What circumstances prompt a workplace discussion in medical evaluations for back pain?
OBJECTIVE
To determine how frequently workplace topics emerge in the interactions between patients and providers in an evaluation for low back pain (LBP) and to determine its association with patient and provider characteristics.


METHODS
Adults with work-related LBP (N = 97; 64 % male; median age = 38) completed a demographic questionnaire and a survey of disability risk factors, then agreed to audio-taping of their visits with a participating occupational healthcare provider (n = 14). Utterance-level verbal exchanges were categorized by trained coders using the Roter interaction analysis system. In addition, coders flagged any instance of workplace discussion between patients and providers.


RESULTS
Workplace discussions occurred in 51 % of visits, and the most frequent topic was physical job demands. Workplace discussions were more frequent among the oldest and youngest patients and when patients were seen by providers who were more patient-centered and made more efforts to establish patient rapport and engagement. However, patients reporting numerous disability risk factors and workplace concerns in the pre-visit questionnaire were no more likely to discuss workplace topics with their providers (p > 0.05). Only the patient-centered orientations of providers and patients remained statistically significant predictors in multivariate modeling (p < 0.05).


CONCLUSIONS
Workplace discussions are facilitated by a patient-centered orientation and by efforts to establish patient engagement and rapport, but workplace discussions are no more frequent among patients with the most significant workplace concerns. Screening questionnaires and other assessment tools may be helpful to foster workplace discussions to overcome possible barriers for returning to work.
Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA. william.shaw@libertymutual.com
William S
WS
Shaw
Edward H
EH
Chin
Candace C
CC
Nelson
Silje Endresen
SE
Reme
Mary J
MJ
Woiszwillo
Santosh K
SK
Verma
D000328:Adult; D000367:Age Factors; D003142:Communication; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009786:Occupational Health Services; D060051:Occupational Injuries / Q000209:etiology*; D010817:Physician-Patient Relations; D062707:Return to Work; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016526:Workload; D017132:Workplace; D055815:Young Adult