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Comparison of risk factors predicting return to work between patients with subacute and chronic non-specific low back pain: systematic review

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Abstract

The objective of the study was to provide an inventory of predictive instruments and their constituting parameters associated with return to work in patients with subacute (2–10 weeks pain duration) and chronic (10–24 weeks pain duration) non-specific low back pain (NSLBP). Data sources included systematic review in Medline, Embase, Cinahl, Central, PEDro, Psyndex, PsychInfo/PsycLit, and Sociofile up to September 2008, in reference lists of systematic reviews on risk factors, and of included studies. For the systematic review, two reviewers independently assessed study eligibility and quality, and extracted data. Disagreements were resolved by consensus. Risk factors were inventorised and grouped into a somatic and psychosocial domain. 23 studies reporting on subacute and 16 studies reporting on chronic patients were included. The studies on subacute patients reported on a total of 56 biomedical factors out of which 35 (63%) were modifiable and 61 psychosocial factors out of which 51 (84%) were modifiable. The corresponding values in studies on chronic patients were 44 biomedical [27 (62%) modifiable] and 61 [40 (66%) modifiable] respectively. Our data suggest that the interdisciplinary approach in patients at risk to develop persistent NSLBP is justified in both, the subacute and chronic disease stages. Psychosocial interventions might be more effective in subacute stages since a higher proportion of modifiable risk factors were identified in that group.

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Author information

Authors and Affiliations

  1. Department of Rheumatology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland

    C. A. M. Heitz & Florian Brunner

  2. Bern University of Applied Sciences, Health, Bern, Switzerland

    R. Hilfiker

  3. Horten Center for Patient Oriented Research, University of Zurich, Zurich, Switzerland

    L. M. Bachmann

  4. Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Zurich, Switzerland

    H. Joronen, D. Uebelhart & A. Klipstein

  5. Rehazentrum Leukerbad, Leukerbad, Switzerland

    T. Lorenz

  6. University of Applied Sciences Western Switzerland/Valais, Leukerbad, Switzerland

    R. Hilfiker

Authors
  1. C. A. M. Heitz
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  2. R. Hilfiker
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  3. L. M. Bachmann
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  4. H. Joronen
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Corresponding author

Correspondence to Florian Brunner.

Additional information

C. A. M. Heitz and R. Hilfiker equally contributed to this work.

Appendix

Appendix

Quality assessment form

  1. 1.

    Were the hypothesis/aim/objective of the study clearly described (prognostic)?

  2. 2.

    Were the patients enrolled consecutive?

  3. 3.

    Were the main characteristics of the included patients in the study clearly described?

  4. 4.

    Was the response rate at baseline at least 80% of the possibly eligible patients?

  5. 5.

    Were the psychosocial data collected with validated instruments?

  6. 6.

    Were data on physical workload collected?

  7. 7.

    Was a clear definition of non-specific low back pain used?

  8. 8.

    Was the treatment standardized?

  9. 9.

    Were prognostic factors that were assessed addressed by treatment?

  10. 10.

    Statistical adjustment for important prognostic factors?

  11. 1.

    Were the statistical methods adequately described?

  12. 11.

    Was the outcome clearly defined?

  13. 12.

    Were the outcome measures available for at least 80% of the included patients?

  14. 13.

    Was the model cross validated in a group of patients different from the group in which it was derived, preferably with different clinicians?

  15. 14.

    Was there a serious methodological flaw not covered by the check-list?

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Heitz, C.A.M., Hilfiker, R., Bachmann, L.M. et al. Comparison of risk factors predicting return to work between patients with subacute and chronic non-specific low back pain: systematic review. Eur Spine J 18, 1829–1835 (2009). https://doi.org/10.1007/s00586-009-1083-9

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