BackgroundMany people with chronic nonspecific musculoskeletal pain (CMP) have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study was to explore why people with CMP stay at work despite pain (motivators) and how they manage to maintain working (success factors).MethodsA semi-structured interview was conducted among 21 subjects who stay at work despite CMP. Participants were included through purposeful sampling. Interviews were audio-recorded, transcribed verbatim, and imported into computer software Atlas.ti. Data was analyzed by means of thematic analysis. The interviews consisted of open questions such as: "Why are you working with pain?" or "How do you manage working while having pain?"ResultsA total of 16 motivators and 52 success factors emerged in the interviews. Motivators were categorized into four themes: work as value, work as therapy, work as income generator, and work as responsibility. Success factors were categorized into five themes: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs.ConclusionsPersonal characteristics, well-developed self-management skills, and motivation to work may be considered to be important success factors and prerequisites for staying at work, resulting in behaviors promoting staying at work such as: raising adjustment latitude, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. Motivators and success factors for staying at work may be used for interventions in rehabilitation and occupational medicine, to prevent absenteeism, or to promote a sustainable return to work. This qualitative study has evoked new hypotheses about staying at work; quantitative studies on staying at work are needed to obtain further evidence.

The newly developed questionnaire to measure the capability set for work is unique because the items go beyond the valued aspects of work by incorporating whether a worker is able to achieve what he/she values in his/her work. The results show that the capability for work questionnaire can serve as a proxy measure of sustainable employability.

We sought to systematically analyze the influence of dose of pain rehabilitation programs (PRPs) for patients with chronic low back pain (CLBP) on disability, work participation, and quality of life (QoL). Literature searches were performed in PubMed, Cochrane Library, Cinahl, and Embase up to October 2012, using MeSH terms, other relevant terms and free-text words. Randomized controlled trials in English, Dutch, and German, analyzing the effect of PRPs, were included. One of the analyzed interventions had to be a PRP. Outcomes should be reported regarding disability, work participation, or QoL. To analyze dose, the number of contact hours should be reported. Two reviewers independently selected titles, abstracts, and full-text articles on the basis of inclusion and exclusion criteria. Data were extracted and risk of bias was assessed. Effect sizes (ES) were calculated for each intervention, and influence of dose variables was analyzed by a mixed model analysis. Eighteen studies were identified, reporting a wide variety of dose variables and contents of PRPs. Analyses showed that evaluation moment, number of disciplines, type of intervention, duration of intervention in weeks, percentage of women, and age influenced the outcomes of PRPs. The independent effect of dose variables could not be distinguished from content because these variables were strongly associated. Because dose variables were never studied separately or reported independently, we were not able to disentangle the relationship between dose, content, and effects of PRPs on disability, work participation, and QoL.