RTW Knowledge Base
RTW Knowledge Base
Home Employee Employer Medico Insurer View All Types About Champions Contact
People Factors
Factors that influence the duration of sick leave due to low-back pain

At a glance:
Certain risk factors have been identified which predict whether sick leave from low back pain is likely to be long term. Some of these factors identified in this study include:

How much sick leave the person expected to need
Whether they were treated by a doctor
Whether their mobility was reduced
Whether they reported job stress

This study showed that a questionnaire on the first day of sick leave can give an idea of how long the person is likely to be absent from work.
Perspectives:
Employee
Most patients recover from back pain within a few weeks, but pain can last much longer. Unfortunately, the longer a person is on sick leave, the less likely they are to return to work.

Most people recover from back pain within four weeks without any special treatment, and studies have identified differences between those who recover and those who remain on sick leave.

People are at higher risk of long term sickness absence if their mobility is reduced. You can't change your level of pain, however, you can decide to remain active, and this will lower your risk of becoming disabled. Light exercise and stretching can be helpful.

People are also at risk of long term sickness absence if they expect to be on sick leave for more than 10 days. Expectation about sick leave can come for your level of discomfort, or from your job conditions. Talk to your employer about accommodating your injury in the workplace, or temporarily reducing your hours, so that you feel comfortable returning to work as early as possible.

People are at risk of sickness absence if they have heavy lifting duties or job stress. People responsible for heavy lifting may find it difficult to return to work because of the physical demands of their job. If you have a back condition and do heavy lifting, discuss return to work options with your treating practitioner.

It's important to recognise that job stress is a problem in itself and can reduce your chances of returning to work. If you are stressed at work, speak to your doctor, employer, or someone you trust about how you might be able to make it easier to cope.

If any of these risk factors sound like you, it's worth speaking to your treating health professional to get some advice.
Employer
This study showed that most people recover from back pain within four weeks without any special treatment. It identified differences between those who recovered and those who remained on sick leave.

1. People are at risk of disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 if they expect to be on sick leave for more than 10 days.
2. People are at risk of disability if they do heavy lifting.
3. People are at risk of disability they are stressed at work.

If you can help your injured workers get back to work earlier, it's likely to help them recover more quickly. Offer modified work duties or hours, or a temporary job as an alternative to heavy lifting. It's important to recognise that job stress is a real issue and can affect physical health. Anything that can be done to reduce stress valuable.
Treater
Some disability risk factors are well-understood, and identifying whether these are present (perhaps by questionnaire) at the beginning of absence can show if there is a risk of long term sick leave.

It is important to assure patients that people normally recover from back pain quickly, and that remaining active will help them recover, not make their problem worse. If possible, take the time to communicate with the patient about the causes of their back pain, and give them whatever advice you can on how to get back to work.
Insurer
The longer a person remains on sick leave from work-related low back pain, the more compensation and treatment costs they generate. Interventions for low back pain can reduce costs and personal suffering.

Most people recover from back pain without treatment.

This study identified some risk factors for disability, and showed that a short questionnaire given in the first few days of sick leave can identify those at risk. Once identified, those at risk of disability can be treated early, reducing sick leave and hence costs.

It may be worthwhile to incorporate a short questionnaire into routine compensation claims, to identify cases where more communication and more assistance will be necessary.
Original Article, Authors & Publication Details:
Ivan A. Steenstra,1,2 Fieke S. Koopman,1,2 Dirk L. Knol,3 Eric Kat,4 Paulien M. Bongers,1,2 Henrica C.W. de Vet,5and Willem van Mechelen1,2 (2005).

Prognostic factors for duration of sick leave due to low-back pain in Dutch health care professionals. Journal of Occupational Rehabilitation; 15(4):591.

1Department of Public and Occupational Health, VU University Medical Center, Amsterdam.
2Body@Work, Research Center Physical Activity, Work and Health TNO, VU University Medical Center, Amsterdam.
3Department of Clinical Epidemiology
epidemiology
The study of factors affecting the health and illness of populations. Also refers to the study of management and control of health problems.
 and Biostatistics, VU University Medical Center, Amsterdam.
4Occupational Health Services, Academic Medical Center, Amsterdam.
5EMGO Institute, VU University Medical Center, Amsterdam.
Background, Study Objectives, How It Was Done:
The longer a person remains on sick leave from work-related low back pain, the more compensation and treatment cost they generate. To control costs and personal suffering, we need to identify risk factors for disability, so that intervention
intervention
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 can be targeted where it is most needed.

Previous research has suggested that age, gender, level of disability, heaviness of work, social isolation and compensation status can all affect duration of sick leave in cases of low back pain.

Workers' self-reports of their psychosocial
psychosocial
Refers to psychological and social factors. Examples of psychosocial factors that affect return to work area include: a person's beliefs about how they will cope with their condition, the attitude of the inured worker's family to their condition and return to work, the employer's return to work policy and the influence of the WorkCover system on a person.
 environment can be used to predict long-term sick leave. Psychosocial risks for disability include job circumstances, strategies for coping with pain and recovery expectations.

This study aimed to determine factors that influence sick leave duration in cases of low back pain.

615 workers who reported sick leave from low back pain within a 2 year period were included in the study. All participants were employees of an Amsterdam university hospital. 64% of the study participants were female and the average age was 42. After calling in sick, workers were asked to complete a standard sick leave questionnaire and return it to the hospital within 2 days.

The questionnaire asked 10 questions about the patients' reason for sick leave, expectations about recovery and use of health care services. Outcomes were measured from the patients' employment records over the six months following the beginning of sick leave. They were:

Return to work – duration of sick leave during the 6 month follow-up period
Lasting return to work – days on sick leave until returning to work for four continuous weeks
Study Findings:
Course of low back pain:

11% of all sick leave was due to musculoskeletal
musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 disorders. The average time taken to return to work was 5 days. 90% of workers recovered after 4 weeks, and 95% after 3 months. 3% of workers still hadn't returned six months after sick leave began.

The average time taken to return to work was 6 days. 87% had a lasting return to work by 4 weeks, and 94% by 3 months. 4% of workers hadn't had a lasting return to work six months after sick leave had begun. 87% had less than 28 days of sick leave.

Factors predicting delayed return to work

Employees took to longer to return to work if:

They predicted they would take more than 10 days to return to work

Their sick leave was caused by:

* Work
* Heavy lifting
* Job stress

Their mobility was limited by their condition
They were admitted to hospital
They were a maintenance worker

Some of these factors had more or less effect when they occurred together.

A worker was at highest risk of delayed return to work(10 times greater risk than workers without risk factors)if they:

1. Expected to stay on sick leave for more than 10 days
2. Were treated by a GP or medical specialist

A worker was at highest risk of delayed lasting return to work (10 times greater risk than workers without risk factors) if they:

1. Expected to stay on sick leave for more than 10 days
2. Reported job stress as a reason for taking sick leave

Factors predicting more days on sick leave:

Workers had more days on sick leave if:

They were older
They predicted they would take more than 10 days to return to work
They saw a GP or specialist for their condition
Their condition was due to work
Their condition was due to heavy lifting
They were admitted to hospital
Their mobility was limited by their condition
They were a maintenance worker
Conclusions:
Interventions for low back pain can be targeted to people at risk of remaining on long-term sick leave. A short questionnaire completed by injured workers at the beginning of sick leave could identify people at risk of longer absence. Most people recover from back pain and get back to work within 4 weeks. It is uncommon for workers to remain on sick leave for more than 6 months.

The strongest risk factor for delayed return to work identified in this study was the workers own prediction of a need for more than 10 days leave.

Workers who reported that their condition was due to job stress returned to work as quickly as others, but took longer to have a lasting return to work.
References:
PubMed Abstract
Total Votes for this Article: 4 Average Rating: 1.0
Poor                               Excellent