title: Validation of an adaptation of the stress process model for predicting low back pain related long-term disability outcomes: a cohort study.
abstract: METHODS
  Twelve-month cohort study.
  
  
  OBJECTIVE
  The aim of the study was to examine the ability of an adaptation of the stress process model to predict different outcomes among low back pain (LBP) sufferers.
  
  
  BACKGROUND
  Recently, the stress process model was adapted and was shown to be useful to partially explain long-term disability related to low back pain, an important occupational health problem.
  
  
  METHODS
  French-speaking compensated workers on sick leave because of subacute common LBP (N=439) completed a questionnaire including the adapted stress process model's factors: life events and appraisal, cognitive appraisal of LBP, emotional distress, avoidance coping strategies, and functional disability. Six and 12 months later, participants gave information about their work status, number of days of absence, and functional disability. Regression analyses were performed to identify significant predictive factors of these outcomes. Pain intensity, fear of work, gender, and presence of pain radiating below the knee were used as control variables.
  
  
  RESULTS
  Number of days of absence, functional disability, and absence from work were predicted at 6 and 12 months by cognitive appraisal of LBP and emotional distress. Functional disability was predicted in addition by functional disability at study entry (T1). When the control variables were considered, number of days of absence was predicted at 6 months by cognitive appraisal, fear of work, and being a male, and, in addition, by emotional distress at 12 months. Functional disability was predicted by functional disability t1, emotional distress, cognitive appraisal of LBP, and fear of work at 6 months, and by the same factors and variables at 12 months, except for functional disability t1. Regarding absence from work, it was predicted at 6 months by fear of work and being a male, and at 12 months by cognitive appraisal of LBP and fear of work.
  
  
  CONCLUSIONS
  In association with fear of work, 2 factors from the adapted stress process model are significantly useful for predicting LBP related long-term disability outcomes and could be targeted by preventive interventions.
authors.affiliation: Département des relations industrielles, Université Laval, Québec, Canada. manon.truchon@rlt.ulaval.ca
authors.forename: Manon
authors.initials: M
authors.lastname: Truchon
authors.forename: Denis
authors.initials: D
authors.lastname: Côté
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Schmouth
authors.forename: Jean
authors.initials: J
authors.lastname: Leblond
authors.forename: Lise
authors.initials: L
authors.lastname: Fillion
authors.forename: Clermont
authors.initials: C
authors.lastname: Dionne
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015203:Reproducibility of Results; D018582:Sick Leave / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D014937:Work / Q000523:psychology; D055815:Young Adult