Determinants of "return to work in good health" among workers with back pain who consult in primary care settings: a 2-year prospective study

• Published in: European spine journal Vol. 16; no. 5; pp. 641 - 655
• Main Authors: Dionne, Clermont E, Bourbonnais, Renée, Frémont, Pierre, Rossignol, Michel, Stock, Susan R, Nouwen, Arie, Larocque, Isabelle, Demers, Eric
• Format: Journal Article
• Language: English
• Published: Germany Springer Nature B.V 01.05.2007; Springer-Verlag
• Subjects: Adaptation, Psychological; Adolescent; Adult; Back pain; Back Pain - psychology; Back Pain - rehabilitation; Cigarette smoking; Cohort analysis; Employment - psychology; Fear; Female; Health Status Indicators; Humans; Male; Middle Aged; Original; Pain; Patient Satisfaction; Primary care; Primary Health Care; Prospective Studies; Recovery of Function; Risk Factors; Sick Leave; Sick Role; Thorax; Workers
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-006-0180-2

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of "return to work in good health" (RWGH--a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of "success" in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of "failure" in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.