Biopsychosocial multivariate predictive model of occupational low back disability.
METHODS
To establish outcome, 253 workers with subacute and chronic low back conditions were assessed with a comprehensive multimethod biopsychosocial protocol at baseline, 3 days after the initial examination, and 3 months later.


OBJECTIVE
To validate empirically a biopsychosocial model for prediction of occupational low back disability.


BACKGROUND
Costs of low back occupational disability continue to spiral despite stabilization of low back injury rates. An empirically based model to predict occupational disability in workers with low back injuries is required.


METHODS
Workers with subacute low back injuries (4-6 weeks after injury, n = 192) and those with chronic back pain (6-12 months after injury, n = 61) were the study participants. The biopsychosocial protocol included five groups of variables: 1) sociodemographic, 2) medical, 3) psychosocial, 4) pain behavior, and 5) workplace-related factors. Predictive validity was investigated through a 3-month follow-up assessment, at which time the return to work outcome was determined. Stepwise logistic regression models were developed to predict work status.


RESULTS
The final integrated model consisted of variables from a wide biopsychosocial spectrum: vitality, health transition, feeling that job is threatened due to injury, expectations of recovery, guarding behavior, perception of severity of disability, time to complete walk, and right leg typical sciatica.


CONCLUSIONS
The "winning" variables identified in the integrated model are dominated by cognitions, which are accompanied by disability behaviors. A cognitive-behavioral model with an adaptation-oriented rather than a pathology-oriented focus is favored for early intervention with high-risk workers since cognitions are amenable to change.
Schultz
Izabela Z
IZ
Department of Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, Canada. ischultz@telus.net
Crook
Joan M
JM
Berkowitz
Jonathan
J
Meloche
Gregory R
GR
Milner
Ruth
R
Zuberbier
Oonagh A
OA
Meloche
Wendy
W
D000328:Adult; D019567:Back Injuries / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D001955:British Columbia; D003071:Cognition; D003710:Demography; D004185:Disability Evaluation; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D008161:Lumbosacral Region; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D009460:Neurologic Examination / Q000379:methods; D009784:Occupational Diseases / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D011237:Predictive Value of Tests; D011379:Prognosis; D011581:Psychological Tests; D016059:Range of Motion, Articular; D015203:Reproducibility of Results