Systematic Review of Prognostic Factors for Return to Work in Workers with Sub Acute and Chronic Low Back Pain

Abstract

Purpose We systematically reviewed the evidence on factors that predict duration of sick leave in workers after 6 weeks low back pain (LBP) related sick leave. We hypothesized that different factors affect the duration of the leave depending on the time away from work. Methods The review occurred in seven phases: (1) developing the central question, (2) conducting the literature search, (3) identifying relevant publications, (4) quality appraisal, (5) data extraction, (6) evidence synthesis, and (7) knowledge translation. We searched for studies that reported episodes of LBP and sick leave that lasted more than 6 weeks. All included studies reported at least one prognostic factor where return to work was the outcome. Results We identified twenty-two relevant publications. The impact of pain, functional status and radiating pain seems to change with duration of work disability. Workers’ recovery expectations remain important after 6 weeks. Modified duties are rarely studied in later phases of work disability. Depression/mental health did not appear to be an important factor in later phases. Workplace physical factors remain important. There is insufficient evidence that pain catastrophising and fear avoidance are predictive factors in later phases. There was moderate evidence for age in the later phases. Functional capacity and claim related factors were supported by some evidence. Discusion Physical demands in the workplace are preventing workers from getting back to work in a timely fashion across phases. The psychosocial work environment is understudied in later phases. Overall, we cannot conclude that prognostic factors change over time.Electronic supplementary materialThe online version of this article (doi:10.1007/s10926-016-9666-x) contains supplementary material, which is available to authorized users.

Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective

“…Nurses with a full work capacity had a 77% higher trunk extension endurance compared to those with work modifications due to CLBP . Furthermore, a systematic review showed that functional status and physical demands may be important prognostic factors impeding return to work in those with CLBP . Even though causality between CLBP and muscle function cannot be determined, improving trunk muscle endurance may provide important training specificity, since it closely relates to occupational demands .…”

“…Even though causality between CLBP and muscle function cannot be determined, improving trunk muscle endurance may provide important training specificity, since it closely relates to occupational demands . Periods of time away from work may lead to deconditioning towards work‐related tasks, and therefore may need to be improved to assist with task completion and return to work . Adequate levels of trunk endurance and overall strength appear to assist with ADLs and could be a prognostic factor for return to work, and should be considered in those with CLBP with high physical requirements.…”

The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review

“…The reference lists of included studies and related systematic reviews [22,[31][32][33][34][35][36] will be searched. Citation searching of questionnaires for depressive symptoms that have been utilized in LBP populations will also be conducted: Center for Epidemiologic Studies Depression Scale, Beck Depression Index, Patient Health Questionnaire-9, and Depression Scale of the Hospital Anxiety and Depression Scale.…”

“…To our best knowledge, a systematic review examining the impact of depressive symptoms and depression on health care utilization in adults with LBP has not been previously conducted. Previous systematic reviews examining depressive symptoms and depression as prognostic factors affecting clinical or work-related outcomes for LBP require updating, as literature searches were completed before or up to early 2016 [22,[31][32][33][34][35][36]. Of these, the reviews with most recent literature searches were conducted by Alhowimel [22].…”

Return to Work of Patients Treated With Spinal Cord Stimulation for Chronic Pain: A Systematic Review and Meta-Analysis

“…The high socioeconomic burden and healthcare utilization associated with chronic pain are therefore often reduced to secondary outcomes . When pain becomes chronic, return to work (RTW) is negatively associated with a delay in referral to treatment, socioeconomic status, attorney involvement, and worker's compensation are . Several studies have shown that unemployment and absenteeism are “negatively associated with quality of life, depression and generally poor health outcomes” .…”