title: Ineffective disability management by doctors is an obstacle for return-to-work: a cohort study on low back pain patients sicklisted for 3-4 months.
abstract: OBJECTIVE
  To determine obstacles for return-to-work in disability management of low back pain patients sicklisted for 3-4 months.
  
  
  METHODS
  A cohort of 467 low back pain patients sicklisted for 3-4 months was recruited. A questionnaire was sent to their occupational physicians (OPs) concerning the medical management, obstacles to return-to-work, and the communication with treating physicians.
  
  
  RESULTS
  The OPs of 300 of 467 patients participated in this study. In many cases OPs regarded the clinical waiting period (43%), duration of treatment (41%), and view (25%) of the treating physicians as obstacles for return-to-work. Psychosocial obstacles for return-to-work such as mental blocks, a lack of job motivation, personal problems, and conflicts at work were all mentioned much less frequently by OPs. In only 19% of the patients was there communication between OP and treating physician. Communication almost always entailed an exchange of information, and less frequently an attempt to harmonise the management policy. Surprisingly communication was also limited, when OPs felt that the waiting period (32%), duration of treatment (30%), and view (28%) of treating physicians inhibited return-to-work. Communication was significantly associated with the following obstacles for return-to-work: passivity with regard to return-to-work and clinical waiting period; adjusted odds ratios were 3.35 and 2.23, respectively.
  
  
  CONCLUSIONS
  Medical management of treating physicians is often an obstacle for return to work regarding low back pain patients sicklisted for 3-4 months, in the opinion of OPs. Nevertheless communication between OPs and the treating physicians in disability management of these patients is limited. More attention to prevention of absenteeism and bilateral communication is needed in medical courses.
authors.affiliation: TNO Work and Employment, Netherlands IWI, formerly AS/tri, Netherlands EMGO-Institute and Department of Social Medicine, VU Medical Centre, Amsterdam, Netherlands. h.anema@arbeid.tno.nl
authors.forename: J R
authors.initials: JR
authors.lastname: Anema
authors.forename: A M
authors.initials: AM
authors.lastname: Van Der Giezen
authors.forename: P C
authors.initials: PC
authors.lastname: Buijs
authors.forename: W
authors.initials: W
authors.lastname: Van Mechelen
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D015331:Cohort Studies; D004651:Employment; D005194:Family Practice / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007400:Interprofessional Relations; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009786:Occupational Health Services / Q000592:standards; D011446:Prospective Studies; D012044:Regression Analysis; D018582:Sick Leave; D011795:Surveys and Questionnaires