Journal of Occupational Rehabilitation

, Volume 12, Issue 2, pp 65–75 | Cite as

Identification of Obstacles for Chronic Pain Patients to Return to Work: Evaluation of a Questionnaire

  • Charlotta MarholdEmail author
  • Steven J. Linton
  • Lennart Melin


The Obstacles to Return-to-Work Questionnaire (ORQ) was developed and evaluated. A total of 154 patients with chronic musculoskeletal pain and prolonged work disability participated in the study. Factor analyses reduced the ORQ to 55 items grouped into 9 subscales. The subscales were named “Depression,” “Pain intensity,” “Difficulties at work return,” “Physical workload and harmfulness,” “Social support at work,” “Worry due to sick leave,” “Work satisfaction,” “Family situation and support,” and “Perceived prognosis of work return.” The subscales showed satisfactory reliability. In order to determine predictive validity a discriminant analysis was conducted with sick leave 9 months after assessment as the outcome. This analysis indicated that the scales “Perceived prognosis of work return,” “Social support at work,” “Physical workload and harmfulness,” “Depression,” and “Pain intensity” could significantly predict sick leave and correctly classified 79% of the patients. The Multidimensional Pain Inventory and the Disability Rating Index could also significantly predict sick leave in this sample and correctly classified as many patients as the ORQ. However, these questionnaires do not include any work-oriented items and they had a lower specificity than the ORQ. This study suggests that patients' perceptions and beliefs about work and returning to work may be a significant hindrance for actual recovery.

return-to-work sick leave prediction back pain neck and shoulder pain prognosis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Karasek RA, Schwartz J, Theorell T. Job characteristics, occupation and coronary heart disease. Final report to National Institute of Occupational Safety and Health. New York: Columbia University, 1982.Google Scholar
  2. 2.
    Bergner M, Bobbitt RA, Carter WB, Gibson BS. The Sickness Impact Profile: Development and final revision of a health status measure. Med Care 1981; 19: 787–805.Google Scholar
  3. 3.
    Hazard RG, Haugh LD, Reid S, Preble JB, MacDonald RT. Early prediction of chronic disability after occupational low back injury. Spine 1996; 21: 945–951.Google Scholar
  4. 4.
    Linton SJ, Halldén K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain 1998; 14: 209–215.Google Scholar
  5. 5.
    Fishbain DA, Rosomoff HL, Goldberg M, Cutler R, Abdel-Moty E, Khalil TK, Steele Rosomoff R. The prediction of return-to-work after multidisciplinary pain center treatment. Clin J Pain 1993; 9: 3–15.Google Scholar
  6. 6.
    Ekberg K, Wildhagen I. Long-term sickness absence due to musculoskeletal disorders: The necessary invention of work conditions. Scand J Rehab Med 1996; 28: 39–47.Google Scholar
  7. 7.
    Van der Giezen AM, Bouter LM, Nijhuis FJN. Prediction of return-to-work of lowback pain patients sicklisted for 3–4 months. Pain 2000; 87: 285–294.Google Scholar
  8. 8.
    Linton SJ. Risk factors for neck and back pain in a working population in Sweden. Work Stress 1990; 4: 41–49.Google Scholar
  9. 9.
    Holmström EB, Lindell J, Moritz U. Low back pain and neck/shoulder pain in construction workers: Occupational workload and psychosocial risk factors. Spine 1992; 17: 672–677.Google Scholar
  10. 10.
    Bongers PM, de Winter CR, Kompier MAJ, Hildebrandt VH. Psychosocial factors atwork and musculoskeletal disease. Scand J Work Environ Health 1993; 19: 297–312.Google Scholar
  11. 11.
    Houtman ILD, Bongers PM, Smulders PGW, Kompier MAJ. Psychosocial stressors at work and musculoskeletal disease. Scand J Work Environ Health 1994; 20: 139–145.Google Scholar
  12. 12.
    Ekberg K, Björkqvist B, Malm P, Bjerre-Kiely B, Karlsson M, Axelson O. Cross-sectional study of risk factors for symptoms in the neck and shoulder area. Ergonomics 1995; 38: 971–980.Google Scholar
  13. 13.
    Hoogendoorn WE, van Poppel MNM, Bongers PM, Koes BW, Bouter LM. Systematic reviewof psychosocial factors at work and private life as risk factors for back pain. Spine 2000; 25: 2114–2115.Google Scholar
  14. 14.
    Wallace M, Buckle P. Ergonomic aspects of neck and upper limb disorders. Int Rev Ergon 1987;1:173–200.Google Scholar
  15. 15.
    Sommerich CM, McGlothlin JD, Marras WS. Occupational risk factors associated with soft tissue disorders of the shoulder: A review of recent investigations in the literature. Ergonomics 1993; 36: 697–717.Google Scholar
  16. 16.
    Kilbom Å. Assessment of physical exposure in relation to work-related musculoskeletal disorders-what information can be obtained from systematic observations? Scand J Work Environ Health 1994; 20: 30–45.Google Scholar
  17. 17.
    Hoogendoorn WE, van Poppel MNM, Bongers PM, Koes BW, Bouter LM. Physical load during work and leisure time as risk factors for back pain. Scand J Environ Health 1999; 25: 387–403.Google Scholar
  18. 18.
    Marhold C, Linton SJ, Melin L. A cognitive-behavioral return-to-work program: Effects on pain patients with a history of long-term versus short-term sick leave. Pain 2001; 91: 155–163.Google Scholar
  19. 19.
    Sandström J, Esbjörnsson E. Return-to-work after rehabilitation: The significance of the patients' own prediction. Scand J Rehab Med 1986; 18: 9–33.Google Scholar
  20. 20.
    Hildebrandt J, Pfingsten M, Saur P, Jansen J. Prediction of success from a multidisciplinary treatment program for chronic low back pain. Spine 1997; 22: 990–1001.Google Scholar
  21. 21.
    Linton SJ, Melin L, Götestam KG. Behavioral analysis of chronic pain and its management. Prog Beh Modif 1984; 4: 1–42.Google Scholar
  22. 22.
    Turk DC. The role of demographic and psychosocial factors in transition from acute to chronic pain. In: Jensen TS, Turner JA, Wiesenfeld-Hallin Z, eds. Progress in pain research and management. Proceedings of the 8th World Congress on Pain, Vol. 8. Seattle: IASP Press, 1997.Google Scholar
  23. 23.
    American Psychological Association. Ethical principles. Am Psychol 1992; 47: 1597–1611.Google Scholar
  24. 24.
    Kerns RD, Turk DC, Rudy TE. The West Haven-Yale multidimensional pain inventory (WHYMPI). Pain 1985; 23: 345–356.Google Scholar
  25. 25.
    Rosenstiel AK, Keefe FJ. The use of coping strategies in low back pain patients: Relationship to patient characteristics and current adjustment. Pain 1983; 17: 33–40.Google Scholar
  26. 26.
    Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. New York: Guilford Press, 1979.Google Scholar
  27. 27.
    Salén BA, Spangfort EV, Nygren ÅL, Nordemar R. The Disability Rating Index: An instrument for the assessment of disability in clinical settings. J Clin Epidem 1994; 47: 1423–1434.Google Scholar
  28. 28.
    Symonds TL, Burton AK, Tillotson KM, Main CJ. Do attitudes and beliefs influence work loss due to low back trouble? Occup Med 1996; 46: 25–32.Google Scholar
  29. 29.
    Fishbain DA, Cutler RB, Rosomoff HL, Khalil T, Steele-Rosomoff RN. Impact of chronic pain patients' job perception variables on actual return-to-work. Clin J Pain 1997; 13: 197–206.Google Scholar
  30. 30.
    Crombie IK, Croft PR, Linton SJ, LeResche L, Von Korff, M. Epidemiology of pain. Seattle: IASP Press, 1999.Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Charlotta Marhold
    • 1
    Email author
  • Steven J. Linton
    • 2
  • Lennart Melin
    • 1
  1. 1.Department of PsychologyUppsala UniversityUppsalaSweden
  2. 2.Department of Occupational and Environmental MedicineÖrebro Medical CenterÖrebroSweden

Personalised recommendations