Determinants of "return to work in good health" among workers with back pain who consult in primary care settings: a 2-year prospective study.
Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of "return to work in good health" (RWGH--a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of "success" in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of "failure" in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.
Dionne
Clermont E
CE
Unité de recherche en santé des populations, Centre de recherche du CHA de Québec, Hôpital du Saint-Sacrement, 1050, chemin Ste-Foy, Quebec City, QC, Canada, G1S 4L8. clermont.dionne@uresp.ulaval.ca
Bourbonnais
Renée
R
Frémont
Pierre
P
Rossignol
Michel
M
Stock
Susan R
SR
Nouwen
Arie
A
Larocque
Isabelle
I
Demers
Eric
E
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001416:Back Pain / Q000523:psychology* / Q000534:rehabilitation*; D004651:Employment / Q000523:psychology*; D005239:Fear; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D018582:Sick Leave; D012803:Sick Role