Worker recovery expectations and fear-avoidance predict work disability in a population-based workers' compensation back pain sample.
METHODS
Prospective, population-based cohort study.


OBJECTIVE
To examine whether worker demographic, pain, disability, and psychosocial variables, assessed soon after work-related back pain disability onset, predict 6-month work disability.


BACKGROUND
Greater age, pain, and physical disability, and certain psychosocial characteristics may be risk factors for prolonged back pain-related work disability, although many studies have been small, findings have been inconsistent, and some psychosocial variables have not been examined prospectively.


METHODS
Workers (N = 1,068) completed telephone interviews assessing demographic, pain, disability, and psychosocial variables 18 days (median) after submitting Workers' Compensation back pain disability claims. Administrative measures of work disability 6 months after claim submission were obtained.


RESULTS
At 6 months, 196 workers (18.4%) were receiving work disability compensation. Age, race, education, and baseline pain and disability were significant predictors of 6-month disability. Adjusting for baseline demographics, pain, disability, and other psychosocial variables, high work fear-avoidance (odds ratio, 4.6; 95% confidence interval, 1.6-13.7) and very low recovery expectations (odds ratio, 3.1, 95% confidence interval, 1.5-6.5) were significant independent predictors.


CONCLUSIONS
Among individuals with acute work-related back pain, high pain and disability, low recovery expectations, and fears that work may increase pain or cause harm are risk factors for chronic work disability.
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA. jturner@u.washington.edu
Judith A
JA
Turner
Gary
G
Franklin
Deborah
D
Fulton-Kehoe
Lianne
L
Sheppard
Thomas M
TM
Wickizer
Rae
R
Wu
Jeremy V
JV
Gluck
Kathleen
K
Egan
D000293:Adolescent; D000328:Adult; D000368:Aged; D001362:Avoidance Learning; D015331:Cohort Studies; D004185:Disability Evaluation; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D017116:Low Back Pain / Q000453:epidemiology* / Q000523:psychology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D014942:Workers' Compensation