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Comparison of risk factors predicting return to work between patients with subacute and chronic non-specific low back pain: systematic review

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Abstract

The objective of the study was to provide an inventory of predictive instruments and their constituting parameters associated with return to work in patients with subacute (2–10 weeks pain duration) and chronic (10–24 weeks pain duration) non-specific low back pain (NSLBP). Data sources included systematic review in Medline, Embase, Cinahl, Central, PEDro, Psyndex, PsychInfo/PsycLit, and Sociofile up to September 2008, in reference lists of systematic reviews on risk factors, and of included studies. For the systematic review, two reviewers independently assessed study eligibility and quality, and extracted data. Disagreements were resolved by consensus. Risk factors were inventorised and grouped into a somatic and psychosocial domain. 23 studies reporting on subacute and 16 studies reporting on chronic patients were included. The studies on subacute patients reported on a total of 56 biomedical factors out of which 35 (63%) were modifiable and 61 psychosocial factors out of which 51 (84%) were modifiable. The corresponding values in studies on chronic patients were 44 biomedical [27 (62%) modifiable] and 61 [40 (66%) modifiable] respectively. Our data suggest that the interdisciplinary approach in patients at risk to develop persistent NSLBP is justified in both, the subacute and chronic disease stages. Psychosocial interventions might be more effective in subacute stages since a higher proportion of modifiable risk factors were identified in that group.

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References

  1. Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain? JAMA 268:760–765. doi:10.1001/jama.268.6.760

    Article  CAS  PubMed  Google Scholar 

  2. Waddell G (2004) The back pain revolution. Churchill Livingstone, Edinburgh

    Google Scholar 

  3. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G (2006) European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15(Suppl 2):S192–S300. doi:10.1007/s00586-006-1072-1

    Article  PubMed  Google Scholar 

  4. Koes BW, van Tulder MW, Ostelo R, Kim Burton A, Waddell G (2001) Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine 26:2504–2513. doi:10.1097/00007632-200111150-00022 discussion 2513-2504

    Article  CAS  PubMed  Google Scholar 

  5. Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, Charlot J, Dreiser RL, Legrand E, Rozenberg S, Vautravers P (2000) The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine 25:1S–33S. doi:10.1097/00007632-200002151-00001

    Article  CAS  PubMed  Google Scholar 

  6. Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B (2003) Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Cochrane Database Syst Rev CD002193

  7. Undertaking systematic reviews of research on effectiveness: CRD’s guidance for those carrying out or commissioning reviews In: CRD (ed). Center for Reviews and Dissemination, York, UK

  8. Altman D, Egger M, Gotzsche P, Pocock S, Vandenbroucke J, von Elm E (2007) In: STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). http://www.strobe-statement.org. Assessed 14 April 2009

  9. Dionne CE, Bourbonnais R, Fremont P, Rossignol M, Stock SR, Larocque I (2005) A clinical return-to-work rule for patients with back pain. CMAJ 172:1559–1567. doi:10.1503/cmaj.1041159

    PubMed  Google Scholar 

  10. Dionne CE, Bourbonnais R, Fremont P, Rossignol M, Stock SR, Nouwen A, Larocque I, Demers E (2007) Determinants of “return to work in good health” among workers with back pain who consult in primary care settings: a 2-year prospective study. Eur Spine J 16:641–655. doi:10.1007/s00586-006-0180-2

    Article  PubMed  Google Scholar 

  11. Faber E, Burdorf A, Bierma-Zeinstra SM, Miedema HS, Koes BW (2006) Determinants for improvement in different back pain measures and their influence on the duration of sickness absence. Spine 31:1477–1483. doi:10.1097/01.brs.0000219873.84232.26

    Article  PubMed  Google Scholar 

  12. Hagen EM, Svensen E, Ericksen HR (2005) Predictors and modifiers of treatment effect influencing sick leave in subacute low back pain patients. Spine 30:2717–2723. doi:10.1097/01.brs.0000190394.05359.c7

    Article  PubMed  Google Scholar 

  13. Heymans MW, De Vet HCW, Knol DL, Bongers PM, Koes BW, Van Mechelen W (2006) Workers’ beliefs and expectations affect return to work 0ver 12 months. J Occup Rehabil 16:685–695. doi:10.1007/s10926-006-9058-8

    Article  PubMed  Google Scholar 

  14. Heymans MW, Anema JR, van Buuren S, Knol DL, van Mechelen W, de Vet HCW (2007) Return to work in a cohort of low back pain patients: development and validation of a clinical prediction rule. Ned Tijdschr Voor Fysiotherapie 117:199–206 Dutch

    Google Scholar 

  15. Hunt DG, Zuberbier OA, Kozlowski AJ, Berkowitz J, Schultz IZ, Milner RA, Crook JM, Turk DC (2002) Are components of a comprehensive medical assessment predictive of work disability after an episode of occupational low back trouble? Spine 27:2715–2719. doi:10.1097/00007632-200212010-00011

    Article  PubMed  Google Scholar 

  16. Loisel P, Vachon B, Lemaire J, Durand MJ, Poitras S, Stock S, Tremblay C (2002) Discriminative and predictive validity assessment of the Quebec task force classification. Spine 27:851–857. doi:10.1097/00007632-200204150-00013

    Article  PubMed  Google Scholar 

  17. Lotters F, Burdorf A (2006) Prognostic factors for duration of sickness absence due to musculoskeletal disorders. Clin J Pain 22:212–221. doi:10.1097/01.ajp.0000154047.30155.72

    Article  PubMed  Google Scholar 

  18. Öhlund C, Lindstroem I, Eek C, Areskoug B, Nachemson A (1996) The causality field (extrinsic and intrinsic factors) in industrial subacute low back pain patients. Scand J Med Sci Sports 6:98–111

    PubMed  Google Scholar 

  19. Okurowski L, Pransky G, Webster B, Shaw WS, Verma S (2003) Prediction of prolonged work disability in occupational low-back pain based on nurse case management data. J Occup Environ Med 45:763–770. doi:10.1097/01.jom.0000079086.95532.e9

    Article  PubMed  Google Scholar 

  20. Pransky GS, Verma SK, Okurowski L, Webster B (2006) Length of disability prognosis in acute occupational low back pain: development and testing of a practical approach. Spine 31:690–697. doi:10.1097/01.brs.0000202761.20896.02

    Article  PubMed  Google Scholar 

  21. Prkachin KM, Schultz IZ, Hughes E (2007) Pain behavior and the development of pain-related disability: the importance of guarding. Clin J Pain 23:270–277. doi:10.1097/AJP.0b013e3180308d28

    Article  PubMed  Google Scholar 

  22. Shaw WS, Means-Christensen A, Slater MA, Patterson TL, Webster JS, Atkinson J (2007) Shared and independent associations of psychosocial factors on work status among men with subacute low back pain. Clin J Pain 23:409–416. doi:10.1097/AJP.0b013e31804eff30

    Article  PubMed  Google Scholar 

  23. Schultz IZ, Crook J, Meloche GR, Berkowitz J, Milner R, Zuberbier OA, Meloche W (2004) Psychosocial factors predictive of occupational low back disability: towards development of a return-to-work model. Pain 107:77–85. doi:10.1016/j.pain.2003.09.019

    Article  CAS  PubMed  Google Scholar 

  24. Schultz IZ, Crook J, Berkowitz J, Milner R, Meloche GR (2005) Predicting return to work after low back injury using the Psychosocial Risk for Occupational Disability instrument: a validation study. J Occup Rehabil 15:365–376. doi:10.1007/s10926-005-5943-9

    Article  CAS  PubMed  Google Scholar 

  25. Soucy I, Truchon M, Cote D (2006) Work-related factors contributing to chronic disability in low back pain. Work 26:313–326

    PubMed  Google Scholar 

  26. Truchon M, Cote D (2005) Predictive validity of the chronic pain coping inventory in subacute low back pain. Pain 116:205–212. doi:10.1016/j.pain.2005.04.003

    Article  PubMed  Google Scholar 

  27. Turner JA, Franklin G, Fulton-Kehoe D, Sheppard L, Wickizer TM, Wu R, Gluck JV, Egan K (2006) Worker recovery expectations and fear-avoidance predict work disability in a population-based workers’ compensation back pain sample. Spine 31:682–689. doi:10.1097/01.brs.0000202762.88787.af

    Article  PubMed  Google Scholar 

  28. Turner JA, Franklin G, Fulton-Kehoe D, Sheppard L, Stover BD, Wu R, Gluck JV, Wickizer TM (2008) ISSLS prize winner: early predictor of chronic work disability. A prospective, population-based study of workers with back injuries. Spine 33:2809–2818. doi:10.1097/BRS.0b013e31817df7a7

    Article  PubMed  Google Scholar 

  29. van der Weide WE, Verbeek JH, Salle HJ, van Dijk FJ (1999) Prognostic factors for chronic disability from acute low-back pain in occupational health care. Scand J Work Environ Health 25:50–56

    PubMed  Google Scholar 

  30. van der Weide WE, Verbeek JH, van Dijk FJ (1999) Relation between indicators for quality of occupational rehabilitation of employees with low back pain. Occup Environ Med 56:488–493. doi:10.1136/oem.56.7.488

    Article  PubMed  Google Scholar 

  31. Weber A, Wilhelm M, Weber U, Raspe H (1998) Is the subjective health status a good predictor of work resumption? Soz Praventivmed 43:177–184. doi:10.1007/BF01349247

    Article  CAS  PubMed  Google Scholar 

  32. Bloch FSPR (2001) Who returns to work & why? A six-country study on work incapacity & reintegration. Transaction Publishers, New Brunswick, London

  33. Bradish CF, Lloyd GJ, Aldam CH, Albert J, Dyson P, Doxey NC, Mitson GL (1988) Do nonorganic signs help to predict the return to activity of patients with low-back pain? Spine 13:557–560. doi:10.1097/00007632-198805000-00021

    Article  CAS  PubMed  Google Scholar 

  34. Haldorsen EMH, Indahl A, Ursin H (1998) Patients with low back pain not returning to work: a 12-month follow-up study… including commentary by Waddell G. Spine 23:1202–1208. doi:10.1097/00007632-199806010-00004

    Article  CAS  PubMed  Google Scholar 

  35. Haldorsen EMH, Kronholm K, Skouen JS, Ursin H (1998) Predictors for outcome of a multi-modal cognitive behavioural treatment program for low back pain patients—a 12-month follow-up study. Eur J Pain 2:293–307. doi:10.1016/S1090-3801(98)90028-3

    Article  PubMed  Google Scholar 

  36. Hansson TH, Hansson EK (2000) The effects of common medical interventions on pain, back function, and work resumption in patients with chronic low back pain: a prospective 2-year cohort study in six countries. Spine 25:3055–3064. doi:10.1097/00007632-200012010-00013

    Article  CAS  PubMed  Google Scholar 

  37. Indahl A, Haldorsen EH, Holm S, Reikeras O, Ursin H (1998) Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain. Spine 23:2625–2630. doi:10.1097/00007632-199812010-00018

    Article  CAS  PubMed  Google Scholar 

  38. Indahl A, Velund L, Reikeraas O (1995) Good prognosis for low back pain when left untampered. A randomized clinical trial. Spine 20:473–477

    Article  CAS  PubMed  Google Scholar 

  39. Lancourt J, Kettelhut M (1992) Predicting return to work for lower back pain patients receiving worker’s compensation. Spine 17:629–640. doi:10.1097/00007632-199206000-00002

    Article  CAS  PubMed  Google Scholar 

  40. Storheim K, Brox JI, Holm I, Bo K (2005) Predictors of return to work in patients sick listed for sub-acute low back pain: a 12-month follow-up study. J Rehabil Med 37:365–371. doi:10.1080/16501970510040344

    Article  PubMed  Google Scholar 

  41. van der Giezen AM, Bouter LM, Nijhuis FJ (2000) Prediction of return-to-work of low back pain patients sicklisted for 3–4 months. Pain 87:285–294. doi:10.1016/S0304-3959(00)00292-X

    Article  PubMed  Google Scholar 

  42. Weber ARH (1998) Abschlussbericht zum deutschen Teil der internationalen ISSA-Studie “Work Incapacity and Reintegration”

  43. Waddell G, Burton AK, Main CJ (2003) Screening to identify people at risk of long-term incapacity for work. The Royal Society of Medicine Press Limited, London

    Google Scholar 

  44. Hayden JA, Chou R, Hogg-Johnson S, Bombardier C (2009) Systematic reviews of low back pain prognosis had variable methods and results-guidance for future prognosis reviews. J Clin Epidemiol [Epub ahead of print]

  45. Wyatt JC, Altman DG (1995) Commentary: prognostic models: clinically usefull or quickly forgotten? Br Med J 311:1539–1541

    Google Scholar 

  46. Vergouwe Y, Steyerberg EW, Eijkemans MJ, Habbema JD (2005) Substantial effective sample sizes were required for external validation studies of predictive logistic regression models. J Clin Epidemiol 58:475–483. doi:10.1016/j.jclinepi.2004.06.017

    Article  PubMed  Google Scholar 

  47. Altman DG, Royston P (2000) What do we mean by validating a prognostic model? Stat Med 19:453–473. doi:10.1002/(SICI)1097-0258(20000229)19:4<453::AID-SIM350>3.0.CO;2-5

    Article  CAS  PubMed  Google Scholar 

  48. Laupacis A, Sekar N, Stiell IG (1997) Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA 277:488–494. doi:10.1001/jama.277.6.488

    Article  CAS  PubMed  Google Scholar 

  49. Justice AC, Covinsky KE, Berlin JA (1999) Assessing the generalizability of prognostic information. Ann Intern Med 130:515–524

    CAS  PubMed  Google Scholar 

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Correspondence to Florian Brunner.

Additional information

C. A. M. Heitz and R. Hilfiker equally contributed to this work.

Appendix

Appendix

Quality assessment form

  1. 1.

    Were the hypothesis/aim/objective of the study clearly described (prognostic)?

  2. 2.

    Were the patients enrolled consecutive?

  3. 3.

    Were the main characteristics of the included patients in the study clearly described?

  4. 4.

    Was the response rate at baseline at least 80% of the possibly eligible patients?

  5. 5.

    Were the psychosocial data collected with validated instruments?

  6. 6.

    Were data on physical workload collected?

  7. 7.

    Was a clear definition of non-specific low back pain used?

  8. 8.

    Was the treatment standardized?

  9. 9.

    Were prognostic factors that were assessed addressed by treatment?

  10. 10.

    Statistical adjustment for important prognostic factors?

  11. 1.

    Were the statistical methods adequately described?

  12. 11.

    Was the outcome clearly defined?

  13. 12.

    Were the outcome measures available for at least 80% of the included patients?

  14. 13.

    Was the model cross validated in a group of patients different from the group in which it was derived, preferably with different clinicians?

  15. 14.

    Was there a serious methodological flaw not covered by the check-list?

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Heitz, C.A.M., Hilfiker, R., Bachmann, L.M. et al. Comparison of risk factors predicting return to work between patients with subacute and chronic non-specific low back pain: systematic review. Eur Spine J 18, 1829–1835 (2009). https://doi.org/10.1007/s00586-009-1083-9

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  • DOI: https://doi.org/10.1007/s00586-009-1083-9

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