Skip to main content

Advertisement

Log in

Level of Distress Among Workers Undergoing Work Rehabilitation for Musculoskeletal Disorders

  • Published:
Journal of Occupational Rehabilitation Aims and scope Submit manuscript

Abstract

Introduction

Many studies have documented the high distress rates and their correlates among individuals experiencing persistent pain due to a musculoskeletal disorder (MSD). However, few have adopted a biopsychosocial perspective to understand this issue.

Objective

The first objective of this study was to examine workers’ distress levels before they start work rehabilitation and to compare it to those in a healthy population. The second objective was to assess the correlations between distress and biopsychosocial factors.

Methods

The participants were 228 workers on sick leave due to persistent pain from an MSD and who were referred to an interdisciplinary work rehabilitation program.

Results

The workers had very high distress levels compared to normative data. Also, the results of a multiple regression showed that duration of absence, high occupational stress, perception of disability, and fear of movement and (re)injury were significantly associated with distress.

Conclusions

These results highlight the importance of considering distress not only as a predictor of work disability, but as an independent outcome measure. This shift of paradigm could provide a more comprehensive approach in the understanding of workers’ disability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Baril, R., Martin, J.-C., Massicotte, P., & Lapointe, C. (1994). Étude exploratoire des processus de réinsertion sociale et professionnelle des travailleurs en réadaptation. Institut de recherche en santé et en sécurité du travail du Québec.

  2. Limoges, J. (1987). Pourquoi travailler? In J. Limoges, R. Lemaire, & F. Dodier (Eds.), Trouver son travail (pp. 13–27). Montréal (Québec, Canada): CIM Fides.

    Google Scholar 

  3. Jackson, T., Iezzi, A., & Lafreniere, K. (1997). The impact of psychosocial features of employment status on emotional distress in chronic pain and healthy comparison samples. Journal of Behavioral Medicine, 20(3), 241–256.

    Article  PubMed  CAS  Google Scholar 

  4. Ohayon, M. M., & Schatzberg, A. F. (2003). Using chronic pain to predict depressive morbidity in the general population. Archives of General Psychiatry, 60(1), 39–47.

    Article  PubMed  Google Scholar 

  5. CSST. (2002). Statistiques sur les affections vertébrales, 1998–2001. Québec (Canada): Commission de la santé et de la sécurité du travail.

    Google Scholar 

  6. CSST. (2002). Statistiques sur les lésions en “ITE” du système musculo-squelettique. Québec (Canada): Commission de la santé et de la sécurité du travail.

  7. McCracken, L. M., Spertus, I. L., Janeck, A. S., Sinclair, D., & Wetzel, F. T. (1999). Behavioral dimensions of adjustment in persons with chronic pain: Pain-related anxiety and acceptance. Pain, 80, 283–289.

    Article  PubMed  CAS  Google Scholar 

  8. Plehn, K., Peterson, R. A., & Williams, D. A. (1998). Anxiety sensivity: Its relationship to functional status in patients with chronic pain. Journal of Occupational Rehabilitation., 8(3), 213–222.

    Article  Google Scholar 

  9. Hellström, C., Jansson, B., & Carlsson, S. G. (1999). Subjective future as a mediating factor in the relation between pain, pain-related distress and depression. European Journal of Pain, 3, 221–233.

    Article  PubMed  Google Scholar 

  10. Hellström, C., & Jansson, B. (2001). Psychological distress and adaptation to chronic pain: Symptomatology in dysfunctional, interpersonnally distressed, and adaptative copers. Journal of Musculoskeletal Pain, 9(3), 51–67.

    Article  Google Scholar 

  11. Naidoo, P., & Pillay, Y. G. (1994). Correlations among general stress, family, environment, psychological distress, and pain experience. Perceptual and Motor Skills, 78, 1291–1296.

    PubMed  CAS  Google Scholar 

  12. Turner, J. A., Jensen, M. P., Warms, C. A., & Cardenas, D. D. (2002). Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury. Pain, 98, 127–134.

    Article  PubMed  Google Scholar 

  13. Von Korff, M., & Simon, G. (1996). The relationship between pain and depression. The British Journal of Psychiatry. Supplement, 30:101–108.

    Google Scholar 

  14. Walker, J., Sofaer, B. (1998). Predictors of psychological distress in chronic pain patients. Journal of Advanced Nursing, 27(2), 320–326.

    Article  PubMed  CAS  Google Scholar 

  15. Waters, S. J., Keefe, F. J., & Strauman, T. J. (2004). Self-discrepancy in chronic low-back pain: Relation to pain, depression, and psychological distress. Journal of Pain and Symptom Management, 27(3):251–259.

    Google Scholar 

  16. McWilliams, L. A., Cox, B. J., & Enns, M. W. (2003). Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain, 106(1–2), 127–133.

    Article  PubMed  Google Scholar 

  17. Currie, S. R., Wilson, K. G., & Curran, D. (2002). Clinical significance and predictors of treatment response to cognitive-behavior therapy for insomnia secondary to chronic pain. Journal of Behavioral Medicine, 25(2), 135.

    Article  PubMed  Google Scholar 

  18. Dysvik, E., Natvig, G. K., Eikeland O., & Lindstrom, T. C. (2005). Coping with chronic pain. International Journal of Nursing Studies, 42, 297–305.

    Article  PubMed  Google Scholar 

  19. Haugli, L., Steen, E., Laerum, E., Nygard R, & Finset, A. (2003). Psychological distress and employment status. Effects of a group learning programme for patients with chronic musculoskeletal pain. Psychology, Health & Medicine, 8(2), 135–148.

    Article  Google Scholar 

  20. Matthews, G. (2000). Distress. In F. George (Ed.), Encyclopedia of stress (pp. 723–729). San Diego, California: Academic Press.

    Google Scholar 

  21. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

    Google Scholar 

  22. Préville, M., Boyer, R., Potvin, L., Perrault C, & Légaré, G. (1992). La détresse psychologique: détermination de la fiabilité et de la validité de la mesure utilisée dans l’enquête Santé Québec. Québec (Canada): Les publications du Québec.

    Google Scholar 

  23. BenDebba, M., Torgerson, W. S., & Long, D. M. (1997). Personality traits, pain duration and severity, functional impairment, and psychological distress in patients with persistent low back pain. Pain, 72, 115–125.

    Article  PubMed  CAS  Google Scholar 

  24. Cano, A., Gillis, M., Heinz, W., Geisser M., & Foran, H. (2004). Marital functioning, chronic pain, and psychological distress. Pain, 107, 99–106.

    Article  PubMed  Google Scholar 

  25. Daffner, S. D., Hilibrand, A. S., Hanscom, B. S., Brislin, B. T., Vaccaro, A. R., & Albert, T. J. (2003). Impact of neck and arm pain on overall health status. Spine, 28(17), 2030–2035.

    Article  PubMed  Google Scholar 

  26. Grotle, M., Vollestad, N. K., Veierod, M. B., & Brox, J. I. (2004). Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain. Pain, 112(3), 343–352.

    Article  PubMed  Google Scholar 

  27. Keefe, F. J., Wilkins, R. H., Cook, W. A. Jr, Crisson, J. E., & Muhlbaier, L. H. (1986). Depression, pain, and pain behavior. Journal of Consulting and Clinical Psychology, 54(5), 665–669.

    Article  PubMed  CAS  Google Scholar 

  28. Vowles, K. E., Gross, R. T., & Sorrell, J. T. (2004). Predicting work status following interdisciplinary treatment for chronic pain. European Journal of Pain, 8(4), 351–358.

    Article  PubMed  Google Scholar 

  29. Vowles, K. E., Zvolensky, M. J., & Gross, R. T. (2004). Pain-related anxiety in the prediction of chronic low-back pain distress. Journal of Behavioral Medicine, 27(1), 77–89.

    Article  PubMed  Google Scholar 

  30. Sullivan, M. J. L., & D’Eon, J. L. (1990). Relation between catastrophizing and depression in chronic pain patients. Journal of Abnormal Psychology, 99(3), 260–263.

    Article  PubMed  CAS  Google Scholar 

  31. Gauthier, N., Sullivan, M. J., Adams, H., Stanish, W. D., & Thibault, P. (2006). Investigating risk factors for chronicity: The importance of distinguishing between return-to-work status and self-report measures of disability. Journal of Occupational and Environmental Medicine/American College of Occupational and Environmental Medicine, 48(3), 312–318.

    PubMed  Google Scholar 

  32. Roth, R. S., Geisser, M. E., Theisen-Goodvich M., & Dixon, P. J. (2005). Cognitive complaints are associated with depression, fatigue, female sex, and pain catastrophizing in patients with chronic pain. Archives of Physical Medicine and Rehabilitation, 86(6), 1147–1154.

    Article  PubMed  Google Scholar 

  33. Samwel, H. J., Evers, A. W., Crul, B. J., & Kraaimaat, F. W. (2006). The role of helplessness, fear of pain, and passive pain-coping in chronic pain patients. The Clinical Journal of Pain, 22(3), 245–251.

    Article  PubMed  Google Scholar 

  34. McCracken, L. M., Gross, R. T., & Eccleston, C. (2002). Multimethod assessment of treatment process in chronic low back pain: Comparison of reported pain-related anxiety with directly measured physical capacity. Behaviour Research and Therapy, 40(5), 585–594.

    Article  PubMed  CAS  Google Scholar 

  35. Vaeroy, H., Tanum, L., Bruaset, H., Morkrid L., & Forre, O. (2005). Symptoms of depression and anxiety in functionally disabled rheumatic pain patients. Nordic Journal of Psychiatry, 59(2), 109–113.

    PubMed  Google Scholar 

  36. Williams, R. A., Pruitt, S. D., Doctor, J. N., et al. (1998). The contributions of job satisfaction to the transition from acute to chronic low back pain. Archives of Physical Medical Rehabiliation, 79, 366–374.

    Article  CAS  Google Scholar 

  37. Frank, J. W., Brooker A., DeMaio, S. E., et al. (1996). Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine, 21, 2918–2929.

    Article  PubMed  CAS  Google Scholar 

  38. Ektor-Andersen, J., Isacsson S, Lindgren, A., Orbaek P., group TMs-s. (1999). The experience of pain from the shoulder-neck area related to the total body pain, self-experience health and mental distress. Pain, 82, 289–295.

    Article  PubMed  CAS  Google Scholar 

  39. Feuerstein, M., Thebarge, R. W. (1991). Perceptions of disability and occupational stress as discriminators of work disability in patients with chronic pain. Journal of Occupational Rehabilitation, 1(3), 185–195.

    Article  Google Scholar 

  40. Magni, G., Moreschi, C., Rigatti-Luchini S., Merskey, H. (1994). Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain, 56(3), 289–297.

    Article  PubMed  CAS  Google Scholar 

  41. Averill, P. M., Novy, D. M., Nelson, D. V., & Berry, L. A. (1996). Correlates of depression in chronic pain patients: A comprehensive examination. Pain, 65(1), 93–100.

    Article  PubMed  CAS  Google Scholar 

  42. Jackson, T., Iezzi A., & Lafreniere, K. (1998). Relations of employment status to emotional distress among chronic pain patients: A path analysis. The Clinical Journal of Pain, 14(1), 55–60.

    Article  PubMed  CAS  Google Scholar 

  43. Loisel, P., & Durand, M. J. (2003). Worker accomodation, clinical intervention and return to work. In T. Sullivan & J. Frank (Eds.), Preventing and managing disability at work. London, ON: Taylor & Francis.

    Google Scholar 

  44. Ilfeld, F. W. (1976). Further validation of a psychiatric symptom index in a normal population. Psychological Report, 39, 1215–1228.

    Google Scholar 

  45. Preville, M., Potvin L., & Boyer, R. (1995). The structure of psychological distress. Psychological Reports, 77(1), 275–293.

    PubMed  CAS  Google Scholar 

  46. Martin, F., Sabourin S., & Gendreau, P. (1989). Les dimensions de la détresse psychologique: Analyse factorielle confirmatoire de type hiérarchique [Dimension of psychological distress: Confirmatory factorial analysis]. International Journal Of Psychology, 24, 571–584.

    Google Scholar 

  47. Mykletun, A., Stordal E., & Dahl, A. A. (2001). Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population. The British Journal of Psychiatry; The Journal of Mental Science, 179, 540–544.

    Article  PubMed  CAS  Google Scholar 

  48. Kalliath, T. J., O’Driscoll, M. P., & Brough, P. (2004). A confirmatory factor analysis of the General Health Questionnaire-12. Stress and Health, 20, 11–20.

    Article  Google Scholar 

  49. Harter, M., Reuter, K., Gross-Hardt K., & Bengel, J. (2001). Screening for anxiety, depressive and somatoform disorders in rehabilitation–validity of HADS and GHQ-12 in patients with musculoskeletal disease. Disability and Rehabilitation, 23(16), 737–744.

    Article  PubMed  CAS  Google Scholar 

  50. Coste, J., Le Parc, J. M., Berge, E., Delecoeuillerie G., & Paolaggi, J. B. (1993). French validation of a disability rating scale for the evaluation of low back pain (EIFEL questionnaire). Revue du Rhumatisme Ed. Française, 60(5), 335–341.

    CAS  Google Scholar 

  51. Roland, M., & Morris, R. (1983). A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine, 8(2), 141–144.

    Article  PubMed  CAS  Google Scholar 

  52. Wood-Dauphinee, S. L. (2001). Assessment of back-related quality of life. Spine, 26(8), 857–861.

    Article  PubMed  CAS  Google Scholar 

  53. Beaton, D., & Schemitsch, E. (2003). Measures of health-related quality of life and physical function. Clinical Orthopaedics and Related Research, 413, 90–105.

    Article  PubMed  Google Scholar 

  54. Al-Obaidi, S. M., Beattie, P., Al-Zoabi B., & Al-Wekeel, S. (2005). The relationship of anticipated pain and fear avoidance beliefs to outcome in patients with chronic low back pain who are not receiving workers’ compensation. Spine, 30(9), 1051–1057.

    Article  PubMed  Google Scholar 

  55. Woby, S. R., Watson, P. J., Roach, N. K., & Urmston, M. (2004). Adjustment to chronic low back pain–the relative influence of fear-avoidance beliefs, catastrophizing, and appraisals of control. Behaviour Research and Therapy, 42(7), 761–774.

    Article  PubMed  Google Scholar 

  56. Garratt, A. M., Moffett, J. K., & Farrin, A. J. (2001). Responsiveness of generic and specific measures of health outcome in low back pain. Spine, 26(1), 71–77.

    Article  PubMed  CAS  Google Scholar 

  57. Patrick, D. L., Deyo, R. A., Atlas, S. J., Singer, D. E., Chapin A., & Keller, R. B. (1995). Assessing health-related quality of life in patients with sciatica. Spine, 20(17), 1899–1908.

    Article  PubMed  CAS  Google Scholar 

  58. Kopec, J. A., & Esdaile, J. M. (1995). Functional disability scales for back pain. Spine, 20(17), 1943–1949.

    Article  PubMed  CAS  Google Scholar 

  59. Roland, M., & Fairbank, J. (2000). The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine, 25(24), 3115–3124.

    Article  PubMed  CAS  Google Scholar 

  60. French, D. J., Roach, P. J., & Mayes, S. (2002). Peur du mouvement chez des accidentes du travail: l’Echelle de Kinesiophobie de Tampa (EKT). Canadian Journal of Behavioural Science, 34(1), 28–33.

    Google Scholar 

  61. Kori, S. H., Miller, R. P., & Todd, D. D. (1990). Kinesiophobia: A new view of chronic pain behavior. Pain Management, January/February, 35–43.

  62. Swinkels-Meewisse, E. J. C. M., Swinkels, R. A. H. M., Verbeek, A. L. M., Vlaeyen, J. W. S., & Oostendorp, R. A. B. (2003). Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Manual Therapy, 8(1), 29–36.

    Article  PubMed  CAS  Google Scholar 

  63. Durand, M. J., Loisel, P., Hong, Q. N., & Charpentier, N. (2002). Helping clinicians in work disability prevention: The work disability diagnosis interview. Journal of Occupational Rehabilitation, 12(3), 191–204.

    Article  PubMed  Google Scholar 

  64. Von Korff, M., Jensen, M. P., & Karoly, P. (2000). Assessing global pain severity by self-report in clinical and health services research. Spine, 25, 3140–3151.

    Article  Google Scholar 

  65. Ferraz, M. B., Quaresma, M. R., Aquino, L. R., Atra, E., Tugwell P., & Goldsmith, C. H. (1990). Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. The Journal of Rheumatology, 17(8), 1022–1024.

    PubMed  CAS  Google Scholar 

  66. Jensen, M. P., Karoly P., & Braver, S. (1986). The measurement of clinical pain intensity: A comparison of six methods. Pain, 27(1), 117–126.

    Article  PubMed  CAS  Google Scholar 

  67. Jensen, M. P., Karoly, P., O’Riordan, E. F., Bland, F. Jr., & Burns, R. S. (1989). The subjective experience of acute pain. An assessment of the utility of 10 indices. The Clinical Journal of Pain, 5(2), 153–159.

    Article  PubMed  CAS  Google Scholar 

  68. Tabachnick, B. G., & Fidell, L. S. (2000). Using multivariate statistics. Boston: Allyn & Bacon.

    Google Scholar 

  69. Wall, P. D., Melzack, R. (1999). Textbook of pain. Edinburgh, Scotland: Churchill Livingstone.

    Google Scholar 

  70. Waddell, G. (1998). The back pain revolution. Edinburgh, London: Churchill Livingston.

    Google Scholar 

  71. Steenstra, I. A., Anema, J. R., Bongers, P. M., de Vet, H. C., Knol, D. L., & Van Mechelen, W. (2006). The effectiveness of graded activity for low back pain in occupational healthcare. Occupational & Environmental Medicine, 63(11), 718–725.

    Article  CAS  Google Scholar 

  72. Boyer, R., Preville, M., Legare G., & Valois, P. (1993). Psychological distress in a noninstitutionalized population of Quebec: Normative results of the Quebec health survey. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 38(5), 339–343.

    PubMed  CAS  Google Scholar 

  73. Légaré G., Préville, M., Massé R., Poulin, C., St-Laurent D., & Boyer, R. (2001). Santé mentale. In G. Légaré, M. Préville, R. Massé, C. Poulin, D. St-Laurent, & R. Boyer (Eds.), Enquête sociale et de santé 1998. Québec (Canada): Les publications du Québec.

    Google Scholar 

  74. Croft, P. R., Papageorgiou, A. C., Ferry, S., Thomas, E., Jayson, M. I., & Silman, A. J. (1995). Psychologic distress and low back pain. Evidence from a prospective study in the general population. Spine, 20(24), 2731–2737.

    Article  PubMed  CAS  Google Scholar 

  75. Magni, G., Caldieron, C., Rigatti-Luchini S., Merskey, H. (1990). Chronic musculoskeletal pain and depressive symptoms in the general population. An analysis of the 1st National Health and Nutrition Examination Survey data. Pain, 43(3), 299–307.

    Article  PubMed  CAS  Google Scholar 

  76. Magni, G., Marchetti, M., Moreschi, C., Merskey H., & Luchini, S. R. (1993). Chronic musculoskeletal pain and depressive symptoms in the National Health and Nutrition Examination. Epidemiologic follow-up study. Pain, 53(2), 163–168.

    Article  PubMed  CAS  Google Scholar 

  77. Watson, P. J., Booker, C. K., Moores L., & Main, C. J. (2004). Returning the chronically unemployed with low back pain to employment. European Journal of Pain, 8(4), 359–369.

    Article  PubMed  Google Scholar 

  78. Coutu, M. F., Durand, M. J., Loisel, P., Dupuis, G., & Gervais, S. (2005). Measurement properties of a new quality of life measure for patients with work disability associated with musculoskeletal pain. Journal of Occupational Rehabilitation, 15(3), 295–312.

    Article  PubMed  CAS  Google Scholar 

  79. Johnson, S. L. (1997). Therapist’s guide to clinical intervention. San Diego, California: Academic Press.

    Google Scholar 

  80. Krause, N., Dasinger, L. K., & Neuhauser, F. (1998). Modified work and return to work: A review of the literature. Journal of Occupational Rehabilitation, 8, 113–139.

    Article  Google Scholar 

  81. Franche, R. L., Krause, N. (2002). Readiness for return to work following injury or illness: Conceptualizing the interpersonal impact of health care, workplace, and insurance factors. Journal of Occupaitonal Rehabilitation, 12(4), 233–255.

    Article  Google Scholar 

  82. Loisel, P., Durand, M. J., Berthelette, D., et al. (2001). Disability prevention - New paradigm for the management of occupational back pain. Disease Management & Health Outcomes, 9(7), 351–360.

    Article  Google Scholar 

  83. Turk, D. C., Monarch, E. S. (2002). Biopsychosocial perspective on chronic pain. In D. C. Turk & R. J. Gatchel (Eds.), Psychological approaches to pain management: A practitioner’s handbook. New York: Guilford.

    Google Scholar 

Download references

Acknowledgements

The preparation of this manuscript was supported by a start-up grant from the FRSQ Health and Society Team program. We are most grateful to all the participants for their time and to the clinicians who so rigorously performed the WoDDI assessment of the participants.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marie-France Coutu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Coutu, MF., Durand, MJ., Loisel, P. et al. Level of Distress Among Workers Undergoing Work Rehabilitation for Musculoskeletal Disorders. J Occup Rehabil 17, 289–303 (2007). https://doi.org/10.1007/s10926-007-9079-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10926-007-9079-y

Keywords

Navigation