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01-05-2007 | Original Article

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

Authors: Clermont E. Dionne, Renée Bourbonnais, Pierre Frémont, Michel Rossignol, Susan R. Stock, Arie Nouwen, Isabelle Larocque, Eric Demers

Published in: European Spine Journal | Issue 5/2007

Abstract

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.

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“To stop working is to become poor” (man, horticulturalist). “You are forced to work to respect some economical standards” (man, horticulturalist). “You can’t stay at home. I have to take care of my family. Working is more rewarding than staying at home, even if you are sick” (man, worker in a paper mill). “Supervisors piss you off, it frustrates me; colleagues piss you off, make your life a living hell. When I retire in 2–3 years, I will still work, but in a much better environment” (man, wrapping clerk). “For me, my absence from work not only meant a loss of earnings, but also more debts and becoming poorer” (summary of 3–4 persons).

“Physicians don’t take us seriously. When they do, they can’t help us” (summary of 3–4 persons). “Nobody will do it for you” (summary of 3–4 persons).

(Centre Hospitalier Universitaire de Québec—CHUQ, Centre Hospitalier Affilié Universitaire de Québec—CHAUQ, CLSC Haute-Ville-des-Rivières, and Centre Hospitalier Affilié Universitaire Hôtel-Dieu de Lévis).

Abenhaim L, Suissa S, Rossignol M (1988) Risk of recurrence of occupational back pain over three year follow up. Br J Ind Med 45:829–833PubMed

Atlas SJ, Deyo RA, Patrick DL, Convery K, Keller RB, Singer DE (1996) The Quebec Task Force classification for spinal disorders and the severity, treatment, and outcomes of sciatica and lumbar spinal stenosis. Spine 21:2885–2892PubMedCrossRef

Baldwin ML, Johnson WG, Butler RJ (1996) The error of using returns-to-work to measure the outcomes of health care. Am J Ind Med 29:632–641PubMedCrossRef

Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:191–215PubMedCrossRef

Bernard PM (2002) Cours: EPM-64312 "Régression logistique". Département de médecine sociale et préventive, Université Laval

Bigos SJ, Battié MC, Spengler DM, Fisher LD, Fordyce WE, Hansson TH et al (1991) A prospective study of work perceptions and psychosocial factors affecting the report of back injury (published erratum appears in Spine 1991 Jun; 16(6):688). Spine 16:1–6PubMedCrossRef

Bodenheimer T, Lorig K, Holman H, Grumbach K (2002) Patient self-management of chronic disease in primary care. JAMA 288:2469–2475PubMedCrossRef

Boersma K, Linton S, Overmeer T, Jansson M, Vlaeyen J, de Jong J (2004) Lowering fear-avoidance and enhancing function through exposure in vivo. A multiple baseline study across six patients with back pain. Pain 108:8–16PubMedCrossRef

Bolton JE (1999) Accuracy of recall of usual pain intensity in back pain patients. Pain 83:533–539PubMedCrossRef

10.

Bradbury J (2003) Why do men and women feel and react to pain differently? Research suggests men and women may not process pain signals the same way. Lancet 361:2052–2053PubMedCrossRef

11.

Brisson C, Blanchette C, Guimont C, Dion G, Moisan J, Vezina M (1998) Reliability and validity of the French version of the 18-item Karasek Job Content Questionnaire. Work Stress 12:322–336

12.

Buchbinder R, Jolley D (2005) Effects of a media campaign on back beliefs is sustained 3 years after its cessation. Spine 30:1323–1330PubMedCrossRef

13.

Buchbinder R, Jolley D, Wyatt M (2001) 2001 Volvo Award Winner in Clinical Studies: effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice. Spine 26:2535–2542PubMedCrossRef

14.

Butler RJ, Johnson WG, Baldwin ML (1995) Measuring success in managing work disability: Why return to work doesn’t work. Ind Relat Labor Rev 48:452–469CrossRef

15.

Butterfield PG, Spencer PS, Redmond N, Feldstein A, Perrin N (1998) Low back pain: predictors of absenteeism, residual symptoms, functional impairment, and medical costs in Oregon workers’ compensation recipients. Am J Ind Med 34:559–567PubMedCrossRef

16.

Cedraschi C, Nordin M, Nachemson AL, Vischer TL (1998) Health care providers should use a common language in relation to low back pain patients. Baillieres Clin Rheumatol 12:1–15PubMedCrossRef

17.

Cherkin D, Deyo RA, Berg AO, Bergman JJ, Lishner DM (1991) Evaluation of a physician education intervention to improve primary care for low-back pain. I. Impact on physicians. Spine 16:1168–72PubMed

18.

Cherkin DC, Deyo RA, Street JH, Barlow W (1996) Predicting poor outcomes for back pain seen in primary care using patients’ own criteria. Spine 21:2900–2907PubMedCrossRef

19.

Cole DC, Ibrahim SA, Shannon HS, Scott F, Eyles J (2001) Work correlates of back problems and activity restriction due to musculoskeletal disorders in the Canadian national population health survey (NPHS) 1994–5 data. Occup Environ Med 58:728–734PubMedCrossRef

20.

Croft PR, Macfarlane GJ, Papageorgiou AC, Thomas E, Silman AJ (1998) Outcome of low back pain in general practice: a prospective study. BMJ 316:1356–1359PubMed

21.

Crombez G, Vlaeyen JW, Heuts PH, Lysens R (1999) Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain 80:329–339PubMedCrossRef

22.

Cypress BK (1983) Characteristics of physician visits for back symptoms: a national perspective. Am J Public Health 73:389–395PubMedCrossRef

23.

Daveluy C, Pica L, Audet N et al (2000) Enquête sociale et de santé1998. Institut de la statistique du Québec, Québec

24.

Derogatis LR (1977) Symptoms checklist-90. Administration, scoring and procedures manual for the revised version. Clinical Psychometric Research, Baltimore

25.

Dionne CE (2005) Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings. J Clin Epidemiol 58:714–718PubMedCrossRef

26.

Dionne CE, Bourbonnais R, Frémont P, Rossignol M, Stock S, Nouwen A et al (2002) Predictors of “return to work in good health" among back pain patients in primary care settings: 3-month outcome in the RAMS-Prognosis study. In: Bombardier C, Rossignol M (eds) Book of abstracts of the International Forum V on Primary Care Research on Low Back Pain. McGill University, Montreal, pp 48–49

27.

Dionne CE, Bourbonnais R, Frémont P, Rossignol M, Stock SR, Larocque I (2005) A clinical return-to-work rule for patients with back pain. CMAJ 172:1559–1567PubMed

28.

Dozois DJA, Dobson KS, Wong M, Hughes D, Long A (1995) Factors associated with rehabilitation outcome in patients with low back pain (LBP): prediction of employment outcome at 9-month follow-up. Rehabil Psychol 40:243–259CrossRef

29.

Druss B (2002) The most expensive medical conditions in America. Health Affairs 21:105–111PubMedCrossRef

30.

Eriksen W, Natvig B, Bruusgaard D (1999) Smoking, heavy physical work and low back pain: a four-year prospective study. Occup Med (Lond) 49:155–160CrossRef

31.

Feuerstein M, Berkowitz SM, Huang GD (1999) Predictors of occupational low back disability: implications for secondary prevention. J Occup Environ Med 41:1024–1031PubMedCrossRef

32.

Fitzgerald ST, Becker DM, Celentano DD, Swank R, Brinker J (1989) Return to work after percutaneous transluminal coronary angioplasty. Am J Cardiol 64:1108–1112PubMedCrossRef

33.

Flor H, Kerns RD, Turk DC (1987) The role of spouse reinforcement, perceived pain, and activity levels of chronic pain patients. J Psychosom Res 31:251–259PubMedCrossRef

34.

Fransen M, Woodward M, Norton R, Coggan C, Dawe M, Sheridan N (2002) Risk factors associated with the transition from acute to chronic occupational back pain. Spine 27:92–98PubMedCrossRef

35.

Friedrich M, Cermak T, Heiller I (2000) Spinal troubles in sewage workers: epidemiological data and work disability due to low back pain. Int Arch Occup Environ Health 73:245–254PubMedCrossRef

36.

Fritz JM, George SZ, Delitto A (2001) The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain 94:7–15PubMedCrossRef

37.

Goldberg MS, Scott SC, Mayo NE (2000) A review of the association between cigarette smoking and the development of nonspecific back pain and related outcomes. Spine 25:995–1014PubMedCrossRef

38.

Hagen KB, Tambs K, Bjerkedal T (2002) A prospective cohort study of risk factors for disability retirement because of back pain in the general working population. Spine 27:1790–1796PubMedCrossRef

39.

Haldorsen EM, Indahl A, Ursin H (1998) Patients with low back pain not returning to work. A 12-month follow-up study. Spine 23:1202–1207PubMedCrossRef

40.

Hart LG, Deyo RA, Cherkin DC (1995) Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine 20:11–19PubMedCrossRef

41.

Heitzmann CA, Kaplan RM (1984) Interaction between sex and social support in the control of type II diabetes mellitus. J Consult Clin Psychol 52:1087–1089PubMedCrossRef

42.

Holm S, Nachemson A (1988) Nutrition of the intervertebral disc: acute effects of cigarette smoking. An experimental animal study. Ups J Med Sci 93:91–99PubMed

43.

Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York

44.

Infante-Rivard C, Lortie M (1996) Prognostic factors for return to work after a first compensated episode of back pain. Occup Environ Med 53:488–494PubMed

45.

Jacob T, Baras M, Zeev A, Epstein L (2001) Low back pain: reliability of a set of pain measurement tools. Arch Phys Med Rehabil 82:735–742PubMedCrossRef

46.

Johnson WG, Baldwin ML, Butler RJ (1998) Back pain and work disability: The need for a new paradigm. Ind Relat 37:9–34CrossRef

47.

Karasek R, Theorell T (1990) Healthy work: stress, productivity, and the reconstruction of working life. Basic Books Inc, New York

48.

Karasek RA. Job Content Questionnaire and User’s Guide (1985) Department of Industrial and System Engineering, University of Southern California, Los Angeles

49.

Lackner JM, Carosella AM (1999) The relative influence of perceived pain control, anxiety, and functional self efficacy on spinal function among patients with chronic low back pain. Spine 24:2254–2260PubMedCrossRef

50.

Lackner JM, Carosella AM, Feuerstein M (1996) Pain expectancies, pain, and functional self-efficacy expectancies as determinants of disability in patients with chronic low back disorders. J Consult Clin Psychol 64:212–220CrossRef

51.

Leclerc A, Niedhammer I, Landre MF, Ozguler A, Etore P, Pietri-Taleb F (1999) One-year predictive factors for various aspects of neck disorders. Spine 24:1455–1462PubMedCrossRef

52.

Linton SJ, Hallden K (1998) Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain 14:209–215PubMedCrossRef

53.

Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M (2001) Effect of a self-management program on patients with chronic disease. Eff Clin Pract 4:256–262PubMed

54.

Macfarlane GJ, Thomas E, Croft PR, Papageorgiou AC, Jayson MI, Silman AJ (1999) Predictors of early improvement in low back pain amongst consulters to general practice: the influence of pre-morbid and episode-related factors. Pain 80:113–119PubMedCrossRef

55.

McIntosh G, Frank J, Hogg-Johnson S, Bombardier C, Hall H (2000) Prognostic factors for time receiving workers’ compensation benefits in a cohort of patients with low back pain. Spine 25:147–157PubMedCrossRef

56.

Nickel R, Egle UT, Eysel P, Rompe JD, Zollner J, Hoffmann SO (2001) Health-related quality of life and somatization in patients with long-term low back pain: a prospective study with 109 patients. Spine 26:2271–2277PubMedCrossRef

57.

Niedhammer I, Siegrist J, Landre MF, Goldberg M, Leclerc A (2000) Psychometric properties of the French version of the effort–reward imbalance model. Rev Epidemiol Santé Publique 48:419–437PubMed

58.

Norlund AI, Waddell G (2000) Cost of back pain in some OECD countries. In: Nachemson AL (ed) Neck and back pain: the scientific evidences of causes, diagnosis, and treatment. Lippincott, Williams & Wilkins, Philadelphia, pp 421–425

59.

Picavet HS, Vlaeyen JW, Schouten JS (2002) Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol 156:1028–1034PubMedCrossRef

60.

Rapoport J, Jacobs P, Bell NR, Klarenbach S (2004) Refining the measurement of the economic burden of chronic diseases in Canada. Chronic Dis Can 25:13–21PubMed

61.

Reigo T, Tropp H, Timpka T (2001) Absence of back disorders in adults and work-related predictive factors in a 5-year perspective. Eur Spine J 10:215–220PubMedCrossRef

62.

Reis S, Hermoni D, Borkan JM, Biderman A, Tabenkin C, Porat A (1999) A new look at low back complaints in primary care: a RAMBAM Israeli Family Practice Research Network study. J Fam Pract 48:299–303PubMed

63.

Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144PubMedCrossRef

64.

Rosenstiel AK, Keefe FJ (1983) The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 17:33–44PubMedCrossRef

65.

Rossignol M, Suissa S, Abenhaim L (1992) The evolution of compensated occupational spinal injuries. A three-year follow-up study. Spine 17:1043–1047PubMedCrossRef

66.

Rothman KJ (1990) No adjustments are needed for multiple comparisons. Epidemiology 1:43–46PubMed

67.

Rothman KJ, Greenland SE (1998) Modern epidemiology, 2nd edn. Lippincott Williams & Wilkins, Philadelphia

68.

Schultz IZ, Crook JM, Berkowitz J, Meloche GR, Milner R, Zuberbier OA et al (2002) Biopsychosocial multivariate predictive model of occupational low back disability. Spine 27:2720–2725PubMedCrossRef

69.

Severeijns R, Vlaeyen JW, van den Hout MA, Weber WE (2001) Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. Clin J Pain 17:165–172PubMedCrossRef

70.

Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I et al (2004) The measurement of effort–reward imbalance at work: European comparisons. Soc Sci Med 58:1483–1499PubMedCrossRef

71.

Spitzer WO (1987) Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Report of the task force on spinal disorders. Spine (European ed.) Suppl 1:1–59

72.

Strong J, Ashton R, Chant D (1991) Pain intensity measurement in chronic low back pain. Clin J Pain 7:209–218PubMedCrossRef

73.

Talbot F, Nouwen A, Gauthier J (1996) Is health locus of control a 3-factor or a 2-factor construct? J Clin Psychol 52:559–568PubMedCrossRef

74.

Thomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson MI, Macfarlane GJ (1999) Predicting who develops chronic low back pain in primary care: a prospective study. BMJ 318:1662–1667PubMed

75.

Tubach F, Leclerc A, Landre MF, Pietri-Taleb F (2002) Risk factors for sick leave due to low back pain: a prospective study. J Occup Environ Med 44:451–458PubMedCrossRef

76.

Turner JA, Aaron LA (2001) Pain-related catastrophizing: what is it? Clin J Pain 17:65–71PubMedCrossRef

77.

Valat JP, Goupille P, Vedere V (1997) Low back pain: risk factors for chronicity. Rev Rhum Engl Ed 64:189–194PubMed

78.

Vallerand RJ (1989) Vers une méthode de validation trans-culturelle des questionnaires psychologiques: implications pour la recherche en langue française. Psychol Can 30:662–680CrossRef

79.

van der Giezen AM, Bouter LM, Nijhuis FJ (2000) Prediction of return-to-work of low back pain patients sicklisted for 3–4 months. Pain 87:285–294PubMedCrossRef

80.

van der Weide WE, Verbeek JH, Salle HJ, van Dijk FJ (1999) Prognostic factors for chronic disability from acute low-back pain in occupational health care. Scand J Work Environ Health 25:50–56PubMed

81.

van Tulder MW, Koes BW, Bouter LM (1995) A cost-of-illness study of back pain in The Netherlands. Pain 62:233–240PubMedCrossRef

82.

Vingard E, Alfredsson L, Hagberg M, Kilbom A, Theorell T, Waldenstrom M et al (2000) To what extent do current and past physical and psychosocial occupational factors explain care-seeking for low back pain in a working population? Results from the Musculoskeletal Intervention Center-Norrtalje Study. Spine 25:493–500PubMedCrossRef

83.

Vingard E, Mortimer M, Wiktorin C, Pernold RPTG, Fredriksson K, Nemeth G et al (2002) Seeking care for low back pain in the general population: a two-year follow-up study: results from the MUSIC-Norrtalje Study. Spine 27:2159–2165PubMedCrossRef

84.

Volinn E, Van Koevering D, Loeser JD (1991) Back sprain in industry. The role of socioeconomic factors in chronicity. Spine 16:542–548PubMedCrossRef

85.

Von Korff M, Balderson BH, Saunders K, Miglioretti DL, Lin EH, Berry S et al (2005) A trial of an activating intervention for chronic back pain in primary care and physical therapy settings. Pain 113:323–330PubMedCrossRef

86.

Von Korff M, Barlow W, Cherkin D, Deyo RA (1994) Effects of practice style in managing back pain. Ann Intern Med 121:187–195PubMed

87.

Von Korff M, Saunders K (1996) The course of back pain in primary care. Spine 21:2833–2837PubMedCrossRef

88.

Wacholder S, Hartge P, Lubin JH, Dosemeci M (1995) Non-differential misclassification and bias towards the null: a clarification. Occup Environ Med 52:557–558PubMed

89.

Waddell G, Newton M, Henderson I, Somerville D, Main C (1993) A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168PubMedCrossRef

90.

Wallston KA, Wallston BS, DeVellis R (1978) Development of the multidimensional health locus of control (MHLC) scales. Health Educ Monogr 6:160–170PubMed

91.

Williams DA, Feuerstein M, Durbin D, Pezzullo J (1998) Health care and indemnity costs across the natural history of disability in occupational low back pain. Spine 23:2329–2336PubMedCrossRef

Title: Determinants of “return to work in good health” among workers with back pain who consult in primary care settings: a 2-year prospective study
Authors: Clermont E. Dionne
Renée Bourbonnais
Pierre Frémont
Michel Rossignol
Susan R. Stock
Arie Nouwen
Isabelle Larocque
Eric Demers
Publication date: 01-05-2007
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 5/2007
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-006-0180-2

At a glance: The STEP trials

Springer Medicine

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

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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