Journal of Occupational Rehabilitation

, Volume 16, Issue 3, pp 430–458 | Cite as

Prediction of Sickness Absence in Patients with Chronic Low Back Pain: A Systematic Review

  • Wietske Kuijer
  • Johan W. Groothoff
  • Sandra Brouwer
  • Jan H. B. Geertzen
  • Pieter U. Dijkstra
Original Paper

Objectives: To provide evidence of predictors for sickness absence in patients with non-specific chronic low back pain (CLBP), distinguishing predictors aimed at the decision to report sick (absence threshold) and decision to return to work (return to work threshold). Methods: Medical and psychological databases were searched, as well as citations from relevant reviews. In- and exclusion criteria were applied. Two reviewers assessed the methodological quality of the papers independently. Results: Many different predictors were studied, and few factors were studied more than once. Consistent evidence was found for own expectations of recovery only as predictor for the decision to return to work. Patients with higher expectations had less sickness absence at the moment of follow-up measurement. As expected, different predictors were found aiming at the absence threshold or the return to work threshold. Furthermore, predictors varied also with the measurement instruments used, timing of follow-up measurements, and definition of outcomes. Until now, too few studies are available to overcome several potential sources of heterogeneity. Conclusions: No core set of predictors exists for sickness absence in general. The characteristics of the study including the decision to report sick or to return to work determined the influence of several predictors on sickness absence in patients with CLBP. Further research and use of a core set of measurements and uniform definitions are needed to predict sickness absence and return to work in patients with CLBP.


Chronic low back pain Prediction Sick leave Systematic review 



The authors want to thank M.F. Reneman (PhD) for his comments on a previous version of this manuscript. This study was supported by grants of ‘Zorgonderzoek Nederland’, number 96-06-006, the Foundation ‘Beatrixoord Noord Nederland’ and the Foundation ‘De Drie Lichten’, the Netherlands.


  1. 1.
    Waddell G, Main CJ. A new clinical model of low back pain and disability. The back pain revolution. London: Churchill Livingstone; 1998. p. 223–240.Google Scholar
  2. 2.
    Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA 1992;268:760–765.PubMedCrossRefGoogle Scholar
  3. 3.
    Andersson GBJ. Epidemiological features of chronic low-back pain. Lancet 1999;354:581–585.PubMedCrossRefGoogle Scholar
  4. 4.
    Waddell G. The physical basis of back pain. In: Waddell G, editor. The back pain revolution. London: Churchill Livingstone; 1998. p. 135–154.Google Scholar
  5. 5.
    Kendall NAS, Linton SJ, Main CJ. Guide to assessing psychosocial yellow flags in acute low back pain: risk factors for long-term disability and work loss. Wellington, New Zealand; 1997.Google Scholar
  6. 6.
    Nachemson AL. Newest knowledge of low back pain. A critical look. Clin Orthop 1992;279:8–20.PubMedGoogle Scholar
  7. 7.
    Maetzel A, Li L. The economic burden of low back pain: a review of studies published between 1996 and 2001. Best Pract Res Clin Rheumatol 2002;16:23–30.PubMedCrossRefGoogle Scholar
  8. 8.
    Allegro JT, Veerman TJ. Sickness absence. In: Drenth JD, Thierry H, de Wolff CJ, editors. Handbook of work and organizational psychology. East Sussex: Psychology Press; 1998. p. 121–144.Google Scholar
  9. 9.
    Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther 2001;81:1641–1674.Google Scholar
  10. 10.
    Elders LA, van der Beek AJ, Burdorf A. Return to work after sickness absence due to back disorders: a systematic review on intervention strategies. Int Arch Occup Environ Health 2000;73:339–348.PubMedCrossRefGoogle Scholar
  11. 11.
    van der Hulst M, Vollenbroek-Hutten MMR, IJzerman MJ. A systematic review of sociodemographic, physical and psychological predictors of multidisciplinary rehabilitation – or, back school treatment outcome in patients with chronic low back pain. Spine 2005;30:813–825.PubMedCrossRefGoogle Scholar
  12. 12.
    Crook J, Milner R, Schultz IZ, Stringer B. Determinants of occupational disability following a low back injury: a critical review of the literature. J Occup Rehabil 2002;12:277–295.PubMedCrossRefGoogle Scholar
  13. 13.
    Truchon M, Fillion L. Biopsychosocial determinants of chronic disability and low-back pain: a review. J Occup Rehabil 2000;10:117–142.CrossRefGoogle Scholar
  14. 14.
    Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med 2001;51:124–135.CrossRefGoogle Scholar
  15. 15.
    Etiology and prognosis: critical appraisel form for observational studies. Cochrane Collaboration website 2002; Available from: URL: Scholar
  16. 16.
    Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain 1998;77:1–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Scholten-Peeters GGM, Verhagen AP, Bekkering GE, van der Windt DAWM, Barnsley L, Oostendorp RAB, Hendriks EJM. Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies. Pain 2003;104:303–322.PubMedCrossRefGoogle Scholar
  18. 18.
    van Tulder M, Furlan A, Bombardier C, Bouter L, editorial board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine 2003;28:1290–1299.PubMedCrossRefGoogle Scholar
  19. 19.
    Assendelft WJJ, Scholten RJPM, Van Eijk JTHM, Bouter LM. De praktijk van systematische reviews. III. Methodologische beoordeling van onderzoeken. Ned Tijdschr Geneeskd 1999;143:714–719.PubMedGoogle Scholar
  20. 20.
    Verhagen AP, de Vet HCW, de Bie RA, Boers M, van den Brandt PA. The art of quality assessment of RCTs included in systematic reviews. J Clin Epidemiol 2001;54:651–654.PubMedCrossRefGoogle Scholar
  21. 21.
    Coté P, Cassidy JD, Carroll L. A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature. Spine 2001;26:E445–E458.PubMedCrossRefGoogle Scholar
  22. 22.
    Bigos SJ, Bowyer O, Braen Gl. Acute low back problems in adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642. Rockville, MD: U.S Department of Health and Human Services; 1994.Google Scholar
  23. 23.
    Aure OF, Nilsen JH, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine 2003;28:525–531.PubMedCrossRefGoogle Scholar
  24. 24.
    Bachman S, Oesch PR, Kool JP, Persili S, Knusel O. Treatment of patients with chronic low back pain in a functional restoration program: Work Related function parameters, pain parameters and the working status after 12 months. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin 2003;13:263–270.CrossRefGoogle Scholar
  25. 25.
    Bendix T, Bendix A, Labriola M, Haestrup C, Ebbehoj N. Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Spine 2000;25:2494–2500.PubMedCrossRefGoogle Scholar
  26. 26.
    Bentsen H, Lindgarde F, Manthorpe R. The effect of dynamic strength back exercise and/or a home training program in 57-year-old women with chronic low back pain. Results of a prospective randomized study with a 3-year follow-up period. Spine 1997;22:1494–1500.PubMedCrossRefGoogle Scholar
  27. 27.
    Beurskens AJ, de-Vet HC, Koke AJ, Regtop W, van der Heijden GJ, Lindeman E, Knipschild PG. Efficacy of traction for nonspecific low back pain. 12-week and 6-month results of a randomized clinical trial. Spine 1997;22:2756–2762.PubMedCrossRefGoogle Scholar
  28. 28.
    Casso G, Cachin C, Van Melle G, Gerster JC. Return-to-work status 1 year after muscle reconditioning in chronic low back pain patients. Joint Bone Spine 2004;71:136–139.PubMedCrossRefGoogle Scholar
  29. 29.
    Durand MJ, Loisel P. Therapeutic return to work: Rehabilitation in the workplace. Work: J Prev, Assess Rehabil 2001;17:57–64.Google Scholar
  30. 30.
    Friedman PJ, Leadley MJ, Stickney J, Austin KL. Prediction of return to work following rehabilitation for chronic low back injury. N Z J Occup Ther 1903;46:20–24.Google Scholar
  31. 31.
    Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I. Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 1998;79:475–487.PubMedCrossRefGoogle Scholar
  32. 32.
    Gibson T, Grahame R, Harkness J, Woo P, Blagrave P, Hills R. Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain. Lancet 1985;1:1258–1261.PubMedCrossRefGoogle Scholar
  33. 33.
    Glomsrod B, Lonn JH, Soukup MG, Bo K, Larsen S. “Active back school”, prophylactic management for low back pain: three-year follow-up of a randomized, controlled trial. J Rehabil Med 2001;33:26–30.PubMedCrossRefGoogle Scholar
  34. 34.
    Hansen FR, Bendix T, Skov P, Jensen CV, Kristensen JH, Krohn L, Schioeler H. Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain. A randomized, observer-blind trial. Spine 1993;18:98–108.PubMedCrossRefGoogle Scholar
  35. 35.
    Hazard RG, Fenwick JW, Kalisch SM, Redmond J, Reeves V, Reid S, Frymoyer JW. Functional restoration with behavioral support. A one-year prospective study of patients with chronic low-back pain. Spine 1989;14:157–161.PubMedCrossRefGoogle Scholar
  36. 36.
    Hildebrandt J, Pfingsten M, Saur P, Jansen J. Prediction of success from a multidisciplinary treatment program for chronic low back pain. Spine 1997;22:990–1001.PubMedCrossRefGoogle Scholar
  37. 37.
    Hurley DA, McDonough SM, Dempster M, Moore AP, Baxter GD. A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain. Spine 2004;29:2207–2216.PubMedCrossRefGoogle Scholar
  38. 38.
    Hurri H. The Swedish back school in chronic low back pain. Part I. Benefits. Scand J Rehabil Med 1989;21:33–40.PubMedGoogle Scholar
  39. 39.
    Jousset N, Fanello S, Bontoux L, Dubus V, Billabert C, Vielle B, Roquelaure Y, Penneau-Fontbonne D, Richard I. Effects of functional restoration versus 3 hours per week physical therapy: a randomized controlled study. Spine 2004;29:487–493.PubMedCrossRefGoogle Scholar
  40. 40.
    Karjalainen K, Malmivaara A, Mutanen P, Pohjolainen T, Roine R, Hurri H. Outcome determinants of subacute low back pain. Spine 2003;28:2634–2640.PubMedCrossRefGoogle Scholar
  41. 41.
    Karjalainen K, Malmivaara A, Pohjolainen T, Hurri H, Mutanen P, Rissanen P, Pahkajarvi H, Levon H, Karpoff H, Roine R. Mini-intervention for subacute low back pain: a randomized controlled trial. Spine 2003;28:533–540.PubMedCrossRefGoogle Scholar
  42. 42.
    Karjalainen K, Malmivaara A, Mutanen P, Roine R, Hurri H, Pohjolainen T. Mini-intervention for subacute low back pain: two-year follow-up and modifiers of effectiveness. Spine 2004;29:1069–1076.PubMedCrossRefGoogle Scholar
  43. 43.
    Keijsers JF, Steenbakkers MW, Meertens RM, Bouter LM. The efficacy of the back school: a randomized trial. Arthritis Care Res 1990;3:204–209.Google Scholar
  44. 44.
    Kendrick D, Fielding K, Bentley E, Miller P, Kerslake R, Pringle M. The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomised (unblinded) controlled trial. BMJ 2001;322:400–405.PubMedCrossRefGoogle Scholar
  45. 45.
    Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine 2003;28:1355–1362.PubMedCrossRefGoogle Scholar
  46. 46.
    Lindstrom I, Ohlund C, Eek C, Wallin L, Peterson LE, Fordyce WE, Nachemson AL. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Phys Ther 1992;72:279–290.PubMedGoogle Scholar
  47. 47.
    Lindstrom I, Ohlund C, Eek C, Wallin L, Peterson LE, Nachemson A. Mobility, strength, and fitness after a graded activity program for patients with subacute low back pain. A randomized prospective clinical study with a behavioral therapy approach. Spine 1992;17:641–652.PubMedGoogle Scholar
  48. 48.
    Lindstrom I, Ohlund C, Nachemson A. Validity of patient reporting and predictive value of industrial physical work demands. Spine 1994;19:888–893.PubMedCrossRefGoogle Scholar
  49. 49.
    Lindstrom I, Ohlund C, Nachemson A. Physical performance, pain, pain behavior and subjective disability in patients with subacute low back pain. Scand J Rehabil Med 1995;27:153–160.PubMedGoogle Scholar
  50. 50.
    Ljunggren AE, Weber H, Kogstad O, Thom E, Kirkesola G. Effect of exercise on sick leave due to low back pain. A randomized, comparative, long-term study. Spine 1997;22:1610–1616.PubMedCrossRefGoogle Scholar
  51. 51.
    Loisel P, Abenhaim L, Durand P, Esdaile JM, Suissa S, Gosselin L, Simard R, Turcotte J, Lemaire J. A population-based, randomized clinical trial on back pain management. Spine 1997;22:2911–2918.PubMedCrossRefGoogle Scholar
  52. 52.
    Loisel P, Poitras S, Lemaire J, Durand P, Southiere A, Abenhaim L. Is work status of low back pain patients best described by an automated device or by a questionnaire? Spine 1998;23:1588–1594.PubMedCrossRefGoogle Scholar
  53. 53.
    Loisel P, Lemaire J, Poitras S, Durand MJ, Champagne F, Stock S, Diallo B, Tremblay C. Cost-benefit and cost-effectiveness analysis of a disability prevention model for back pain management: a six year follow up study. Occup Environ Med 2002;59:807–815.PubMedCrossRefGoogle Scholar
  54. 54.
    Lonn JH, Glomsrod B, Soukup MG, Bo K, Larsen S. Active back school: prophylactic management for low back pain. A randomized, controlled, 1-year follow-up study. Spine 1999;24:865–871.PubMedCrossRefGoogle Scholar
  55. 55.
    Moffett JK, Torgerson D, Bell-Syer S, Jackson D, Llewlyn-Phillips H, Farrin A, Barber J. Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. BMJ 1999;319:279–283.PubMedGoogle Scholar
  56. 56.
    Niemisto L, Lahtinen-Suopanki T, Rissanen P, Lindgren KA, Sarna S, Hurri H. A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine 2003;28:2185–2191.PubMedCrossRefGoogle Scholar
  57. 57.
    Ohlund C, Lindstrom I, Areskoug B, Eek C, Peterson LE, Nachemson A. Pain behavior in industrial subacute low back pain. Part I. Reliability: Concurrent and predictive validity of pain behavior assessments. Pain 1994;58:201–209.PubMedCrossRefGoogle Scholar
  58. 58.
    Ohlund C, Eek C, Palmbald S, Areskoug B, Nachemson A. Quantified pain drawing in subacute low back pain. Validation in a nonselected outpatient industrial sample. Spine 1996;21:1021–1030.PubMedCrossRefGoogle Scholar
  59. 59.
    Ohlund C, Lindstrom I, Eek C, Areskoug B, Nachemson A. The causality field (extrinsic and intrinsic factors) in industrial subacute low back pain patients. Scand J Med Sci Sports 1996;6:98–111.PubMedCrossRefGoogle Scholar
  60. 60.
    Petersen T, Kryger P, Ekdahl C, Olsen S, Jacobsen S. The effect of McKenzie therapy as compared with that of intensive strengthening training for the treatment of patients with subacute or chronic low back pain: a randomized controlled trial. Spine 2002;27:1702–1709.PubMedCrossRefGoogle Scholar
  61. 61.
    Pfingsten M, Hildebrandt J. Treatment of chronic low back pain through intensive activation—an assessment of 10 years. Anasthesiol Intensivmed Notfmed Schmerzther 2001;36:9–589.Google Scholar
  62. 62.
    Pfingsten M, Hildebrandt J, Saur P, Franz C, Seeger D. Multidisciplinary treatment program on chronic low back pain, part 4. Prognosis of treatment outcome and final conclusions. Schmerz 1997;11:1–41.CrossRefGoogle Scholar
  63. 63.
    Sandstrom J, Esbjornsson E. Return to work after rehabilitation. The significance of the patient's own prediction. Scand J Rehabil Med 1986;18:29–33.PubMedGoogle Scholar
  64. 64.
    Sandstrom J. Clinical and social factors in rehabilitation of patients with chronic low back pain. Scand J Rehabil Med 1986;18:35–43.PubMedGoogle Scholar
  65. 65.
    Schultz IZ, Crook J, Meloche GR, Berkowitz J, Milner R, Zuberbier OA, Meloche W. Psychosocial factors predictive of occupational low back disability: towards development of a return-to-work model. Pain 2004;107:77–85.PubMedCrossRefGoogle Scholar
  66. 66.
    Soukup MG, Glomsrod B, Lonn JH, Bo K, Larsen S. The effect of a Mensendieck exercise program as secondary prophylaxis for recurrent low back pain. A randomized, controlled trial with 12-month follow-up. Spine 1999;24:1585–1591.PubMedCrossRefGoogle Scholar
  67. 67.
    Soukup MG, Lonn J, Glomsrod B, Bo K, Larsen S. Exercises and education as secondary prevention for recurrent low back pain. Physiother Res Int 2001;6:27–39.PubMedCrossRefGoogle Scholar
  68. 68.
    Staal JB, Hlobil H, Twisk JW, Smid T, Koke AJ, Van Mechelen W. Graded activity for low back pain in occupational health care: a randomized, controlled trial. Ann Intern Med 2004;140:77–84.PubMedGoogle Scholar
  69. 69.
    Storheim K, Brox JI, Holm I, Koller AK, Bo K. Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomized controlled trial. J Rehabil Med 2003;35:132–140.PubMedCrossRefGoogle Scholar
  70. 70.
    Storro S, Moen J, Svebak S. Effects on sick-leave of a multidisciplinary rehabilitation programme for chronic low back, neck or shoulder pain: comparison with usual treatment. J Rehabil Med 2004;36:12–16.PubMedGoogle Scholar
  71. 71.
    Torstensen TA, Ljunggren AE, Meen HD, Odland E, Mowinckel P, Geijerstam S. Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self-exercise in patients with chronic low back pain. A pragmatic, randomized, single-blinded, controlled trial with 1-year follow-up. Spine 1998;23:2616–2624.PubMedCrossRefGoogle Scholar
  72. 72.
    Van den Hout JHC, Vlaeyen JWS, Heuts PHTG, Zijlema JHL, Wijnen JAG. Secondary prevention of work-related disability in nonspecific low back pain: does problem-solving therapy help? A randomized clinical trial. Clin J Pain 2003;19:87–96.PubMedCrossRefGoogle Scholar
  73. 73.
    Ozguler A, Leclerc A, Landre M, Pietrie-Taleb F, Niedhammer I. Individual and occupational determinants of low back pain according to various definitions of low back pain. J Epidemiol Community Health 2000;54:215–220.PubMedCrossRefGoogle Scholar
  74. 74.
    Wasiak R, Verma S, Pransky G, Webster B. Risk factors for recurrent episodes of care and work disability: case of low back pain. J Occup Environ Med 2004;46:68–76.PubMedCrossRefGoogle Scholar
  75. 75.
    De Vet HCW, Heymans MW, Dunn KM, Pope DP, van der Beek AJ, Macfarlane GJ, Bouter LM, Croft PR. Episodes of low back pain. A proposal for uniform definitions to be used in research. Spine 2002;27:2409–2416.PubMedCrossRefGoogle Scholar
  76. 76.
    Amick BC, Lerner D, Rogers WH, Rooney T, Katz JN. A review of health-related work outcome measures and their uses, and recommended measures. Spine 2000;25:3152–3160.PubMedCrossRefGoogle Scholar
  77. 77.
    Frymoyer JW. Back pain and sciatica. N Engl J Med 1988;318:291–300.PubMedCrossRefGoogle Scholar
  78. 78.
    Von Korff M, Saunders KJD. The course of back pain in primary care. Spine 1996;21:2833–2837.PubMedCrossRefGoogle Scholar
  79. 79.
    Scholten RJPM, Kostense PJ, Assendelft WJJ, Bouter LM. de praktijk van systematische reviews. IV. Het combineren van de resultaten van afzonderlijke onderzoeken. Ned Tijdschr Geneeskd 1999;143:786–791.PubMedGoogle Scholar
  80. 80.
    Scholten RJPM, Assendelft WJJ, Kostense PJ, Bouter LM. De praktijk van systematische reviews. V. Heterogeniteit tussen onderzoeken en subgroepanalysen. Ned Tijdschr Geneeskd 1999;143:843–848.PubMedGoogle Scholar
  81. 81.
    Hoogendoorn WE, van Poppel MNM, Bongers PM, Koes BW, Bouter LM. Physical load during work and leisure time as risk factors for back pain [review]. Scand J Work Environ Health 1999;25:387–403.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006 2006

Authors and Affiliations

  • Wietske Kuijer
    • 1
    • 2
    • 4
  • Johan W. Groothoff
    • 1
    • 2
  • Sandra Brouwer
    • 1
    • 2
  • Jan H. B. Geertzen
    • 1
    • 2
  • Pieter U. Dijkstra
    • 1
    • 2
    • 3
  1. 1.Center for Rehabilitation, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  2. 2.Northern Center for Healthcare Research, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  3. 3.Department of Oral and Maxillofacial Surgery, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  4. 4.Han UniversityFaculty of Health and Social StudiesGL NijmegenThe Netherlands

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