Early childhood abuse in chronic spinal disorder patients. A major barrier to treatment success.

STUDY
DESIGN: Prevalence rates of childhood abuse, socioeconomic outcome data, and levels of psychopathology were evaluated for graduates of a functional restoration program for chronically disabled spinal disorder patients in a workers' compensation environment.
OBJECTIVES: To describe psychological profiles and evaluate treatment outcomes for chronic spinal disorder patients with a history of childhood abuse. SUMMARY OF BACKGROUND DATA: There is increasing evidence to indicate that traumatic childhood events may leave adult survivors psychologically distressed. It is possible that because of this level of psychological distress, chronic spinal disorder patients may be unable to return to a productive life-style after completing a rehabilitation program.
METHODS: Two hundred ninety-nine male and 174 female patients from a cohort (N = 473) of consecutive graduates of a functional restoration program were assessed for the presence of childhood abuse by structured interview. Prevalence rates were compared with a comparison group of subjects without a history of chronic spinal disorder disability. In addition, the 79 chronic spinal disorder patients with a history of childhood abuse were compared on several socioeconomic outcomes with a matched group of workers with chronic spinal disorders without a history of childhood abuse. Psychopathology in the two groups of chronic spinal disorder patients was evaluated using Diagnostic and Statistical Manual of Mental Disorders criteria, the Minnesota Multiphasic Personality Inventory, and Symptom Checklist-90-Revised.
RESULTS: A history of childhood abuse was found to be related to a higher level of psychological distress in chronic spinal disorder patients. In addition, poorer socioeconomic outcomes, such as lower work retention rates and higher postrehabilitation operations to the same area of injury, were found in the chronic spinal disorder patients with a history of childhood abuse compared with workers without a history of childhood abuse in whom chronic spinal disorders developed.
CONCLUSIONS: These results demonstrate that although a history of childhood abuse is associated with greater psychosocial disturbances in chronically disabled spinal disorder patients, such disturbances do not interfere with an initial positive response to an effective tertiary rehabilitation program such as functional restoration. However, a history of childhood abuse may be related to poorer socioeconomic outcomes after discharge from rehabilitation programs. Additional treatment options may be needed for these patients.