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Expectations for Return to Work Predict Return to Work in Workers with Low Back Pain: An Individual Participant Data (IPD) Meta-Analysis

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Abstract

Purpose Low back pain is associated with disability and lost productivity due to inability of workers to return to work. Personal recovery expectation beliefs may be associated with return to work outcomes in those with low back pain at high risk for chronic disability. We aimed to (1) assess whether workers’ expectations for return to work, following a low back pain episode, are associated with subsequent return to work; and (2) explore the relationships between return to work expectations and other prognostic factors in their association with work outcomes.

Methods We conducted an Individual Participant Data (IPD) meta-analysis using data from five prospective cohort studies identified by a Cochrane prognostic factor review. A one-stage IPD meta-analysis approach was applied. Multi-level mixed effects models were used to determine the unadjusted and adjusted associations between expectations and return to work (logistic regression) and time to return to work (parametric survival models with Weibull distribution).

Results The final dataset included 2302 participants. Positive expectations for return to work were associated with return to work at follow-up in both unadjusted (Odds Ratio (OR) 2.95; 95% Confidence Interval (CI) 2.21, 3.95) (n = 2071) and comprehensively adjusted (OR 2.01; 95% CI 1.46, 2.77) (n = 1109) models. Similar findings were identified for shorter length of time to return to work in both unadjusted (HR 2.40; 95% CI 2.09, 2.75) (n = 1156) and minimally adjusted (HR 2.43; 95% CI 2.12, 2.79) (n = 1154) models.

Conclusions Results suggest workers with low expectations for return to work are at increased risk for long-term work disability.

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Data Availability

Data used for analyses in this study were used under a data sharing agreement license and are not publicly available. Restrictions apply to the availability of the primary study datasets. They may be available from primary study authors upon reasonable request and with permission of the appropriate institutions’ ethics review board.

Code Availability

Not Applicable.

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Acknowledgements

The study authors would like to acknowledge those researchers involved in the design, data collection, analyses, manuscript development and publication for all included primary studies. We would like to acknowledge the contributions of Andrea Smith in the initial development and design of this study, as well as her identification of studies eligible for inclusion. We thank Rachel Ogilvie for her input and feedback on the study protocol. Victoria Sullivan received funding to support this project through the Dalhousie Faculty of Medicine Gladys Osman Studentship. The funding body was not involved in the design of the study.

Funding

Victoria Sullivan received funding to support this project through the Dalhousie Faculty of Medicine Gladys Osman Studentship. The funding body was not involved in the design of the study. Funding sources for the primary studies included in this IPD meta-analysis are available in the respective publications.

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Authors and Affiliations

  1. Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada

    Victoria Sullivan, Maria N. Wilson & Jill A. Hayden

  2. Department of Physical Therapy, University of Alberta, Edmonton, Canada

    Douglas P. Gross

  3. Spine Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark

    Ole Kudsk Jensen

  4. Division of Occupational and Environmental Medicine, Departments of Medicine and Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA

    William S. Shaw

  5. Epidemiologist, Director Program Evaluation & Research Outcomes, LifeWorks, Toronto, ON, Canada

    Ivan A. Steenstra

  6. Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada

    Victoria Sullivan

Authors
  1. Victoria Sullivan
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  2. Maria N. Wilson
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  3. Douglas P. Gross
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  4. Ole Kudsk Jensen
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  5. William S. Shaw
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Contributions

VS and JH designed the project. VS developed the initial study protocol with direction and input from JH and MW. MW provided methodological and logistical contributions, as well as data analyses and interpretation. DG, OKJ, WS and IS reviewed, prepared, and provided interpretation of raw primary datasets. VS, MW and JH were involved in the initial development of the manuscript. All authors assisted in the development and review of the final version of the study manuscript. All authors confirmed agreement with the final manuscript.

Corresponding author

Correspondence to Victoria Sullivan.

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Conflict of interest

Douglas Gross declares that the primary study, from which we utilized data for this project, was funded by the Workers’ Compensation Board of Alberta. The remainder of the study authors report that they do not have conflicts of interest to declare.

Ethical Approval

Approval was obtained from The Health Sciences Research Ethics Board at Dalhousie University, Halifax, NS. The board found that the proposed research was in accordance with the Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans. Where necessary, primary study authors also sought approval for data sharing from their respective institutions’ ethics review boards. Procedures in our study adhere to the tenets of the Declaration of Helsinki.

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Where appropriate, informed consent was obtained from individual participants included in the primary studies.

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Sullivan, V., Wilson, M.N., Gross, D.P. et al. Expectations for Return to Work Predict Return to Work in Workers with Low Back Pain: An Individual Participant Data (IPD) Meta-Analysis. J Occup Rehabil 32, 575–590 (2022). https://doi.org/10.1007/s10926-022-10027-w

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