Cost-Effectiveness of Early Versus Delayed Functional Restoration for Chronic Disabling Occupational Musculoskeletal Disorders

Brian R. Theodore, Tom G. Mayer, Robert J. Gatchel

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Purpose Despite extensive evidence for the treatment effectiveness of interdisciplinary functional restoration (FR) for chronic disabling occupational musculoskeletal disorders (CDOMD), there is little documentation on the cost-effectiveness of early rehabilitation using FR. Methods A total of 1,119 CDOMD patients were classified according to duration of disability on FR entry, corresponding to early rehabilitation (ER: 4–8 months of disability, N = 373), intermediate duration (ID: 9–18 months, N = 373), and delayed rehabilitation (DR: >18 months, N = 373). Groups were matched on sex, age, ethnicity, and injured musculoskeletal region. One-year post-rehabilitation outcomes included return-to-work, work retention and healthcare utilization. Economic analyses included a cost-effectiveness analysis of the FR program, and estimation of the total cost-of-illness. Results At 1-year post-rehabilitation, all groups were comparable on return-to-work (overall 88 %), work retention (overall 80 %), and additional healthcare utilization (overall, 2.2 % of patients received re-operations/new surgeries, 2 visits to new healthcare provider). Savings of up to 64 % in medical costs, and up to 80 % in disability benefits and productivity losses was associated with the ER group. The cost of rehabilitation was also up to 56 % lower when administered early. Overall, ER resulted in estimated cost savings of up to 72 % (or almost $170,000 per claim). Conclusions Duration of disability does not negatively impact objective work or healthcare utilization outcomes following interdisciplinary FR. However, early rehabilitation is more likely to be a cost-effective solution compared to cases that progress >8 months and receiving FR as a treatment of “last resort”.

Original languageEnglish
Article number6
Pages (from-to)303-315
Number of pages13
JournalJournal of Occupational Rehabilitation
Issue number2
StatePublished - 22 Jun 2015


  • Chronic pain
  • Cost-effectiveness analysis
  • Disability
  • Functional restoration
  • Musculoskeletal disorders
  • Socioeconomic outcomes


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