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What Influences Positive Return to Work Expectation?: Examining Associated Factors in a Population-Based Cohort of Whiplash-Associated Disorders

Ozegovic, Dejan PT, MSc*; Carroll, Linda J. PhD*†‡; Cassidy, J. David PhD, DrMedSci§¶∥

doi: 10.1097/BRS.0b013e3181d12432
Occupational Health/Ergonomics

Study Design. Cross-sectional study of population-based traffic cohort.

Objective. To determine which factors are associated with both positive and negative expectations for returning to work after vehicle collision resulting in neck pain.

Summary of Background Data. Positive expectations predict better outcomes for a variety of health conditions, including return to work from soft-tissue injury (including whiplash-associated disorders [WADs]). However, we know little about those with negative expectations who may be at risk for poor WAD outcomes.

Methods. We assessed expectations for return to work in a population-based cohort of 2335 individuals with traffic-related WAD. We used logistic regression analysis to model factors associated with expecting to return to work (compared with not expecting to return to work or being unsure).

Results. Depressive symptomatology, lower education, lower income, male sex, and greater initial pain (greater percentage of body in pain and greater intensity of neck pain) were associated with lower return-to-work expectation.

Conclusion. A number of demographic, socioeconomic, and injury-related factors were associated with expectations for return to work in WAD. Two of the strongest associated factors were depressive symptomatology and postcollision initial neck pain intensity. These results support using a biopsychosocial approach to evaluate expectancies and their influence on important health outcomes.

To determine which factors are associated with both positive and negative expectations for returning to work after vehicle collision, we performed a cross-sectional study in a population-based cohort and found that pain and demographic and psychologic variables were statistically associated with return to work expectation.

From the *Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Alberta, Canada; †Alberta Heritage Foundation for Medical Research, Alberta, Canada; ‡Department of Public Health Sciences; §Centre of Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation Solutions; ¶Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada; and ∥Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

Acknowledgment date: August 26, 2009. Revision date: December 14, 2009. Acceptance date: December 16, 2009.

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

Corporate/industry, institutional, and other 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.

Data collection was supported by a grant from Saskatchewan Government Insurance Corporation.

L.C. has received funding from insurance companies to undertake research on neck pain. J.D.C. has received funding from Saskatchewan Government Insurance and other public and private insurance companies to undertake studies on traffic injuries, and partially funded by the Ontario Workplace Safety and Insurance Board (WSIB) through a Centre of Research Expertise award. D.O. declares no conflicts of interest.

The study sponsors had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

D.O. performed the data analysis, interpreted the results, was lead writer of the manuscript, and approved the final version. L.C. co-wrote the study protocol, secured funding as a co-investigator, assisted in development of the instruments, data analysis, interpretation of results, manuscript preparation, and writing of the manuscript, and approved the final version. J.D.C. co-wrote the study protocol, secured funding as the principal investigator, assisted in development of the instruments and interpretation of results, and approved the final version.

Address correspondence and reprint requests to Dejan Ozegovic, PT, MSc, 4075 RTF, University of Alberta, Edmonton, Alberta, Canada T6G 2E1; E-mail: ozegovic@ualberta.ca

© 2010 Lippincott Williams & Wilkins, Inc.