Self-reported Severity Measures as Predictors of Return-to-work Outcomes in Occupational Back Pain


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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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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Correspondence to Marjorie L. Baldwin.



Table AI Sample means by survey period
Table AII Semi-elasticity estimates from the model with no severity measures

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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).

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  • Low back pain
  • Return to work
  • Back functionality
  • Mental well being