Date of Award

1-1-1999

Degree Type

Thesis

Degree Name

Doctor of Philosophy

Faculty

Faculty of Community Services, Education and Social Sciences

First Advisor

Professor Don Thomson

Abstract

Previous research exploring the relationship between litigation status and the symptoms of the plaintiff has been inconsistent and limited by methodological dlfficulties. While Mendelson (1984, 1986, 1988) argued there was no difference In symptoms and rates of work return between litigating chronic pain patients and those not involved in the compensation system, others argued that work related injuries were maintained either by the plaintiffs' wish for monetary compensation (compensation neurosis), or by their involvement in the medico-legal process with the stress of the litigation slowing down the recuperative process (nomogenic influences). Dworkin and colleagues (1985) highlighted the importance of including employment status as a variable of effect by arguing the inconsistencies in the literature on the effects of litigation may be explained by the variability among studies in the percentages of patients who were receiving compensation (or who had litigation pending) who were also working. The present longitudinal study addressed many of the methodological short comings of previous research and examined the relationship between litigation status, employment, psychological distress, pain and disability over the duration of the compensation process. 200 chronic back pain participants were selected from patients who, between March 1991 and November 1993, attended an initial assessment interview at the Perth Pain Management Centre (PPMC) a multidisciplinary pain centre. According to their litigation and employment status these patients were divided into four groups (n=5O), namely a non-litigation non-working group (NLnw), a non- working group (NLw), a litigating non-working group (Lnw) and a litigating working group(Lw). All participants completed three questionnaire, one at intake, one a minimum of 2 years later (for litigants during the litigation process) with the final questionnaire completed a minimum of 15 months thereafter (for litigants after they had settled their claim). Questionnaires contained measures of pain (Visual Analogue Scale, Short Form McGill Pain Questionnaire), depression (Zung Self-Rating Depression Scale), anxiety (Modified Somatic Perception Questionnaire) and disability (Oswestry Disability Questionnaire). Overall participants who were working scored lower on all the measures than did participants who were not working. On the other hand participants who were litigating scored higher on all the measures then did participants who were not litigating. There was a significant time effect on all measures but this was qualified on some measures by the Interaction of Time with Litigation status (VAS, Zung, Oswestry) and Time with Work status (Zung). The present research further demonstrated that both litigation and employment were significant factors influencing recovery from injury. Implications of these findings are discussed including the view that efforts should be directed towards minimising nomogenic factors while maximising the chances of returning injured workers to their workplace, even if this is in an alternative, reduced capacity.

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