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Initial Patient and Clinician Expectations of Return to Work After Acute Onset of Work-Related Low Back Pain

Kapoor, Sachin DO, MBA, MPH; Shaw, William S. PhD; Pransky, Glenn MD, MOccH; Patterson, William MD, MPH

Journal of Occupational and Environmental Medicine: November 2006 - Volume 48 - Issue 11 - p 1173-1180
doi: 10.1097/01.jom.0000243401.22301.5e
Original Articles

Objective: The objective of this study was to compare patient and provider expectations of return to work (RTW) after acute onset of low back pain (LBP).

Methods: Workers sick-listed after onset of LBP (N = 300) completed a questionnaire about work, injury, and psychosocial disability risk factors and rated their likelihood of full RTW within 4 weeks. Clinicians provided an independent estimate of work absence, and patients were followed for 3 months.

Results: Clinician and patient expectations were weakly correlated, and both were predictive of actual RTW outcomes. Patient expectations were associated with differences in pain, mood, prior back pain, job demands, functional limitation, and marital status. Factors associated with clinician prognosis were similar but with more emphasis on physical examination findings.

Conclusions: Even before treatment, patients may form a negative expectation for RTW that is associated with a longer duration of work absence.

From the Department of Environmental Health (Dr Kapoor), Harvard School of Public Health, Boston, Massachusetts, and now With Kaiser Permanente, Concord, California; Liberty Mutual Research Institute for Safety (Dr Shaw, Dr Pransky), Center for Disability Research, Hopkinton, Massachusetts, and the University of Massachusetts Medical School, Department of Family Medicine & Community Health, Worcester, Massachusetts; and Concentra Health Services (Dr Patterson), Burlington, Massachusetts.

Supported by research funding from the Liberty Mutual Group, Boston, Massachusetts.

Address correspondence to: William Shaw, PhD, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748; E-mail

©2006The American College of Occupational and Environmental Medicine