This paper focuses on the identification and testing of potential psychosocial factors contributing to an integrated multivariate predictive model of occupational low back disability. Psychosocial predictors originate from five traditions of psychosocial research: psychopathological, cognitive, diathesis-stress, human adaptation and organizational psychology. The psychosocial variables chosen for this study reflect a full range of research findings. They were investigated using 253 subacute and chronic pain injured workers. Three outcome measures were utilized: return-to-work status, duration of disability and disability costs. The key psychosocial predictors identified were expectations of recovery and perception of health change. Also implicated, but to a lesser degree, were occupational stability, skill discretion at work, co-worker support, and the response of the workers' compensation system and employer to the disability. All psychosocial models were better at predicting who will return than who will not return to work.

The instrument can be useful and practical for prediction of return to work outcomes in the subacute stage after low back injury in the workers' compensation context.

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The "winning" variables identified in the integrated model are dominated by cognitions, which are accompanied by disability behaviors. A cognitive-behavioral model with an adaptation-oriented rather than a pathology-oriented focus is favored for early intervention with high-risk workers since cognitions are amenable to change.

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