Prospective population-based cohort study.
To identify early predictors
of chronic work disability
after work-related back injury.
Summary of Background Data.
Identification of early predictors
of prolonged disability after back injury could increase understanding concerning the development of chronic, disabling pain, and aid in secondary prevention. Few studies have examined predictors
across multiple domains in a large, population-based sample.
Workers (N = 1885) were interviewed 3 weeks (average) after submitting a lost work-time claim for a back injury. Sociodemographic, employment-related, pain and function, clinical, health care, administrative/legal, health behavior, and psychological domain variables were assessed via
worker interviews, medical records, and administrative databases. Logistic regression analyses identified early predictors
of work disability
compensation 1 year after claim submission.
Significant baseline predictors
of 1-year work disability
in the final multidomain model were injury severity (rated from medical records), specialty of the first health care provider seen for the injury (obtained from administrative data), and worker-reported physical disability (Roland-Morris disability questionnaire), number of pain sites, “very hectic” job, no offer of a job accommodation (e.g.
, light duty), and previous injury involving a month or more off work. The model showed excellent ability to discriminate between workers who were/were not disabled at 1 year (area under the receiver operating characteristic curve = 0.88, 95% CI = 0.86–0.90).
Among workers with new lost work-time back injury claims, risk factors
for chronic disability include radiculopathy, substantial functional disability, and to a lesser extent, more widespread pain and previous injury with extended time off work. The roles of employers and health care providers also seem important, supporting the need to incorporate factors external to the worker in models of the development of chronic disability and in disability prevention efforts.