Journal of Occupational Rehabilitation

, Volume 15, Issue 3, pp 377–392 | Cite as

Secondary Prevention of Work Disability: Community-Based Psychosocial Intervention for Musculoskeletal Disorders

  • Michael J. L. Sullivan
  • L. Charles Ward
  • Dean Tripp
  • Douglas J. French
  • Heather Adams
  • William D. Stanish
Article

Abstract

Introduction: One objective of the present research was to examine the degree to which psychological risk factors could be reduced through participation in a community-based psychosocial intervention for work-related musculoskeletal disorders. A second objective was to examine whether psychosocial risk reduction had an effect on the probability of return to work. Methods: Participants were 215 Workers Compensation Board claimants with work-related musculoskeletal disorders who had been absent from work for an average of approximately 7 months (M = 28.8 weeks, range = 4–100 weeks) and were referred to a community-based multidisciplinary secondary prevention program in Nova Scotia, Canada. Results: In the current sample, 63.7% of participants returned to work within 4 weeks of treatment termination. The percentage reductions in targeted risk factors from pretreatment to posttreatment were as follows: catastrophizing (32%), depression (26%), fear of movement/re-injury (11%), and perceived disability (26%). Logistic regression indicated that elevated pretreatment scores on fear of movement and re-injury (OR = 0.58, 95% CI = 0.35–0.95) and pain severity (OR = 0.64, 95% CI = 0.43–0.96) were associated with a lower probability of return to work. A second logistic regression addressing the relation between risk factor reduction and return to work revealed that only reductions in pain catastrophizing (OR = 0.17, 95% CI = 0.07–0.46) were significant predictors of return to work. Conclusions: The results of the present study provide further evidence that risk factor reduction can impact positively on short term return to work outcomes. Significance: Outcomes of rehabilitation programs for work disability might be improved by incorporating interventions that specifically target catastrophic thinking. Community-based models of psychosocial intervention might represent a viable approach to the management of work disability associated with musculoskeletal disorders.

Keywords

psychosocial risk factors occupational disability secondary prevention catastrophizing rehabilitation work-related musculoskeletal disorders return to work 

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References

  1. 1.
    Gatchel RJ, Polatin PB, Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low back disability. Spine 1995; 20: 2701–2709.Google Scholar
  2. 2.
    Feuerstein M, Berkowitz SM, Huang GD. Predictors of occupational low back disability: Implications for secondary prevention. J Occup Environ Med 1999; 41: 1024–1031.PubMedGoogle Scholar
  3. 3.
    Waddell G. The back pain revolution. Edinburg: Churchill Livingstone, 1998.Google Scholar
  4. 4.
    Gatchel RJ. Musculoskeletal disorders: primary and secondary interventions. J Electrom Kinesiol 2004; 14: 161–170.CrossRefGoogle Scholar
  5. 5.
    Linton SJ. New avenues for the prevention of chronic musculoskeletal pain and disability. Amsterdam: Elsevier, 2002.Google Scholar
  6. 6.
    Turk DC. A diathesis-stress model of chronic pain and disability following traumatic injury. Pain Res Manag 2002; 7: 9–19.Google Scholar
  7. 7.
    Sullivan T, Frank J. Restating disability or disabling the state: Four challenges. In: Sullivan T, ed. Injury and the new world of work. Vancouver: UBC Press, 2000.Google Scholar
  8. 8.
    Dionne CE. Low back pain. In: Crombie IK, ed. Epidemiology of pain. Seattle: IASP Press, 1999.Google Scholar
  9. 9.
    Spitzer WO, LeBlanc FE, Dupuis M. A scientific approach to the assessment and management of activity related spinal disorders: A monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine 1987; 12(Supp 75): S3–S59.Google Scholar
  10. 10.
    Frank J, Sinclair S, Hogg-Johnson S, Shannon H, Bombardier C, Beaton D, Cole D. Preventing disability from work-related low-back pain - new evidence gives new hope—if we can just get all the players onside. Can Med Assoc J 1998; 158: 1625–1631.Google Scholar
  11. 11.
    Williams DA, Feuerstein M, Durbin D, Pezzullo J. Health care and indemnity costs across natural history of disability in occupational low back pain. Spine 1998; 21: 2329–2336.CrossRefGoogle Scholar
  12. 12.
    Schultz IZ, Crook J, Meloche GR, Berkowitz J, Milner R, Zuberbier OA, Meloche W. Psychosocial predictors of occupational low back disability: Towards development of a return-to-work model. Pain 2004; 107: 77–85.CrossRefPubMedGoogle Scholar
  13. 13.
    Waddell G, Burton AK, Main CJ. Screening to identify people at risk of long-term incapacity for work. London, UK: Royal Society of Medicine Press, 2003.Google Scholar
  14. 14.
    Feuerstein M, Thebarge RW. Perceptions of disability and occupational stress as discriminatory of work disability in in patients with chronic pain. J Occup Rehab 1991; 1: 185–195.CrossRefGoogle Scholar
  15. 15.
    Feuerstein M, Huang GD, Haufler AJ, Miller JK. Development of a screen for predicting clinical outcomes in patients with work-related upper extremity disorders. J Occup Environ Med 2000; 42: 749–761.PubMedGoogle Scholar
  16. 16.
    Linton SJ. Do psychological factors increase risk for back pain in the general population in both cross-sectional and prospective analysis? Eur J Pain, in press.Google Scholar
  17. 17.
    Sullivan MJL, Stanish W, Waite H, Sullivan ME, Tripp D. Catastrophizing, pain, and disability following soft tissue injuries. Pain 1998; 77: 253–260.CrossRefPubMedGoogle Scholar
  18. 18.
    Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain 2000; 85: 31–332.CrossRefPubMedGoogle Scholar
  19. 19.
    Burton AK, Tillotson KM, Main CJ, Hollis S. Psychosocial predictors of outcome in acute and subchronic low back trouble. Spine 1995; 20: 722–728.PubMedGoogle Scholar
  20. 20.
    Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 2002; 27: E109–E120.CrossRefPubMedGoogle Scholar
  21. 21.
    Pincus T, Vlaeyen JW, Kendall NA, Von Korff MR, Kalauokalani DA, Reis S. Cognitive-behavioral therapy and psychosocial risk factors in low back pain: Directions for the future. Spine 2002; 27: E133–E138.CrossRefPubMedGoogle Scholar
  22. 22.
    McNeil DW, Au AR, Zvolensky MJ, McKee DR, Klineberg IJ, Ho CCK. Fear of pain in orofacial patients. Pain 2001; 89: 245–252.CrossRefPubMedGoogle Scholar
  23. 23.
    Buer N, Linton SJ. Fear-avoidance beliefs and catastrophizing: Occurrence and risk factor in back pain and ADL in the general population. Pain 2002; 99: 485–491.CrossRefPubMedGoogle Scholar
  24. 24.
    Klenerman L, Slade PD, Stanley M, Pennie B, Reilly JP, Atchison LE, Troup JDG, Rose MJ. The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine 1995; 20: 478–484.PubMedGoogle Scholar
  25. 25.
    Gheldof ELM, Vinck J, Vlaeyen JWS, Hidding A, Crombez G. The differential role of pain, work characteristics and pain-related fear in explaining back pain and sick leave in occupational settings. Pain, 2005; 113: 71–81.CrossRefPubMedGoogle Scholar
  26. 26.
    Sullivan MJL, Thorn B, Haythornthwaite JA, Keefe FJ, Martin M, Bradley LA, Lefebvre JC. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain 2001; 17: 52–64.CrossRefPubMedGoogle Scholar
  27. 27.
    Severeinjs R, Vlaeyen JWS, van den Hout MA, Picavet HSJ. Pain catastrophizing is associated with heath indices in musculoskeletal pain: A cross-sectional study in the Dutch community. Health Psychol 2004; 23: 49–57.CrossRefPubMedGoogle Scholar
  28. 28.
    Sullivan MJL, Stanish WD. Psychologically based occupational rehabilitation: The Pain-Disability Prevention Program. Clin J Pain 2003; 19: 97–104.CrossRefPubMedGoogle Scholar
  29. 29.
    Jensen MP, Turner JA, Romano JM. Correlates of improvement in multidisciplinary treatment of chronic pain. J Consult Clin Psychol 1994; 62: 172–179.CrossRefPubMedGoogle Scholar
  30. 30.
    Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pan and disability. Pain 1993; 52: 157–168.CrossRefPubMedGoogle Scholar
  31. 31.
    van der Giezen AM, Bouter LM, Nijhuis FJN. Prediction of return-to-work of low back pain patients sick listed for 3–4 months. Pain 2000; 87: 285–294.CrossRefPubMedGoogle Scholar
  32. 32.
    Coia P, Morley S. Medical reassurance and patients’ responses. J Psychosom Res 1998; 45: 377–386.CrossRefPubMedGoogle Scholar
  33. 33.
    Pfingsten M, Hildebrandt J, Leibing E, Franz C, Saur P. Effectiveness of a multimodal treatment program for chronic low-back pain. Pain 1997; 73: 77–85.CrossRefPubMedGoogle Scholar
  34. 34.
    Feuerstein M, Shaw WS, Lincoln AE, Miller VL, Wood PM. Clinical and workplace factors associated with a return to modified duty in work-related upper extremity disorders. Pain 2003; 102: 51–61.CrossRefPubMedGoogle Scholar
  35. 35.
    Hildebrandt J, Pfingsten M, Saur P, Jansen J. Prediction of success from a multidisciplinary treatment program for chronic pain. Spine 1997; 22: 990–1001.CrossRefPubMedGoogle Scholar
  36. 36.
    Banks SM, Kerns RD. Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychol Bull 1996; 119: 95–100.CrossRefGoogle Scholar
  37. 37.
    Sullivan MJL, Reesor K, Mikail S, Fisher R. The treatment of depression in chronic low back pain: Review and recommendations. Pain 1992; 50: 5–13.CrossRefPubMedGoogle Scholar
  38. 38.
    Romano JM, Turner JA. Chronic pain and depression: does the evidence support a relationship? Psychol Bull 1985; 97: 18–34.CrossRefPubMedGoogle Scholar
  39. 39.
    Rush AJ, Polatin P, Gatchel RJ. Depression and chronic low back pain. Spine 2000; 25: 2566–2571.CrossRefPubMedGoogle Scholar
  40. 40.
    Burns JW, Kubilus A, Bruehl S, Harden RN, Lofland K. Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis. J Consult Clin Psychol 2003; 71: 81–91.CrossRefPubMedGoogle Scholar
  41. 41.
    Hurwitz EL, Morgenstern H, Yu F. Cross-sectional and longitudinal associations of low-back pain and associated disability with psychological distress among patients enrolled in the UCLA Low Back Pain Study. J Clin Epidemiol 2003; 56: 463–471.CrossRefPubMedGoogle Scholar
  42. 42.
    Sullivan MJL, Stanish W, Sullivan ME, Tripp D. Differential predictors of pain and disability in patients with whiplash injuries. Pain Res Manag 2002; 7: 68–74.PubMedGoogle Scholar
  43. 43.
    Watson PJ, Booker CK, Moores L, Main CJ. Returning the chronically unemployed with low back pain to employment. Eur J Pain 2004; 8: 359–369.CrossRefPubMedGoogle Scholar
  44. 44.
    Vowles KE, Gross RT, Sorrell JT. Predicting work status following interdisciplinary treatment for chronic pain. Eur J Pain 2004; 8: 351–358.CrossRefPubMedGoogle Scholar
  45. 45.
    Kori SH, Miller RP, Todd DD. Kinesophobia: A new view of chronic pain behavior. Pain Manag 1990; Jan, 35–43.Google Scholar
  46. 46.
    Vlaeyen JWS, Kole-Snijders AMJ, Rotteveel A, Ruesink R, Heuts PHTG. The role of fear of movement/(re)injury in pain disability. J Occup Rehab 1995; 5: 235–252.Google Scholar
  47. 47.
    Sullivan MJL, Bishop S, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychol Assessm 1995; 7: 524–532.CrossRefGoogle Scholar
  48. 48.
    Pollard CA. Preliminary validity study of the Pain Disability Index. Percept Motor Skills 1984; 59: 974.PubMedGoogle Scholar
  49. 49.
    Tait RC, Pollard CA, Margolis RB, Duckro PN, Krause SJ. The Pain Disability Index: Psychometric and validity data. Arch Phys Med Rehab 1987; 68: 438–441.Google Scholar
  50. 50.
    Tait RC, Chibnall JT, Krause S. The Pain Disability Index: Psychometric properties. Pain 1990; 14: 171–182.CrossRefGoogle Scholar
  51. 51.
    Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory — II. San Antonio TX: Psychological Corporation, 1996.Google Scholar
  52. 52.
    Bishop SR, Edgley K, Fisher R, Sullivan MJL. Screening for depression in chronic low back pain with the Beck Depression Inventory. Can J Rehab 1993; 7: 143–148.Google Scholar
  53. 53.
    Arnau RC, Meagher MW, Norris MP, Bramson R. Psychometric properties of the Beck Depression Inventory II with primary care medical patients. Health Psychol 2001; 20: 112–119.CrossRefPubMedGoogle Scholar
  54. 54.
    Melzack R. The McGill Pain Questionnaire. Pain 1975; 1: 272–299.Google Scholar
  55. 55.
    Turk DC, Rudy TE, Salovey P. The McGill Pain Questionnaire reconsidered: Confirming the factor analysis and examining appropriate uses. Pain 1985; 21: 385–397.CrossRefPubMedGoogle Scholar
  56. 56.
    Nagelkerke NJD. A note on a general definition of the coefficient of determination. Biometrika 1991; 78: 691–692.Google Scholar
  57. 57.
    Shaw WS, Feuerstein M, Lincoln AE, Miller VI, Wood PM. Ergonomic and psychosocial factors affect daily function in Worker’s Compensation claimants with persistent upper extremity disorders. J Occup Environ Med 2002; 44: 606–615.PubMedGoogle Scholar
  58. 58.
    Shaw WS, Feuerstein M. Generating workplace accommodations: Lessons learned from the Integrated Case Management Study. J Occup Rehab 2004; 14: 207–216.CrossRefGoogle Scholar
  59. 59.
    Linton SJ, Boersma K. Early identification of patients at risk for developing a persistent back problem: The predictive validity of the Orebro Musculoskeletal Pain Questionnaire. Clin J Pain 2003; 19: 80–86.CrossRefPubMedGoogle Scholar
  60. 60.
    Feuerstein M, Nicholas RA, Huang GD, Dimberg L, Ali D, Rogers H. Job stress management and ergonomic intervention for work-related upper extremity disorders. Appl Ergonom 2004; 35: 565–574.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Michael J. L. Sullivan
    • 1
  • L. Charles Ward
    • 2
  • Dean Tripp
    • 3
  • Douglas J. French
    • 4
  • Heather Adams
    • 5
  • William D. Stanish
    • 6
  1. 1.Department of PsychologyUniversity of MontrealMontrealCanada
  2. 2.V.A. Medical CenterTuscaloosaAlabama
  3. 3.Department of PsychologyQueen’s UniversityKingstonCanada
  4. 4.Department of PsychologyUniversity of MonctonMonctonNew Brunswick
  5. 5.Department of PsychologyUniversity of MontrealMontrealCanada
  6. 6.Department of SurgeryDalhousie UniversityHalifaxCanada

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