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.
Turner
Judith A
JA
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA. jturner@u.washington.edu
Franklin
Gary
G
Fulton-Kehoe
Deborah
D
Sheppard
Lianne
L
Wickizer
Thomas M
TM
Wu
Rae
R
Gluck
Jeremy V
JV
Egan
Kathleen
K
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