The development of predictive and process models of return to work following an episode of low back pain

Abstract

Many people experience Iow back pain at some point in their lives. Most recover within a short period but a small proportion go on to chronic disability. The prevalence of, and costs associated with work absenteeism relating to, Iow back pain have made the early identification of people at risk for work disability an important research goal. Much ofthe research to date has been conducted with chronic Iow back pain patients. The findings from the comparatively small body of work involving acute Iow back pain patients have been inconsistent, in part due to the atheoretical selection of variables. There is, however, acceptance that any predictive model of return to work needs to adopt a biopsychosocial approach and that a supportive work environment is an important ingredient in a return to work outcome. To investigate factors impacting on return to work, two qualitative studies were undertaken with work supervisors (Λ∕ = 41) and employees with a current or recent episode of Iow back pain (Λ∕ = 16). Supervisors perceived their role played little part in the employee's return to work as this was effected primarily through a reduction in pain levels and "having the right attitude". In comparison, a four-phase Process Model of Return to Work developed from the employee interviews suggests a complex interaction of factors involved in a resumption of work duties which primarily revolve around monitoring pain and activity levels and comparing achievable activities to available work duties. A third study involving the completion of a postal questionnaire by 217 workers' compensation claimants investigated a range of variables including individual characteristics and treatment provider and workplace factors that the employee qualitative data suggested were potential predictors of a return to work after 28 days. It was found that variables directly and indirectly related to pain and perceived physical functioning contributed most to a Predictive Model of Return to Work. The two return to work models were integrated into a comprehensive Process Model of Return to Work which attempts to explain the interaction between the recovery process, individual employee characteristics, and environmental factors. This model supports the notion of a biopsychosocial perspective in return to work outcomes.