Primary studies included in this systematic review

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Prognostic factors for perceived recovery or functional improvement in non-specific low back pain: Secondary analyses of three randomized clinical trials

Journal European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Year 2010
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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The objective of this study was to report on secondary analyses of a merged trial dataset aimed at exploring the potential importance of patient factors associated with clinically relevant improvements in non-acute, non-specific low back pain (LBP). From 273 predominantly male army workers (mean age 39 ± 10.5 years, range 20-56 years, 4 women) with LBP who were recruited in three randomized clinical trials, baseline individual patient factors, pain-related factors, work-related psychosocial factors, and psychological factors were evaluated as potential prognostic variables in a short-term (post-treatment) and a long-term logistic regression model (6 months after treatment). We found one dominant prognostic factor for improvement directly after treatment as well as 6 months later: baseline functional disability, expressed in Roland-Morris Disability Questionnaire scores. Baseline fear of movement, expressed in Tampa Scale for Kinesiophobia scores, had also significant prognostic value for long-term improvement. Less strongly associated with the outcome, but also included in our final models, were supervisor social support and duration of complaints (short-term model), and co-worker social support and pain radiation (long-term model). Information about initial levels of functional disability and fear-avoidance behaviour can be of value in the treatment of patient populations with characteristics comparable to the current army study population (e.g., predominantly male, physically active, working, moderate but chronic back problems). Individuals at risk for poor long-term LBP recovery, i.e., individuals with high initial level of disability and prominent fear-avoidance behaviour, can be distinguished that may need additional cognitive-behavioural treatment. © 2009 Springer-Verlag.

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Emotional support predicts more sickness absence and poorer self assessed work ability: a two-year prospective cohort study.

Journal BMC public health
Year 2010
Links Pubmed DOI PubMed Central

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: While back pain and stressful work environment are shown to be important causes of sickness absence the effect of psychosocial resources on sickness absence, and on self assessed work ability, is less commonly investigated. The aim of this study was to assess these associations in a two-year follow-up study. METHODS: 341 working people aged 45 to 64, randomly drawn from the population, responded to a questionnaire at baseline and at a two-year follow-up. Poisson regression was used to analyse the association of psychosocial factors (psychosocial instruments on work environment, emotional support and psychological resources) and previous back pain (low back and/or neck) at baseline with sickness absence (spells and days) at follow-up, controlling for effects of age, sex, BMI, smoking, alcohol, occupation, disease and previous sickness absence. Logistic regression was used to study the associations of psychosocial factors and previous back pain at baseline with self assessed prognosis of poor work ability six months from follow-up. Finally, a multivariate analysis tested the independent effects of previous back pain and 3 psychosocial factors derived in a factor analysis: 1. work environment; 2. emotional support; 3. psychological resources, on work ability and absence days and spells. RESULTS: 80% of the sickness absence spells within the last 12 months before follow-up were short-term (≤ 14 days). In the final model, high emotional support predicted more sickness absence spells (RR 1.36; 1.11-1.67) and days (RR 1.68, 1.22-2.31). Previous back pain (OR 2.56; 1.13-5.81), high emotional support (OR 1.58; 1.02-2.46), and low psychological resources (OR 0.62; 0.44-0.89) were related to poorer self assessed prognosis of work ability at follow up. CONCLUSIONS: In a general middle aged working population high emotional support was related to more sickness absence and also poorer self assessed prognosis of work ability. Our findings suggest that both sickness absence and self assessed work ability are dependent of life outside work and can be affected by a person's close community.

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The impact of decision latitude, psychological load and social support at work on the development of neck, shoulder and low back symptoms among female human service organization workers

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Journal International Journal of Industrial Ergonomics
Year 2009
Links DOI Google Scholar

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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The aim of the present study was to investigate longitudinal relations between decision latitude, psychological workload and social support and musculoskeletal neck, shoulder and low back symptoms. In this longitudinal two-wave cohort study a questionnaire survey was conducted among female human service organization workers (n = 1690). The analyses were based on respondents who were considered free from the respective symptoms at baseline measurements, resulting in study samples of n = 741 for neck symptoms, n = 670 for shoulder symptoms, and n = 640 for low back symptoms. In general support was found for the job demand–control–(support) model. High strain work (high psychological load coupled with low decision latitude) in combination with low social support (‘iso-strain’) was related to increased risks of developing symptoms (occurrence of new episode) in all the body regions studied (neck, shoulder and low back). Relevance to industry The results indicate that, in order to minimize the occurrence of musculoskeletal symptoms, it is important to ensure that employees have adequate levels of decision latitude, to keep the workload at optimal levels, and to provide supervisor support and structures that facilitate coworker support.

Primary study

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Association of psychosocial work characteristics with low back pain outcomes.

Authors Mielenz TJ , Garrett JM , Carey TS
Journal Spine
Year 2008
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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STUDY DESIGN: This is a secondary analysis of a prospective cohort of 295 patients with acute low back pain presenting to 31 primary care physicians in North Carolina. OBJECTIVE: This study examines the hypothesis that dissatisfaction with job tasks and lack of social support from coworkers and supervisor are associated with poorer low back pain outcomes. SUMMARY OF BACKGROUND DATA: Psychosocial work characteristics are thought to be associated with the occurrence, report, and development of long-term disability from low back pain, but the studies are inconclusive. METHOD.: Three psychosocial work characteristics were separately compared to these outcomes: time to functional recovery, attainment of complete recovery, and clinically relevant change on the Modified Roland Scale. RESULTS: Relative to subjects with more social support from coworkers, subjects with less social support from coworkers have 1.55 (95% CI = 1.04-2.34) times the risk of not attaining complete recovery from low back pain at 8 weeks. For all other outcomes evaluated in this study, there was not an association with the psychosocial work characteristics. Biomechanical demands were found not to modify this association. CONCLUSION: This analysis provides evidence that social support in the workplace from coworkers but not social support from a supervisor or job task satisfaction are likely targets for intervention.

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Ghaffari M

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Belstress study

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Primary study

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Risk factors for more severe regional musculoskeletal symptoms: a two-year prospective study of a general working population.

Authors Andersen JH , Haahr JP , Frost P
Journal Arthritis and rheumatism
Year 2007
Links Pubmed DOI

This article is included in 8 Systematic reviews Systematic reviews (8 references)

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OBJECTIVE: To quantify the relative contribution of work-related physical and psychosocial factors, individual factors, and health-related factors to the development of more severe musculoskeletal pain in the neck and upper limbs and the back and lower limbs. METHODS: In this cohort study of 5,604 workers from industrial and service companies, we collected information on work-related physical and psychosocial exposures and on individual and health-related factors. Questionnaires were completed at baseline by 4,006 participants (71.5%) and after 24 months by 3,276 (82%). At followup, participants with no or minor pain were included in Cox regression analyses to determine which factors predicted more severe regional pain. RESULTS: Of the 4,006 baseline respondents, only 7.7% were free of regional pain. A total of 1,513 participants were free of severe pain at baseline and completed the 24-month followup. Highly repetitive work predicted arm pain, heavy lifting and prolonged standing predicted low back pain, and heavy pushing or pulling predicted lower limb pain. Low job satisfaction predicted neck/shoulder pain and lower limb pain, whereas other psychosocial work place factors were only of marginal importance. High levels of fear avoidance were associated with arm pain and lower limb pain. A high body mass index was highly associated with lower limb pain. CONCLUSION: Very few workers are totally free of pain in musculoskeletal regions, and we question the concept of incidence of musculoskeletal pain. The transition from no or minor pain to more severe pain was influenced by physical and psychosocial work place factors together with individual and health-related factors.

Primary study

Unclassified

Determinants of "return to work in good health" among workers with back pain who consult in primary care settings: a 2-year prospective study.

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Journal European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Year 2007
Links Pubmed DOI PubMed Central

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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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.

Primary study

Unclassified

Work-related factors contributing to chronic disability in low back pain.

Authors Soucy I , Truchon M , Côté D
Journal Work (Reading, Mass.)
Year 2006
Links Pubmed

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Low back pain is a costly and incapacitating musculoskeletal disorder. Prospective studies documenting the capacity of work-related factors to predict chronicity are few in number, the methodology used is very diversified, and the results obtained diverge. The aim of the present study is to investigate the capacity of work-related objective (non-psychosocial) and psychosocial factors to predict chronic disability related to low back pain. A longitudinal prospective study with two measurement times was carried out. The sample (N = 258) consisted of workers with subacute low back pain who were on sick leave and receiving compensation from the CSST (Quebec Workers' Compensation Board). Of all the work-related variables measured, perceived stress and fears and beliefs about work were associated with return to work status at the six-month follow-up. The results obtained show the importance of considering fears and beliefs about work when identifying people in the subacute phase of low back pain who are at risk of developing chronic disability.

Primary study

Unclassified

Pain and pain-related fear are associated with functional and social disability in an occupational setting: evidence of mediation by pain-related fear.

Journal European journal of pain (London, England)
Year 2006
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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This study examined the role of work-related, psychosocial and psychological factors in predicting functional and social disability in working employees. In a cross-sectional design, 890 working employees (reporting at least 1 day of back pain during the past year) completed self-report measures of back pain, disability, pain-related fear, negative and positive affectivity, job satisfaction, job stress and physical work load. Regression analyses revealed that pain intensity was a strong predictor of functional (beta = .69, p < .001) and social disability (beta = .67, p < .001). Fear of (re)injury due to movement (beta = .25, p < .001; beta = .28, p < .001) had additional predictive value in both models. Further, (singular) mediation tests indicated that fear for (re)injury partially mediated the relation between pain intensity and disability, and between negative affectivity and disability. Finally, path analyses revealed both fear and pain intensity as mediators between negative affectivity and disability. Overall, our findings point at the relevance of the cognitive-behavioral model of avoidance in occupational settings.