what the changes so for study
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to have free opt impose of the measurements is the critical portion you cannot
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compare worker's comp to normal 'cause come patients as a comparison because
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invariably you have three times the art of having problems so having prospectors
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studies really important to measure effect of how treatment for this population
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and the function measurements of these uh factors such as range of motion grip strength no study
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bone union sense we test i think that you have to look at the whole spectrum outcomes measures questionnaires may
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not be as precise workers compensation patients were compared to so call more objective all kinds for example
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well union type what those things are hard to faint how to discuss but even with a range of motion groups trying to
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pin string those things can be feign in patients workers compensation
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you have to understand the limitations of everyone these measures
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so my my overall conclusion is that i think the workers compensation patients represent eight distinct group
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uh patients they need separate consideration but the ways of the screen to control for them
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and one of the very good way to do things is that if that is a cop population that you're interested in and you
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should be interested and we should be interesting workers compensation we gotta have prospective studies to really know the fact for treatment
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thank you picture of use the machine
