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Differences in sustainable return to work after chronic low back pain between countries are mainly due to differences in workplace interventions. 

Work interventions and job characteristics had greater impact on rates of sustainable return to work than medical interventions or the characteristics of the participant.

Work interventions associated with higher return to work rates are:

• Adaptation of the workplace;
• Job alteration to fit the abilities of the worker;
• A change in working hours; and
• Continuing benefits after the participant returns to work.

Job characteristics associated with higher return to work rates are:

• A greater ability of the worker to complete their workplace tasks;
• Less physical demands in the workplace; and
• Less stressful work.

Countries with less strict eligibility criteria for long term disability benefits also had higher sustainable return to work rates.

The researchers recommended that individual packages of work interventions and flexible (partial) disability benefits should be adapted to the individual in order to prevent workplace disability due to low back pain.

Why the research matters

There are significant differences in disability benefits for occupational low back pain between different countries. There are also many differences in disability policies.  A comparison of the outcomes for workers related to different policies may enable policy-makers to reassess the effectiveness of their own disability policies.

What the research involved
Data was collected from six similarly designed studies, conducted in Denmark, Germany, Israel, the Netherlands, Sweden, and the United States. The studies involved a two year follow up of people off work for 3-4 months due to low back pain.  The six studies had a combined total of 2,825 participants. Information was collected from participants via questionnaires at three months and then one and two years after the start of sick leave.  The main outcome assessed by the studies was duration until permanent return to work.

Summary of research findings

The study found:

• Medical and work interventions for people with low back pain varied considerably between countries;
  • Participants from the USA had the highest rates of surgery (35.1%);
  • Participants from Israel and Denmark had the highest rates of pain relieving medication usage (86.9 and 78.9%, respectively);
  • Participants from Germany had the highest rates of passive treatment and manipulation (41.7%);
  • Participants from the USA and the Netherlands most frequently underwent exercise therapy (63.0%); and
  • Participants from Germany and Denmark had the highest rates of back schools (28%);
• Sustainable return to work, defined as those who were still working at the end of the two year period, ranged from 22% of German participants to up to 62% of Dutch participants;
• Work interventions and job characteristics had greater impact on rates of sustainable return to work than medical interventions or the characteristics of the participant;
  • Work interventions associated with higher return to work rates were adaptation of the workplace, job alteration to fit the abilities of the worker, a change in working hours, and continuing benefits after the participant had returned to work; and
  • Job characteristics associated with higher return to work rates were a greater ability of the worker to complete their workplace tasks, less physical demands in the workplace and less stressful work;
• Differences between countries in eligibility criteria for entitlement to long-term and/or partial disability benefits also contributed to the differences in rates of sustainable return to work:
  • Countries with less strict criteria had higher sustainable return to work rates.

The study recommended that individual packages of work interventions and flexible (partial) disability benefits should be adapted to the individual in order to prevent workplace disability due to low back pain.

Original research

Can cross country differences in return-to-work after chronic occupational back pain be explained? An exploratory analysis on disability policies in a six country cohort study.
Anema JR, Schellart AJ, Cassidy JD, Loisel P, Veerman TJ, van der Beek AJ.
J Occup Rehabil. 2009 Dec;19(4):419-26.

Link to PubMed abstract