Expectations, perceptions, and physiotherapy predict prolonged sick leave in subacute low back pain

Abstract

BackgroundBrief intervention programs for subacute low back pain (LBP) result in significant reduction of sick leave compared to treatment as usual. Although effective, a substantial proportion of the patients do not return to work. This study investigates predictors of return to work in LBP patients participating in a randomized controlled trial comparing a brief intervention program (BI) with BI and physical exercise.MethodsPredictors for not returning to work was examined in 246 patients sick listed 8-12 weeks for low back pain. The patients had participated in a randomized controlled trial, with BI (n = 122) and BI + physical exercise (n = 124). There were no significant differences between the two intervention groups on return to work. The groups were therefore merged in the analyses of predictors. Multiple logistic regression analysis was used to identify predictors for non return to work at 3, 12, and 24 months of follow-up.ResultsAt 3 months of follow-up, the strongest predictors for not returning to work were pain intensity while resting (OR = 5.6; CI = 1.7-19), the perception of constant back strain when working (OR = 4.1; CI = 1.5-12), negative expectations for return to work (OR = 4.2; CI = 1.7-10), and having been to a physiotherapist prior to participation in the trial (OR = 3.3; CI = 1.3-8.3). At 12 months, perceived reduced ability to walk far due to the complaints (OR = 2.6; CI = 1.3-5.4), pain during activities (OR = 2.4; CI = 1.1-5.1), and having been to a physiotherapist prior to participation in the trial (OR = 2.1; CI = 1.1-4.3) were the strongest predictors for non return to work. At 24 months age below 41 years (OR = 2.9; CI = 1.4-6.0) was the only significant predictor for non return to work.ConclusionIt appears that return to work is highly dependant on individual and cognitive factors. Patients not returning to work after the interventions were characterized by negative expectations, perceptions about pain and disability, and previous physiotherapy treatment. This is the first study reporting that previous treatment by physiotherapists is a risk factor for long-term sick leave. This has not been reported before and is an interesting finding that deserves more scrutiny.

Effects of Physical and Personal Risk Factors on Sick Leave Due to Musculoskeletal Disorders

“…This could be attributed to the nature of the workers' tasks, manual work, force exertion, awkward postures, repetitive work, inappropriate workstations, etc. The high rate of low back pain revealed in this study is in agreement with the results of other studies [16,17]. According to Diaz-Ledezma, Urrutia, Romeo, et al [3] and Murtezani, Hundozi, Orovcanec, et al [14], there is a relationship between sick leave and workers who suffer from acute low back pain.…”

Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (The CINS trial)

“…The BI consists of a thorough medical examination followed by information about back pain and an encouragement to stay physically active and return to work (Indahl et al, 1995). The information is communicated with optimism and is believed to lower fear avoidance and increase the belief in recovery, which is in itself an important prognostic factor (Hildebrandt et al, 1997;Reme et al, 2009). …”

Tendencias epistemológicas de las acciones de la salud pública. Una revisión desde la fisioterapia

“…Su principal desventaja es que no describe la importancia de cada factor dándole mayor énfasis al ámbito biológico e individual que a lo social. Este es el modelo que predomina encontrado en 17 investigaciones [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”