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Risk Factors Associated With the Transition From Acute to Chronic Occupational Back Pain

Fransen, Marlene, PhD,*; Woodward, Mark, PhD,*; Norton, Robyn, PhD,*; Coggan, Carolyn, PhD,†; Dawe, Martin, BA,†; Sheridan, Nicolette, MPH

Occupation Health Ergonomics

Study Design.  A prospective cohort study was conducted on workers claiming earnings-related compensation for low back pain. Information obtained at the time of the initial claim was linked to compensation status (still claiming or not claiming) 3 months later.

Objective.  To identify individual, psychosocial, and workplace risk factors associated with the transition from acute to chronic occupational back pain.

Summary of Background Data.  Despite the magnitude of the economic and social costs associated with chronic occupational back pain, few prospective studies have investigated risk factors identifiable in the acute stage.

Methods.  At the time of the initial compensation claim, a self-administered questionnaire was used to gather information on a wide range of risk factors. Then 3 months later, chronicity was determined from claimants’ computerized records.

Results.  The findings showed that 3 months after the initial assessment, 204 of the recruited 854 claimants (23.9%) still were receiving compensation payments. A combined multiple regression model of individual, psychosocial, and workplace risk factors demonstrated that severe leg pain (odds ratio [OR], 1.9), obesity (OR, 1.7), all three Oswestry Disability Index categories above minimal disability (OR, 3.1–4), a General Health Questionnaire score of at least 6 (OR, 1.9), unavailability of light duties on return to work (OR, 1.7), and a job requirement of lifting for three fourths of the day or more all were significant, independent determinants of chronicity (P < 0.05).

Conclusions.  Simple self-report measures of individual, psychosocial, and workplace factors administered when earnings-related compensation for back pain is claimed initially can identify individuals with increased odds for development of chronic occupational disability.

From the *Institute for International Health, University of Sydney, Australia, and the

†Injury Prevention Research Centre, University of Auckland, New Zealand.

Supported by the Accident Rehabilitation and Compensation Insurance Corporation (ACC). The Injury Prevention Research Centre is jointly funded by the Health Research Council of New Zealand and the ACC.

Acknowledgment date: February 6, 2001.

First revision date: May 10, 2001.

Acceptance date: May 17, 2001.

Device status category: 1.

Conflict of interest category: 14.

Address reprint requests to

Marlene Fransen, PhD

Institute for International Health

P.O. Box 576

Newtown, New South Wales 2042


© 2002 Lippincott Williams & Wilkins, Inc.