Skip to main content

Return to Work After Injury: A Review of Evidence Regarding Expectations and Injury Perceptions, and their Influence on Outcome

Abstract

Introduction Work disability after injury is a complex problem, and there remains a lack of clarity about what factors are most influential on whether or not someone will experience difficulty returning to work. Increasingly, expectations and injury perceptions are being explored as potential factors in work disability, because of their role in influencing behaviours. Methods This paper reviewed the literature regarding how expectations (regarding injury recovery and return to work) and injury perceptions relate to return to work outcome. A wide range of electronic journal databases were searched, and identified articles were critically appraised to assess quality and relevance. Results were then synthesised and discussed in relation to the evidence available regarding the role of expectations and injury perceptions in return to work, and implications for practice and further research. Results Findings showed that evidence regarding to how both expectations and injury perceptions contribute to return to work outcome is limited. Some suggestions for application to practice are made. Methodological issues and key points to consider for future research are discussed. Conclusions While in general little is known about how much expectations and injury perceptions influence return to work outcome, it is clear that the issue requires further investigation. Key limits to current knowledge result from inadequate methods of measuring expectation/s, lack of clear definitions of ‘return to work outcome’ and differences in timeframes and populations. Never-the-less, there is promising evidence to suggest that, in particular, pain catastrophizing research is warranted due to its correlation with outcome and amenability to change.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Stover B, Wickizer TM, Zimmerman F, Fulton-Kehoe D, Franklin G. Prognostic factors of long-term disability in a workers’ compensation system. J Occup Environ Med. 2007;49(1):31–40. doi:10.1097/01.jom.0000250491.37986.b6.

    PubMed  Article  Google Scholar 

  2. 2.

    Frank J, Sinclair S, Hogg-Johnson S, Shannon H, Bombardier C, Beaton D, et al. 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(12):1625–31.

    CAS  Google Scholar 

  3. 3.

    Turner JA, Franklin G, Fulton-Kehoe D, Sheppard L, Wickizer TM, Wu R, et al. Worker recovery expectations and fear-avoidance predict work disability in a population-based workers’ compensation back pain sample. Spine. 2006;31(6):682–9. doi:10.1097/01.brs.0000202762.88787.af.

    PubMed  Article  Google Scholar 

  4. 4.

    Bowling A. Research methods in health: investigating health and health services. Philadelphia: Open University Press; 1997.

    Google Scholar 

  5. 5.

    Oakley A. Design and analysis of social intervention studies in health research. In: Bowling A, Ebrahim S, editors. Handbook of health research methods: investigation, measurement and analysis. Maidenhead: Open University Press; 2005. p. 246–65.

    Google Scholar 

  6. 6.

    Peat JK, Mellis C, Williams K, Zuan W. Health science research: a handbook of quantitative methods. London: SAGE Publications Ltd.; 2002.

    Google Scholar 

  7. 7.

    Heijbel B, Josephson M, Jensen I, Stark S, Vingard E. Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: prospective study with clinical implications. J Occup Rehabil. 2006;16(2):173–84. doi:10.1007/s10926-006-9016-5.

    PubMed  Article  Google Scholar 

  8. 8.

    Young AE, Wasiak R, Roessler RT, McPherson KM, Anema JR, van Poppel MNM. Return-to-work outcomes following work disability: stakeholder motivations, interests and concerns. J Occup Rehabil. 2005;15(4):543–56. doi:10.1007/s10926-005-8033-0.

    PubMed  Article  Google Scholar 

  9. 9.

    Sullivan MJ, Stanish W, Waite H, Sullivan M, Tripp DA. Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain. 1998;77(3):253–60. doi:10.1016/S0304-3959(98)00097-9.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Ross CE, Mirowsky J. Does employment affect health? J Health Soc Behav. 1995;36(3):230–43. doi:10.2307/2137340.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Pransky G, Gatchel R, Linton SJ, Loisel P. Improving return to work research. J Occup Rehabil. 2005;15(4):453–7. doi:10.1007/s10926-005-8027-y.

    PubMed  Article  Google Scholar 

  12. 12.

    Petticrew M, Roberts H. Systematic reviews in the social sciences: a practical guide. Malden, Oxford, Victoria: Blackwell; 2006.

    Google Scholar 

  13. 13.

    Khan KS, ter Riet G, Glanville J, Sowden AJ, Kleijnen J, editors. Undertaking systematic reviews of research on effectiveness: CRD’s guidance for those carrying out or commissioning reviews. NHS Centre for Reviews and Dissemination, University of York: York; 2001.

    Google Scholar 

  14. 14.

    Schultz IZ, Stowell AW, Feuerstein M, Gatchel RJ. Models of return to work for musculoskeletal disorders. J Occup Rehabil. 2007;17(2):327–52. doi:10.1007/s10926-007-9071-6.

    PubMed  Article  Google Scholar 

  15. 15.

    Sullivan MJ, Charles Ward L, Tripp D, French DJ, Adams H, Stanish WD. Secondary prevention of work disability: community-based psychosocial intervention for musculoskeletal disorders. J Occup Rehabil. 2005;15(3):377–92. doi:10.1007/s10926-005-5944-7.

    PubMed  Article  Google Scholar 

  16. 16.

    Fineout-Overholt E, Melnyk B. Building a culture of best practice. Nurse Leader. 2005;3(6):26–30.

    Article  Google Scholar 

  17. 17.

    Public Health Resource Unit. Critical appraisal skills programme: making sense of evidence. 2002 (cited 28 February, 2007); Available from: http://www.phru.nhs.uk/casp/casp.htm.

  18. 18.

    Magnussen L, Strand LI, Skouen JS, Eriksen HR. Motivating disability pensioners with back pain to return to work—a randomized controlled trial. J Rehabil Med. 2007;39(1):81–7. doi:10.2340/16501977-0004.

    PubMed  Article  Google Scholar 

  19. 19.

    Chan SK, Man DW. Barriers to returning to work for people with spinal cord injuries: a focus group study. Work (Reading, Mass.). 2005;25(4):325–32.

    Google Scholar 

  20. 20.

    Chapin MH, Kewman DG. Factors affecting employment following spinal cord injury: a qualitative study. Rehabil Psychol. 2001;46(4):400–416. doi:10.1037/0090-5550.46.4.400.

    Article  Google Scholar 

  21. 21.

    Shaw WS, Huang YH. Concerns and expectations about returning to work with low back pain: identifying themes from focus groups and semi-structured interviews. Disabil Rehabil. 2005;27(21):1269–81. doi:10.1080/09638280500076269.

    PubMed  Article  Google Scholar 

  22. 22.

    Sullivan MJ, Stanish WD. Psychologically based occupational rehabilitation: the Pain-Disability Prevention Program. Clin J Pain. 2003;19(2):97–104. doi:10.1097/00002508-200303000-00004.

    PubMed  Article  Google Scholar 

  23. 23.

    Sullivan MJL, Adams H, Rhodenizer T, Stanish WD. A psychosocial risk factor-targeted intervention for the prevention of chronic pain and disability following whiplash injury. Phys Ther. 2006;86(1):8–18.

    PubMed  Google Scholar 

  24. 24.

    Fritz JM, George SZ, Delitto A. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain. 2001;94(1):7–15. doi:10.1016/S0304-3959(01)00333-5.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Fritz J, George SZ. Identifying psychosocial variables in patients with acute work-related low back pain: the importance of fear-avoidance beliefs. Phys Ther. 2002;82(10):973–83.

    PubMed  Google Scholar 

  26. 26.

    Boersma K, Linton SJ. Screening to identify patients at risk: profiles of psychological risk factors for early intervention. Clin J Pain. 2005;21(1):38–43. doi:10.1097/00002508-200501000-00005.

    PubMed  Article  Google Scholar 

  27. 27.

    Tate RB, Yassi A, Cooper J. Predictors of time loss after back injury in nurses. Spine. 1999;24(18):1930–5. doi:10.1097/00007632-199909150-00012.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Cole DC, Mondloch MV, Hogg-Johnson S. Listening to injured workers: how recovery expectations predict outcomes—a prospective study. Can Med Assoc J. 2002;166(6):749–54.

    Google Scholar 

  29. 29.

    Hogg-Johnson S, Cole DC. Early prognostic factors for duration on temporary total benefits in the first year among workers with compensated occupational soft tissue injuries. Occup Environ Med. 2003;60(4):244–53. doi:10.1136/oem.60.4.244.

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Schonherr MC, Groothoff JW, Mulder GA, Schoppen T, Eisma WH. Vocational reintegration following spinal cord injury: expectations, participation and interventions. Spinal Cord. 2004;42(3):177–84. doi:10.1038/sj.sc.3101581.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Kapoor S, Shaw WS, Pransky G, Patterson W. Initial patient and clinician expectations of return to work after acute onset of work-related low back pain. J Occup Environ Med. 2006;48(11):1173–80. doi:10.1097/01.jom.0000243401.22301.5e.

    PubMed  Article  Google Scholar 

  32. 32.

    Shaw WS, Pransky G, Patterson W, Linton SJ, Winters T. Patient clusters in acute, work-related back pain based on patterns of disability risk factors. J Occup Environ Med. 2007;49(2):185–93. doi:10.1097/01.jom.0000254205.47334.c3.

    PubMed  Article  Google Scholar 

  33. 33.

    Shaw WS, Pransky G, Patterson W, Winters T. Early disability risk factors for low back pain assessed at outpatient occupational health clinics. Spine. 2005;30(5):572–80. doi:10.1097/01.brs.0000154628.37515.ef.

    PubMed  Article  Google Scholar 

  34. 34.

    Gibson L, Strong J. Assessment of psychosocial factors in functional capacity evaluation of clients with chronic back pain. Brit J Occup Ther. 1998;61(9):399–404.

    Google Scholar 

  35. 35.

    Woby S, Watson P, Roach N, Urmstom M. Adjustment to chronic low back pain—the relative influence of fear-avoidance beliefs, catastrophizing, and appraisals of control. Behav Res Ther. 2004;42(7):761–74. doi:10.1016/S0005-7967(03)00195-5.

    PubMed  Article  Google Scholar 

  36. 36.

    Sullivan M, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assessment. 1995;7:524–32. doi:10.1037/1040-3590.7.4.524.

    Article  Google Scholar 

  37. 37.

    Kori S, Miller R, Todd D. Kinesophobia: a new view of chronic pain behaviour. Pain Manage. 1990;3:35–43.

    Google Scholar 

  38. 38.

    Elfving B, Andersson T, Grooten W. Low levels of physical activity in back pain patients are associated with high levels of fear-avoidance beliefs and pain catastrophizing. Physiother Res Int. 2007;12(1):14–24. doi:10.1002/pri.355.

    PubMed  Article  Google Scholar 

  39. 39.

    Vlaeyen J, Kole-Snijders A, Boeren R, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62:363–72. doi:10.1016/0304-3959(94)00279-N.

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Sandstrom J, Esbjornsson E. Return to work after rehabilitation—the significance of the patients own prediction. Scand J Rehabil Med. 1986;18(1):29–33.

    PubMed  CAS  Google Scholar 

  41. 41.

    Schultz I, Crook J, Berkowitz J, Milner R, Meloche G. 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):365–76. doi:10.1007/s10926-005-5943-9.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Schultz IZ, Crook JM, Berkowitz J, Meloche GR, Milner R, Zuberbier OA, et al. Biopsychosocial multivariate predictive model of occupational low back disability. Spine. 2002;27(23):2720–5. doi:10.1097/00007632-200212010-00012.

    PubMed  Article  Google Scholar 

  43. 43.

    Krause N, Frank JW, Dasinger LK, Sullivan TJ, Sinclair SJ. Determinants of duration of disability and return-to-work after work related injury and illness: challenges for future research. Am J Ind Med. 2001;40:464–84. doi:10.1002/ajim.1116.

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Amik BC, Lerner D, Rogers WH, Rooney T, Katz JN. A review of health-related work outcome measures and their uses, and recommended measures. Spine. 2000;25(24):3152–60. doi:10.1097/00007632-200012150-00010.

    Article  Google Scholar 

  45. 45.

    Patel S, Greasley K, Watson PJ. Barriers to rehabilitation and return to work for unemployed chronic pain patients: a qualitative study. Eur J Pain (London, England). 2007;11(8):831–840. doi:10.1016/j.ejpain.2006.12.011.

    Article  Google Scholar 

  46. 46.

    Shaw L, Segal R, Polatajko H, Harburn K. Understanding return to work behaviours: promoting the importance of individual perceptions in the study of return to work. Disabil Rehabil. 2002;24(4):185–95. doi:10.1080/09638280110066299.

    PubMed  Article  Google Scholar 

  47. 47.

    Eklund M. Chronic pain and vocational rehabilitation: a multifactorial analysis of symptoms, signs and psycho-socio-demographics. J Occup Rehabil. 1992;2(2):53–66. doi:10.1007/BF01079012.

    Article  Google Scholar 

  48. 48.

    Foreman P, Murphy G. Work values and expectancies in occupational rehabilitation: the role of cognitive variables in the return-to-work process. J Rehabil. 1996;62(3):44–8.

    Google Scholar 

  49. 49.

    Gross DP, Battie MC. Work-related recovery expectations and the prognosis of chronic low back pain within a workers’ compensation setting. J Occup Environ Med. 2005;47(4):428–33. doi:10.1097/01.jom.0000158706.96994.a5.

    PubMed  Article  Google Scholar 

  50. 50.

    Schultz I, Crook J, Meloche G, Berkowitz J, Milner R, Zuberbier O, et al. Psychosocial factors predictive of occupational low back disability: towards development of a return-to-work model. Pain. 2004;107(1–2):77–85. doi:10.1016/j.pain.2003.09.019.

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    Magnussen L, Strand L, Skouen JS, Eriksen HR. Motivating disability pensioners with back pain to return to work—a randomised control trial. J Rehabil Med. 2007;39:81–7. doi:10.2340/16501977-0004.

    PubMed  Article  Google Scholar 

  52. 52.

    Fritz JM, George SZ. Identifying psychosocial variables in patients with acute work-related low back pain: the importance of fear-avoidance beliefs. Phys Ther. 2002;82(10):973–83.

    PubMed  Google Scholar 

  53. 53.

    Lange C, Burgmer M, Braunheim M, Heuft G. Prospective analysis of factors associated with work reentry in patients with accident-related injuries. J Occup Rehabil. 2007;17(1):1–10. doi:10.1007/s10926-006-9039-y.

    PubMed  Article  Google Scholar 

  54. 54.

    Dozois DJ, Dobson KS, Wong M, Hughes D, et al. Factors associated with rehabilitation outcome in patients with low back pain (LBP): prediction of employment outcome at 9-month follow-up. Rehabil Psychol. 1995;40(4):243–59. doi:10.1037/0090-5550.40.4.243.

    Article  Google Scholar 

  55. 55.

    Gatchel RJ, Polatin PB, Kinney RK. Predicting outcome of chronic back pain using clinical predictors of psychopathology—a prospective analysis. Health Psychol. 1995;14(5):415–20. doi:10.1037/0278-6133.14.5.415.

    PubMed  Article  CAS  Google Scholar 

  56. 56.

    Shaw WS, Huang Y-H. Concerns and expectations about returning to work with low back pain: identifying themes from focus groups and semi-structured interviews. Disabil Rehabil. 2005;27(21):1269–81. doi:10.1080/09638280500076269.

    PubMed  Article  Google Scholar 

Download references

Acknowledgement

Appreciation is extended to Amanda E. Young for her comments on an early draft of this paper.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Joanna Fadyl.

Appendix

Appendix

Table 5 Summary table—measurement of expectation
Table 6 Summary table—Outcome variable measurement

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fadyl, J., McPherson, K. Return to Work After Injury: A Review of Evidence Regarding Expectations and Injury Perceptions, and their Influence on Outcome. J Occup Rehabil 18, 362–374 (2008). https://doi.org/10.1007/s10926-008-9153-0

Download citation

Keywords

  • Expectation
  • Injury perception
  • Return to work
  • Pain catastrophizing
  • Fear-avoidance