Take Home Messages:

Employers can identify workers at increased risk of poor outcomes because of back pain. This can be done by asking about:

• The person’s expectations about their recovery; and
• Fear avoidance beliefs/behaviours.

Understanding a person’s expectations and fears about their back problem – and whether these cause them to avoid activities – can be evaluated through a discussion with the worker.

Why the study matters:

Non-specific low back pain is common. Up to 90% of adults experience low back pain at some stage in their lives. Back pain can prevent a person from working. A small proportion of people do not return to the workforce and this has significant long-term negative consequences: personal, social and economic.

Low back pain costs millions of dollars due to decreased productivity, treatment costs and compensation claims.

Early identification of at-risk individuals is important in lowering the overall burden arising from back pain.

What the study involved:

The authors reviewed relevant research articles on low back pain. A total of 24 studies were analysed.

The research articles examined psychosocial factors affecting failure to return to work. This included:

• Recovery expectations;
• Fear avoidance beliefs/behaviours;
• Depression;
• Stress and anxiety;
• Job satisfaction; and
• Compensation.

Summary of study findings:

Recovery expectation

• Is a strong predictor of return to work.
• Positive recovery expectations were associated with positive health outcomes.
• Realistic expectations of outcome –job/financial security, re-injury, work-place support and self image was associated with earlier return to work.
• Expectations indicate whether psychosocial factors need to be addressed.

Fear avoidance beliefs/behaviours

• Fear of pain can result in avoidance of situations where pain may be induced.
• Pain-related fear leads to increased perceived disability, deconditioning and decreased functional performance.
• Employers should assess fear avoidance beliefs and behaviours early on in treatment.

Factors which do not impact long term disability and failure to return to work are:

• Depression;
• Stress and anxiety;
• Job satisfaction; and
• Compensation.

Employers can identify those who are at increased risk of poor outcomes. This is best done early on in treatment to prevent long term disability.

Original research:

Psychosocial predictors of failure to return to work in non-chronic non-specific low back pain- a systematic review

Iles RA, Davidson M, Taylor NF.
Occup Environ Med. 2008 Aug;65(8):507-17. Epub 2008 Apr 16.

Link to Pubmed abstract