Predicting Return to Work for Workers with Low-Back Pain

Scientists at the Institute for Work & Health (IWH) investigated the idea of predicting return to work (RTW) for workers with low-back pain (LBP). The objective of this study was to assess the evidence on factors from different domains that predict the duration of sick leave in workers in the beginning of a LBP-related sick leave episode. A systematic review was done in which the IWH scientists identified the studies that looked at prognostic factors associated with time until RTW for workers with LBP, covering studies published in the time frame from January 1966 to April 2011. (This work represents an update on an earlier 2005 review.) Thirty papers from 25 different studies met all of the inclusion criteria. (Eleven were articles captured in the earlier review, and 19 were published after the 2005 review.) The team assessed the methodological quality of the studies that were included. The team found five general factors with strong evidence for returning to work: recovery expectations; healthcare provider type; self-reported disability; pain intensity; and radiating pain. Additionally, workplace-specific factors predictive of RTW were physical demands; accommodation and modified duties; and job satisfaction. The study also found factors that did not predict RTW and factors with mixed evidence. The scientists discussed the review with practitioners in a knowledge transfer workshop. The findings of this systematic review can be used to develop an approach for identifying at-risk workers with LBP, or more specifically, those workers in the early stages of work disability from LBP at high risk for poor RTW outcomes. Practitioners could prioritise and allocate resources based on this new information. The factors identified in this review could be used to screen those workers at high risk of long-term or permanent disability. From these findings a screening tool could be developed, although such a tool would require validation to obtain reliable risk estimates. However, applying this new knowledge in practice should be executed in a structured way. The effectiveness of choosing interventions for workers with LBP based on prognostic information for RTW needs to be established and therefore applying this approach should be done with care.