It’s a tool for predicting long term disability in injured workers, developed by Linton et al in 1998.

The longer form questionnaire contains 24 questions, while the short form contains 10 or sometimes 12. 

The 10 question Orebro covers:

1. The length of time the current pain problem has been experienced
2. Pain rating during the past week
3. The degree to which pain prevents doing light work for an hour
4. Ability to sleep
5. Degree of tension or anxiety in the past week
6. Degree of feeling depressed in the past week
7. Perception of risk that the pain may become persistent
8. The chance of a return to work in normal duties within three months
9. The degree to which pain indicates that the activity stops
10. The level of agreement that the worker’s normal job not be conducted with the present pain

Each of the questions has a scoring system, and these are added to provide a total score out of 100. A score over 50 in the 10-question Orebro indicates that the worker may be at high risk of extended disability. It has been shown to accurately predict long term disability in 85% of cases.

In an Australian pilot project conducted by Dr Gary Pearce and Andrew McGarity at the Concord Hospital (2005 to 2007), an abbreviated version of the Orebro was used on a control group and intervention group, each comprising 80 people. They found that high risk injured workers could be identified within 48 hours of the injury occurring. When interventions were provided to the intervention group high risk cases, there were overall savings of 25% compared to the control group.

Professor Michael Nicholas, PhD MAPS FPMANZCA, from the Pain Management Research Institute at the University of Sydney explored the problem of how to identify high risk cases. In many situations, early intervention is unnecessary and the injured worker returns to the workplace. In other cases however, the injury is high risk and may result in a far longer absence from the workplace. He believes that through early identification, injured workers at high risk may be assisted to return to work earlier.

Professor Nicholas’s study looked at work-related significant soft tissue injuries which did not require surgery, and the short form Orebro was conducted via telephone. 580 people participated in the study, with 214 from the control hospital and 366 from the intervention hospital. They had an average age of 45 and 80% were female. The injury sites were predominantly back, lower limbs and upper limbs.

He found that after 18 months, the intervention group averaged $16,000 in cost while the control group averaged $20,000 in cost. There was an average saving of 22% through providing early interventions.  Psychology interventions were found to be particularly effective, although only 50% took up the option of seeing a psychologist.  

How can the Orebro be used in RTW?

While not completely fail safe, the Orebro Musculoskeletal Questionnaire can assist case managers, RTW coordinators and rehabilitation providers to determine early which injured workers require additional assistance to return to the workplace. By providing this assistance, workers may be able to return to the workplace earlier.

Common interventions might include:

• Physiotherapy
• Psychology treatment
• Engaging rehabilitation providers
• Ergonomic changes

An additional benefit of the Orebro is that it can be conducted in a variety of ways. 

• In person
• Over the telephone
• Electronically
• Via post

An iPad app is also available for US$2.99 which may prove to be useful. 

The short form Orebro can also be conducted very quickly and is therefore time efficient.

An example of the Orebro Musculoskeletal Questionnaire can be found here.