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.
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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.
Feuerstein M, Berkowitz SM, Huang GD. Predictors of occupational low back disability: Implications for secondary prevention. J Occup Environ Med 1999; 41: 1024–1031.
Waddell G. The back pain revolution. Edinburg: Churchill Livingstone, 1998.
Gatchel RJ. Musculoskeletal disorders: primary and secondary interventions. J Electrom Kinesiol 2004; 14: 161–170.
Linton SJ. New avenues for the prevention of chronic musculoskeletal pain and disability. Amsterdam: Elsevier, 2002.
Turk DC. A diathesis-stress model of chronic pain and disability following traumatic injury. Pain Res Manag 2002; 7: 9–19.
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.
Dionne CE. Low back pain. In: Crombie IK, ed. Epidemiology of pain. Seattle: IASP Press, 1999.
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.
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.
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.
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.
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.
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.
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.
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.
Sullivan MJL, Stanish W, Waite H, Sullivan ME, Tripp D. Catastrophizing, pain, and disability following soft tissue injuries. Pain 1998; 77: 253–260.
Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain 2000; 85: 31–332.
Burton AK, Tillotson KM, Main CJ, Hollis S. Psychosocial predictors of outcome in acute and subchronic low back trouble. Spine 1995; 20: 722–728.
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.
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.
McNeil DW, Au AR, Zvolensky MJ, McKee DR, Klineberg IJ, Ho CCK. Fear of pain in orofacial patients. Pain 2001; 89: 245–252.
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.
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.
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.
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.
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.
Sullivan MJL, Stanish WD. Psychologically based occupational rehabilitation: The Pain-Disability Prevention Program. Clin J Pain 2003; 19: 97–104.
Jensen MP, Turner JA, Romano JM. Correlates of improvement in multidisciplinary treatment of chronic pain. J Consult Clin Psychol 1994; 62: 172–179.
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.
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.
Coia P, Morley S. Medical reassurance and patients’ responses. J Psychosom Res 1998; 45: 377–386.
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.
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.
Hildebrandt J, Pfingsten M, Saur P, Jansen J. Prediction of success from a multidisciplinary treatment program for chronic pain. Spine 1997; 22: 990–1001.
Banks SM, Kerns RD. Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychol Bull 1996; 119: 95–100.
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.
Romano JM, Turner JA. Chronic pain and depression: does the evidence support a relationship? Psychol Bull 1985; 97: 18–34.
Rush AJ, Polatin P, Gatchel RJ. Depression and chronic low back pain. Spine 2000; 25: 2566–2571.
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.
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.
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.
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.
Vowles KE, Gross RT, Sorrell JT. Predicting work status following interdisciplinary treatment for chronic pain. Eur J Pain 2004; 8: 351–358.
Kori SH, Miller RP, Todd DD. Kinesophobia: A new view of chronic pain behavior. Pain Manag 1990; Jan, 35–43.
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.
Sullivan MJL, Bishop S, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychol Assessm 1995; 7: 524–532.
Pollard CA. Preliminary validity study of the Pain Disability Index. Percept Motor Skills 1984; 59: 974.
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.
Tait RC, Chibnall JT, Krause S. The Pain Disability Index: Psychometric properties. Pain 1990; 14: 171–182.
Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory — II. San Antonio TX: Psychological Corporation, 1996.
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.
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.
Melzack R. The McGill Pain Questionnaire. Pain 1975; 1: 272–299.
Turk DC, Rudy TE, Salovey P. The McGill Pain Questionnaire reconsidered: Confirming the factor analysis and examining appropriate uses. Pain 1985; 21: 385–397.
Nagelkerke NJD. A note on a general definition of the coefficient of determination. Biometrika 1991; 78: 691–692.
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.
Shaw WS, Feuerstein M. Generating workplace accommodations: Lessons learned from the Integrated Case Management Study. J Occup Rehab 2004; 14: 207–216.
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.
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.
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Sullivan, M.J.L., Ward, L.C., Tripp, D. et al. Secondary Prevention of Work Disability: Community-Based Psychosocial Intervention for Musculoskeletal Disorders. J Occup Rehabil 15, 377–392 (2005). https://doi.org/10.1007/s10926-005-5944-7
- psychosocial risk factors
- occupational disability
- secondary prevention
- work-related musculoskeletal disorders
- return to work