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Early Disability Risk Factors for Low Back Pain Assessed at Outpatient Occupational Health Clinics

Shaw, William S. PhD*†; Pransky, Glenn MD, MoccH*†; Patterson, William MD, MPH‡; Winters, Thomas MD, MPH§

Spine:
doi: 10.1097/01.brs.0000154628.37515.ef
Occupational Health/Ergonomics
Abstract

Study Design. Inception cohort (≤14 days after pain onset) with 1-month follow-up.

Objective. To determine whether disability risk factors provided by patients and clinicians at a first medical visit for acute occupational low back pain predict outcomes.

Summary of Background Data. Improving health and work outcomes for patients with occupational low back pain may require early identification of risk factors for persistent pain and disability. Previous studies of back pain prognosis have not assessed patients at the time of initial provider contact, and many have not differentiated between occupational and nonoccupational injuries.

Method. Patients (183 female, 385 male) presenting to occupational health clinics with recent onset occupational low back pain (≤14 days duration) completed a 16-item survey of potential disability risks including demographic, injury, workplace, psychosocial, and symptom factors. After the initial visit, clinicians completed an additional 10-item questionnaire of symptoms and initial prognosis. Outcome variables of functional limitation and work status were assessed 1 month after pain onset.

Results. In multivariate analyses, functional improvement and return to work were more strongly predicted by employer factors (job tenure, physical work demands, availability of modified duty, earlier reporting to employer) and self-ratings of pain and mood than by health history or physical examination. A logistic regression model had a sensitivity of 74.3% to predict those remaining out of work and a specificity of 70.1%.

Conclusions. Early screening for disability risk factors may be helpful to identify those patients at greatest risk for delayed recovery from occupational low back pain. Intervention strategies for high-risk patients might be improved by focusing on job factors, pain coping strategies, and expectations for recovery.

In Brief

A 16-item patient self-report questionnaire and a 10-item clinician questionnaire of disability risk factors were used to predict function and work outcomes among 568 patients presenting to occupational health clinics for acute (≤14 days) occupational low back pain. One-month functional improvement and return to work were more strongly predicted by employer factors and self-ratings of pain and mood than by health history or physical examination. The results suggest early intervention for high-risk patients should focus on job factors, pain coping strategies, and expectations for recovery.

Author Information

From the *Liberty Mutual Center for Disability Research, Hopkinton, Massachusetts, †Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts, ‡Occupational Health + Rehabilitation Inc, Hingham, Massachusetts, and §Occupational and Environmental Health Network, Waltham, Massachusetts.

Acknowledgment date: April 23, 2003. First revision date: December 30, 2003. Second revision date: February 12, 2004. Third revision date: March 29, 2004. Acceptance date: April 6, 2004.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to William S. Shaw, PhD, Liberty Mutual Center for Disability Research, 71 Frankland Road, Hopkinton, MA 01748; E-mail: william.shaw@libertymutual.com

Note from Editor. The Appendix to this article can be viewed on Article Plus.

© 2005 Lippincott Williams & Wilkins, Inc.