title: Should General Practitioners Issue a Sick Certificate to Employees Who Consult for Low Back Pain in Primary Care?
abstract: OBJECTIVE
  Back pain is a common problem and has significant societal impact. Sickness certification is commonly issued to patients consulting their general practitioner with low back pain. The aim of this study was to investigate the association of certification for low back pain with clinical outcomes and cost consequences.
  
  
  METHODS
  A prospective cohort study using linked questionnaire and medical record data from 806 low back pain patients in 8 UK general practices: comparison of 116 (14.4%) who received a sickness certificate versus 690 who did not receive certification. The primary clinical measure was the Roland and Morris Disability Questionnaire (RMDQ). Data on back pain consultation and work absenteeism were used to calculate healthcare and societal costs.
  
  
  RESULTS
  Participants issued a sickness certificate had higher back-related disability at baseline consultation and 6-month follow-up [mean difference 3.1 (95% CI 1.8, 4.4) on the RMDQ], indicating worse health status. After fully adjusting for baseline differences, most changes in clinical outcomes at 6 months were not significantly different between study groups. Productivity losses were significantly higher for the certification group, with most absence occurring after the expected end of certification; mean difference in costs due to absenteeism over 6 months was £1,956 (95% CI £941, £3040).
  
  
  CONCLUSIONS
  There was no clear evidence of a difference in clinical outcomes between individuals issued a sickness certificate and those not issued a certification for their back pain. With little overall contrast in clinical outcomes, policy makers and care providers may wish to draw on the likely difference in societal costs alongside issues in ethical and moral care in their consideration of patient care for low back pain.
authors.affiliation: Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK, a.m.lewis@keele.ac.uk.
authors.forename: M
authors.initials: M
authors.lastname: Lewis
authors.forename: G
authors.initials: G
authors.lastname: Wynne-Jones
authors.forename: P
authors.initials: P
authors.lastname: Barton
authors.forename: D G T
authors.initials: DG
authors.lastname: Whitehurst
authors.forename: S
authors.initials: S
authors.lastname: Wathall
authors.forename: N E
authors.initials: NE
authors.lastname: Foster
authors.forename: E M
authors.initials: EM
authors.lastname: Hay
authors.forename: D
authors.initials: D
authors.lastname: van der Windt
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis*; D008297:Male; D058007:Physicians, Primary Care; D011320:Primary Health Care; D011446:Prospective Studies; D018582:Sick Leave / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D014938:Work Capacity Evaluation