Systematic Review of Prognostic Factors for Return to Work in Workers with Sub Acute and Chronic Low Back Pain

Ivan A Steenstra, Claire Munhall, Emma Irvin, Nelson Oranye, Steven Passmore, Dwayne Van Eerd, Quenby Mahood, Sheilah Hogg-Johnson, Ivan A Steenstra, Claire Munhall, Emma Irvin, Nelson Oranye, Steven Passmore, Dwayne Van Eerd, Quenby Mahood, Sheilah Hogg-Johnson

Abstract

Purpose We systematically reviewed the evidence on factors that predict duration of sick leave in workers after 6 weeks low back pain (LBP) related sick leave. We hypothesized that different factors affect the duration of the leave depending on the time away from work. Methods The review occurred in seven phases: (1) developing the central question, (2) conducting the literature search, (3) identifying relevant publications, (4) quality appraisal, (5) data extraction, (6) evidence synthesis, and (7) knowledge translation. We searched for studies that reported episodes of LBP and sick leave that lasted more than 6 weeks. All included studies reported at least one prognostic factor where return to work was the outcome. Results We identified twenty-two relevant publications. The impact of pain, functional status and radiating pain seems to change with duration of work disability. Workers' recovery expectations remain important after 6 weeks. Modified duties are rarely studied in later phases of work disability. Depression/mental health did not appear to be an important factor in later phases. Workplace physical factors remain important. There is insufficient evidence that pain catastrophising and fear avoidance are predictive factors in later phases. There was moderate evidence for age in the later phases. Functional capacity and claim related factors were supported by some evidence. Discusion Physical demands in the workplace are preventing workers from getting back to work in a timely fashion across phases. The psychosocial work environment is understudied in later phases. Overall, we cannot conclude that prognostic factors change over time.

Keywords: Disability; Disability evaluation; Prognosis; Review; Sick leave; Systematic.

Conflict of interest statement

This review was funded through a grant from Workplace Research and Innovation Program of the Workers Compensation Board of Manitoba. Ivan Steenstra, Claire Munhall, Nelson Oranye, Dwayne Van Eerd, Quenby Mahood, Emma Irvin and Sheilah Hogg-Johnson have no conflicts of interest to declare. Steven Passmore held the Canadian Chiropractic Research Foundation Professorship in Spine Biomechanics and Human Neurophysiology, in the College of Rehabilitation at the University of Manitoba from the Canadian Chiropractic Research Foundation. As of 2013, the Institute for Work and Health operates with core funding from the Province of Ontario. The stewardship of this funding lies with the Ontario Ministry of Labour (MOL). Previously, the Institute operated with core funding support from the Workplace Safety and Insurance Board (WSIB).

Figures

Fig. 1
Fig. 1
Flowchart chronicling the search process

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