Introduction We test an array of biopsychosocial, cognitive-behavioral, and work-related factors to identify the best predictors of work disability following a back injury. Methods We test the validity of alternative severity measures in predicting the likelihood of four distinct, mutually exclusive patterns of post-injury employment in the first year after onset of back pain. The study sample includes 959 participants in the ASU Healthy Back Study, a prospective cohort study of workers who filed claims for occupational back pain between 1999 and 2002. Self-reported severity measures include: NRS-101 measures of the intensity of back or leg pain, Roland–Morris scale of functional disability, and mental and physical components of the SF-12. Results All the severity measures have significant predictive power on return-to-work outcomes even after 1 year. Baseline physical functioning and overall mental and physical health status are more predictive of specific patterns of post-injury employment than pain intensity measures, possibly because there is considerable idiosyncratic variation in the pain intensity measures. The mental component of the SF-12, in particular, is relatively robust to alternate specifications, consistently statistically significant, and has the lowest probability significance level in explaining patterns of employment 1 year after injury.
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Bureau of Labor Statistics, U.S. Department of Labor. Lost-worktime injuries and illnesses: characteristics and resulting time away from work, 2004.DOL Publication No. USDL 05-2312 December 13, 2005. Retrieved from http://www.bls.gov/news.release/osh2.nro.htm.
Mychaskiw MA, Thomas J III. Indirect costs due to back pain in the United States [abstract]. Contributed podium presentations of ISPOR Seventh Annual International Meeting. Value Health 2002;5(3):117–137.
Hashemi L, Webster BS, Clancy EA. Trends in disability duration and cost of workers’ compensation low back pain claims (1988–1996). J Occup Environ Med 1998;40(12):1110–1119.
Gallagher RM, Rauh V, Haugh LD, Milhous R, Callas PW, Langelier R, McClallen JM, Frymoyer J. Determinants of return-to-work among low back pain patients. Pain 1989;39(1):55–67.
Dozois DJ, Dobson KS, Wong M, Hughes D, Long A. Predictive utility of the CSQ in low back pain: individual vs. composite measures. Pain 1996;66(2–3):171–180.
Schultz IZ, Crook JM, Berkowitz J, Meloche GR, Milner R, Zuberbier OA, Meloche W. Biopsychosocial multivariate predictive model of occupational low back disability. Spine 2002;27(23):2720–2725.
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(1–2):77–85.
Schultz IZ, Crook J, Berkowitz J, Milner R, Meloche GR. Predicting return to work after low back injury using the Psychosocial Risk for Occupational Disability Instrument: a validation study. J Occup Rehabil 2005;15(3):365–376.
Truchon M, Côté D. Predictive validity of the Chronic Pain Coping Inventory in subacute low back pain. Pain 2005;116(3):205–212.
Shaw WS, Pransky G, Fitzgerald TE. Early prognosis for low back disability: intervention strategies for health care providers. Disabil Rehabil 2001;23(18):815–828.
Steenstra IA, Verbeek JH, Heymans MW, Bongers PM. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occup Environ Med 2005;62(12):851–860.
Grotle M, Vollestad NK, Veierod MB, Brox JI. Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain. Pain 2004;112(3):343–352.
Côté P, Baldwin ML, Johnson WG. Early patterns of care for occupational back pain. Spine 2005;30;5:581–587.
Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 1986;27:117–26.
Roland M, Morris R. 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 1983;8(2):141–4.
Deyo RA. Comparative validity of the Sickness Impact Profile and shorter scales for functional assessment in low-back pain. Spine 1986;11(9):951–4.
Deyo RA, Centor RM. Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance. J Chronic Dis 1986;39(11):897–906.
Stratford PW, Binkley J, Solomon P, Gill C, Finch E. Assessing change over time in patients with low back pain. Phys Ther 1994;74(6):528–33.
Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, Wood-Dauphinee S, Lamping DL, Williams JI. The Quebec Back Pain Disability Scale measurement properties. Spine 1995;20(3):341–52.
Stratford PW, Binkley J, Solomon P, Finch E, Gill C, Moreland J. Defining the minimum level of detectable change for the Roland-Morris Questionnaire. Phys Ther 1996;76(4):359–65; discussion 366–8.
Leclaire R, Blier F, Fortin L, Proulx R. A cross-sectional study comparing the Oswestry and Roland-Morris functional disability scales in two populations of patients with low back pain of different levels of severity. Spine 1997;22(1):68–71.
Beurskens AJ, de Vet HC, Koke AJ. Responsiveness of functional status in low back pain: a comparison of different instruments. Pain 1996;65(1):71–6.
Hsiegh CY, Phillips RB, Adams AH, Pope MH. Functional outcomes of low back pain: Comparison of four treatment groups in a randomized controlled trial. J Manipulative Physiol Ther 1992;15(1):4–9.
Ware JE, Kosinski M, Keller SD. SF-12. How to Score the SF-12 Physical, Mental Health summary Scales. 1st ed. Boston MA: The Health Institute, New England Medical Center; 1995.
Ware JE, Turner-Bowker DM, Kosinski M, et al. SF-12v2TM: How to Score Version 2 of the SF-12 Health Survey. Lincoln, RI: QualityMetric Incorporated; 2002.
Ware J Jr, Kosinski M, Keller KD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34(3):220–33.
Luo X, George ML, Kakouras I, Edwards CL, Pietrobon R, Richardson W, Hey L. Reliability, validity, and responsiveness of the Short Form 12-item survey (SF-12) in patients with back pain. Spine 2003;28(15):1739–45.
Butler RJ. The economics of social insurance, employee benefits. Boston MA: Kluwer Academic Publishers; 1996.
Hosmer DW, Lemeshow S. Applied logistic regression. New York: John Wiley and Sons; 2000.
Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med 2002;137:586–597.
Johnson WG, Baldwin ML, Butler RJ. Back pain and work disability: the need for a new paradigm. Industrial Relations 1998;37(1):9–34.
This research was supported by a grant, with full freedom to publish, from the National Chiropractic Mutual Insurance Company, a national insurer of doctors of chiropractic. Industry and Institutional funds were also received in support of this work; we are especially grateful to the Office of the Vice President for Research and Economic Affairs, Arizona State University, as well as the College of Family, Home, and Social Sciences at Brigham Young University.
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Baldwin, M.L., Butler, R.J., Johnson, W.G. et al. Self-reported Severity Measures as Predictors of Return-to-work Outcomes in Occupational Back Pain. J Occup Rehabil 17, 683–700 (2007). https://doi.org/10.1007/s10926-007-9102-3
- Low back pain
- Return to work
- Back functionality
- Mental well being