Determinants of "return to work in good health" among workers with back pain who consult in primary care settings: a 2-year prospective study

Abstract

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of "return to work in good health" (RWGH--a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of "success" in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of "failure" in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.

Fig. 1

Evolution of “return to work in good health” among the study participants

Fig. 2

Schematization of relations between variables of the final multivariate model among women and the 2-year “return to work in good health” categories. The “success” category constituted the reference group. Modifiable determinants are preceded by an asterisk (*). Risk factors are identified with (R), while protective factors are identified with (P)

Fig. 3

Schematization of relations between variables of the final multivariate model among men and the 2-year “return to work in good health” categories. The “success” category constituted the reference group. Modifiable determinants are preceded by an asterisk (*). Risk factors are identified with (R), while protective factors are identified with (P)