Journal of Pain Research (Mar 2023)

Healthcare Costs, Time to Fitness for Work, and Related Factors in Chronic Complex Regional Pain Syndrome: A Comparative and Longitudinal Study of 5-Year Follow-Up

  • Duong HP,
  • Léger B,
  • Scholz-Odermatt SM,
  • Burrus C,
  • Vuistiner P,
  • Konzelmann M,
  • Luthi F

Journal volume & issue
Vol. Volume 16
pp. 683 – 693

Abstract

Read online

Hong Phuoc Duong,1,* Bertrand Léger,1 Stefan Markus Scholz-Odermatt,2 Cyrille Burrus,1,3 Philippe Vuistiner,1 Michel Konzelmann,1,3 François Luthi1,3,4,* 1Department of Medical Research, Clinique romande de réadaptation, Sion, 1951, Switzerland; 2Department of Statistics, Sammelstelle für die Statistik der Unfallversicherung (SSUV), c/o Swiss Accident Insurance Fund (Suva), Lucerne, 6002 Switzerland; 3Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, 1951, Switzerland; 4Department of Rheumatology and Rehabilitation, Hôpital Orthopédique, University and University Hospital of Lausanne, Lausanne, 1011, Switzerland*These authors contributed equally to this workCorrespondence: Bertrand Léger, Tel +41 27 603 2075, Email [email protected]: To assess and compare the healthcare costs, time to fitness for work (TFW) between chronic complex regional pain syndrome (CRPS) and non-CRPS; and identify factors associated with these outcomes in a comparative longitudinal study.Patients and Methods: 148 patients with chronic CRPS of the hand and 273 patients with chronic hand impairments but without CRPS (non-CRPS) were admitted at a Swiss rehabilitation clinic between 2007 and 2016. Healthcare costs and TFW were retrieved from insurance data over 5 years after the accident. Socio-demographic factors, biopsychosocial complexity measured by means of the INTERMED questionnaire, pain intensity and DASH disability scores were collected during rehabilitation. Generalized estimation equations and Cox proportional-hazards models were used to identify factors associated with outcomes.Results: Healthcare costs were increased by 20% for the CRPS versus non-CRPS group (coefficient = 1.20, 95% CI = 1.08– 1.35, p< 0.001). The median TFW was longer for CRPS than non-CRPS patients (816 vs 672 days, p = 0.02). After adjusting for covariates, TFW did not differ between the two groups (hazard ratio = 0.94, 95% CI = 0.73– 1.21, p=0.61). For CRPS patients, higher healthcare costs were associated with severe or moderate initial injury, high INTERMED or DASH disability scores. Longer TFW were associated with severe initial injury, low educational level, no work contract, and high INTERMED or DASH disability scores.Conclusion: Overall, the healthcare costs were higher for CRPS than non-CRPS patients, but the TFW was comparable. We demonstrated also the significant associations of disability and biopsychosocial factors with the healthcare costs and TFW in CRPS patients.Keywords: complex regional pain syndrome, healthcare costs, biopsychosocial complexity, work incapacity, fitness for work, CRPS

Keywords