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The prognostic value of depressive symptoms, fear-avoidance, and self-efficacy for duration of lost-time benefits in workers with musculoskeletal disorders
  1. F Lötters1,
  2. R-L Franche2,
  3. S Hogg-Johnson2,
  4. A Burdorf1,
  5. J D Pole2
  1. 1Department of Public Health, University Medical Center Rotterdam, Netherlands
  2. 2Institute for Work & Health, Toronto, Ontario, Canada
  1. Correspondence to:
 Dr F Lötters
 AStri Research & Consultancy, Stationsweg 26, 2312 AV Leiden, Netherlands; f.lotters{at}


Background: The psychological factors of depressive symptoms, fear-avoidance, and self-efficacy are deemed to be important in the work disability process. However, the prognostic value of these factors for time on benefit is not well understood.

Aims: To analyse the prognostic value of psychological factors for the number of days on total compensation benefit over a 12 month period.

Methods: In a longitudinal study of 187 workers receiving total compensation benefits due to musculoskeletal disorders, the prognostic value of psychological factors measured 4–5 weeks post-injury for duration on total compensation benefit over 12 months was analysed. Cox proportional hazard regression analyses were conducted. Special emphasis was given to variable selection and to the analysis of confounding effects of potential prognostic variables.

Results: The final model indicated that increased depressive symptoms and poorer physical health significantly increase the number of days on total benefit. Confounders included in the final model were pain and fear of income loss. In the final model the impact of fear-avoidance ceased to be significant when work related variables were included in the fully adjusted model. This illustrates that interrelationships between variables must be taken into account when building multivariate prognostic models. The addition of work related variables to the model did not result in any major changes in the adjusted model, which suggests that when measured 4–5 weeks post-injury, psychological and physical health factors are strong predictors of time on benefits, while work conditions are less important.

Conclusion: Results suggest that the presence of depressive symptoms and poor physical health in workers on benefit due to musculoskeletal disorders increases the number of days on total compensation benefits significantly, when controlling for confounding variables.

  • MSD, musculoskeletal disorder
  • RTW, return to work
  • WSIB, Workplace Safety & Insurance Board
  • musculoskeletal disorders
  • return to work
  • psychological factors
  • confounding effects

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  • Published Online first 27 April 2006

  • Funding: this project was partly funded by the Work Disability Prevention CIHR Training Program of the University of Sherbrooke, Quebec, Canada

  • Competing interests: none declared

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