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Pain Most Prominent Indicator of Ability to Return to Work Following Acute Lower Back Injury
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Posted on: 05/31/2007
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Doctors know that psychosocial factors can play a role in the duration and outcome of lower back pain but, until now, few studies have focused on workers with lower back pain and when - and if - they can return to work. Also, the studies that have been done have used populations drawn from those who were able to make claims from workman's compensation, perhaps affecting the study outcome.
This prospective cohort study of 140 male military personnel investigated the psychosocial variables, including job satisfaction, life stress, social support, and coping and their effects on pain, mood, and overall function. The study participants were assessed at baseline, six months and one year. The men were between 18 and 50 years of age and were experiencing their first episode of lower back pain. Their back pain had begun between six and 10 weeks earlier. Men who were taking or had taken medications to alter their moods, such as for depression or anxiety, weren't eligible to take part.
The study participants were all examined by a physician and answered the same questionnaires at all three time points of the study. The questionnaires were: the Descriptor Differential Scale (DDS) for pain, the Pain and Impairment Relationship Scale (PAIRS) for everyday function, an interview regarding life adversity, the Social Support Questionnaire for support networks, the Ways of Coping Scale (WOC) for dealing with stressful situations, the Hamilton Rating Scale for Depression, and a return-to-work evaluation. During the study period, all participants received the usual orthopedic care.
At the end of the study, the researchers found that most of the participants continued to complain of pain but most, 63 percent, were able to return to work full time, without any restrictions. At the start of the study, only 37 percent of the participants were able to work full time.
When comparing participants who returned to work full time or with adaptations or restrictions, the researchers noted that at six months, 58.6 percent of the participants had returned to work with no restrictions, 10 percent were working with some modifications, 18.6 percent were doing alternate work, and 5.7 percent were going to be receiving discharges from the military shortly. Of the remaining participants, 1.4 percent had already left the military and the rest were lost to follow up. At 12 months, only 4.3 percent required modifications at work, 5.7 percent had completed their enlistment, and the remaining were lost to follow up.
The researchers analyzed the results and found that pain was the only significant indication as to whether a participant's work status would change throughout the year. Other factors, such as social support and coping didn't appear to play a similar role.
Although the findings in this study didn't find a connection between emotional distress and return to work, the researchers did find that almost half of the participants, 49 percent, did report significant depression symptoms at two months. They point out that if the depressive symptoms were present before the back injury occurred, recovery may be affected.
Although the study was limited to males and the sample size was small, the researchers concluded that early intervention to improve function may improve rates of return to work, and reduce or prevent work disability.
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References:
William S. Shaw, PhD, et al. Shared and Independent Associations of Psychosocial Factors on Work Status Among Men With Subacute Low Back Pain. In Clin J Pain. June 2007. Vol. 23. No. 5.
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