title: Exploring how pain leads to productivity loss in primary care consulters for osteoarthritis: a prospective cohort study.
abstract: OBJECTIVE
  Osteoarthritis pain has become a leading cause of decreased productivity and work disability in older workers, a major concern in primary care. How osteoarthritis pain leads to decreased productivity at work is unclear; the aim of this study was to elucidate causal mechanisms and thus identify potential opportunities for intervention.
  
  
  METHODS
  Population-based prospective cohort study of primary care consulters with osteoarthritis. Path analysis was used to test proposed mechanisms by examining the association between pain at baseline, and onset of work productivity loss at three years for mediation by physical limitation, depression, poor sleep and poor coping mechanisms.
  
  
  RESULTS
  High pain intensity was associated with onset of work productivity loss (Adjusted Odds Ratio 2.5; 95%CI 1.3, 4.8). About half of the effect of pain on work productivity was a direct effect, and half was mediated by the impact of pain on physical function. Depression, poor sleep quality and poor coping did not mediate the association between high pain intensity and onset of work productivity loss.
  
  
  CONCLUSIONS
  As pain is a major cause of work productivity loss, results suggest that decreasing pain should be a major focus. However, successfully improving function may have an indirect effect by decreasing the impact of pain on work productivity, especially important as significant pain reduction is often difficult to achieve. Although depression, sleep problems, and coping strategies may be directly related to work productivity loss, addressing these issues may not have much effect on the significant impact of pain on work productivity.
authors: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
authors: Ross
authors: R
authors: Wilkie
authors: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
authors: Elaine M
authors: EM
authors: Hay
authors: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
authors: Peter
authors: P
authors: Croft
authors: Center for Disability Research, Liberty Mutual Research Institute, 71 Frankland Rd., Hopkinton, Massachusetts, 01748, United States of America.
authors: Glenn
authors: G
authors: Pransky
mesh_terms: D000041:Absenteeism; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003253:Consultants / Q000706:statistics & numerical data*; D003863:Depression / Q000209:etiology; D004526:Efficiency; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000503:physiopathology* / Q000523:psychology; D010146:Pain / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation; D012959:Socioeconomic Factors; D014938:Work Capacity Evaluation