Ready or Not? Applying the Transtheoretical Model of Change on Return-to-Work Following CBT for Chronic Low Back Pain

Chronic low back pain (CLBP) is a leading cause of work-related disability with limited benefit from biomedical treatments. Multidisciplinary approaches, including cognitive-behavioral therapy (CBT) show promise, but outcomes may depend on readiness to change. The Transtheoretical Model may help identify who benefits most, yet its relevance for return-to-work (RTW) outcomes in CLBP remains underexplored. This secondary analysis of a randomized controlled trial examined whether readiness to change, measured by the Pain Stages of Change Questionnaire (PSOCQ), was associated with back pain intensity and disability, and whether it predicted RTW 12 months after a multidisciplinary intervention for CLBP.

414 participants on long-term sick leave due to CLBP were randomized to either: brief intervention (BI), BI + CBT, BI + seal oil, or BI + soy oil. Baseline measures included PSOCQ, pain intensity, and Oswestry Disability Index. RTW was assessed via registry data at 12 months.

Hierarchal regression showed that higher precontemplation scores were significantly associated with greater baseline back pain and disability, while higher maintenance scores were linked to less back pain. In the CBT group, logistic regression revealed that higher precontemplation scores significantly predicted a 63% reduction in odds of RTW.

Readiness to change is associated with pain intensity and disability cross-sectionally, and RTW 12 months following CBT, with less ready individuals experiencing more pain and lower RTW. Assessing stage of change may help tailor rehabilitation and identify those less likely to benefit from CBT.

This study was registered with ClinicalTrials.gov (Identifier: NCT00463970) 2007-04-19.