Expectations, perceptions, and physiotherapy predict prolonged sick leave in subacute low back pain

Area of Science:

• Occupational health
• Rehabilitation medicine
• Pain management

Background:

• Brief intervention programs (BI) reduce sick leave for subacute low back pain (LBP) but a significant number of patients do not return to work.
• This study investigates predictors of return to work (RTW) in LBP patients undergoing BI versus BI plus physical exercise.

Purpose of the Study:

• To identify predictors for non-return to work in patients with subacute low back pain.
• To analyze these predictors at 3, 12, and 24 months post-intervention.

Main Methods:

• A randomized controlled trial comparing BI and BI + physical exercise was conducted with 246 patients on sick leave for 8-12 weeks.
• Multiple logistic regression analysis was used to identify predictors for non-return to work at multiple follow-up points.
• Intervention groups were merged for predictor analysis due to no significant difference in RTW outcomes.

Main Results:

• At 3 months, predictors for non-RTW included resting pain intensity, perceived constant back strain, negative return-to-work expectations, and prior physiotherapy.
• At 12 months, predictors included perceived reduced walking ability, pain during activities, and prior physiotherapy.
• At 24 months, age below 41 years was the sole significant predictor for non-RTW.

Conclusions:

• Return to work is significantly influenced by individual and cognitive factors.
• Patients not returning to work often had negative expectations, specific pain/disability perceptions, and had received prior physiotherapy.
• Previous physiotherapy treatment emerged as a novel risk factor for long-term sick leave in LBP patients, warranting further investigation.