The histories of 509 patients treated for low back injuries were studied for differences that might be related to compensation. Only 55.8% of the 272 patients receiving compensation were rated as improved at time of discharge, as compared to 88.5% of the 237 patients not receiving compensation. Over two-thirds of the patients who did not receive compensation had appeared for treatment during the first month of symptoms, whereas only about one-half of the patients who received compensation had been seen at this point. The mean number of treatments received by the compensation group, both men and women, greatly exceeded that for the noncompensation group. Some patients in the compensation group responded well to conservative management and returned to their jobs after a minimum number of treatments, but in others there appeared to be a difficulty within the basic personality structure. Psychiatric experience with the latter type has not been encouraging. Throughout the study, the women expecting compensation showed the worst response to treatment while receiving the greatest number of treatments. Prompt adequate diagnosis and early adequate conservative treatment are recommended as essential in handling these patients, but there is real need for further investigation of the medical, psychological, and legal aspects of this complaint.
Krusen EM, Ford DE. COMPENSATION FACTOR IN LOW BACK INJURIES. JAMA. 1958;166(10):1128–1133. doi:10.1001/jama.1958.02990100016004
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