• James Rainville, Glenn Pransky, Aage Indahl, and Eric K Mayer.
• Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA. jrainvil@caregroup.harvard.edu
• Spine. 2005 Nov 15; 30 (22): 2579-84.

Study DesignLiterature review.ObjectivesTo review the literature about the performance of physicians as mediators of temporary and permanent disability for patients with chronic musculoskeletal complaints. To assess specifically the nature and variance of recommendations from physicians, factors influencing physician performance, and efforts to influence physician behavior in this area.Summary Of Background DataWhile caring for patients with musculoskeletal injuries, physicians are often asked to recommend appropriate levels of activity and work. These recommendations have significant consequences for patients' general health, employment, and financial well-being.MethodsMedical literature search.ResultsPhysician recommendations limiting activity and work after injury are highly variable, often reflecting their own pain attitudes and beliefs. Patients' desires strongly predict disability recommendations (i.e., physicians often acquiesce to patients' requests). Other influences include jurisdiction, employer, insurer, and medical system factors. The most successful efforts to influence physician recommendations have used mass communication to influence public attitudes, while reinforcing the current standard of practice for physicians.ConclusionsPhysician recommendations for work and activity have important health and financial implications. Systemic, multidimensional approaches are necessary to improve performance.

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