Investigating decisions to absent from work with low back pain: a study combining patient and GP factors

Determinants of who is and who is not sick-listed following an initial consultation for LBP have received little attention. Both patient and practitioner factors are suggested to be predictive but the interaction has not been investigated.

To investigate patient and GP factors which determine sickness certification for low back pain.

Thirty-four General Practitioners recruited 126 patients into the study. Patients completed questionnaires including work status; LBP history; pain; disability, mood and beliefs about back pain.

No differences between sick-listed and non-sick-listed groups were observed for age; back beliefs; anxiety; depression or fear-avoidance beliefs about physical activity. Those sick-listed demonstrated greater pain intensity (p=0.009); perceived disability (p=0.040); and fear-avoidance beliefs about work (p<0.000). Regression analyses for GP factors only; patient factors only; and combined GP and patient factors were performed. The ability of the models to correctly classify subjects ranged from 69% for GP variables only; 75% for patient variables only and 82% for the combined model.

Whether a sickness certificate is issued following an initial consultation for LBP was best explained by combining GP and patient factors. The implications for this in managing absence from work are discussed.