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

Abstract

Abstract

Objectives To identify psychosocial predictors of failure to return to work in non-chronic (lasting less than three months) non-specific low back pain (NSLBP).

Methods A systematic review of prognostic studies was performed. Medline, Embase, PsychINFO, CINAHL and PEDro electronic bibliographic databases up to April 2006 were searched. Included studies took baseline measures in the non-chronic phase of NSLBP (i.e. within 3 months of onset), included at least one psychosocial variable and studied a sample with at least 75% of participants with NSLBP. Baseline measures had to be used to predict at least one work-specific outcome.

Results The search identified 24 studies meeting the inclusion criteria. From these studies there is strong evidence that recovery expectation is predictive of work outcome and that depression, job satisfaction and stress/psychological strain are not predictive of work outcome. There is moderate evidence that fear avoidance beliefs are predictive of work outcome and that anxiety is not predictive of work outcome. There is insufficient evidence to determine whether compensation or locus of control are predictive of work outcome.

Conclusions To predict work outcome in non-chronic NSLBP, psychosocial assessment should focus on recovery expectation and fear avoidance. More research is needed to determine the best method of measuring these constructs and to determine how to intervene when a worker has low recovery expectations. Key words: low back pain, prognosis, sick leave, psychosocial, review