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People Factors
Beliefs and expectations affect return to work

At a glance:
When an employee takes sick leave for low-back pain, several factors can increase the amount of time it takes them to return to work.

 These include:

         Low job satisfaction
         A lack of social support at work
         Expecting to take more time off work
         Expecting treatment to be successful
         More severe pain
         Pain that radiates to the leg
Perspectives:
Employee
Many factors can influence how quickly a person with back pain is able to return to work. You have the power to change some of these factors.

Several studies have shown that people's expectations influence how quickly they return to work. If you think you are going to be out of work for a long time you probably will be.

Your expectations about returning to work are not necessarily based on how much pain you experience. Rather, they will flow from your understanding of your condition, how it is likely to progress, and what you believe you are capable of achieving.

For this reason, it is very important have a good understanding of problems like back pain. You may worry that you will have long-term problems, or that you should avoid doing certain things. These questions should be discussed with your doctor.
Employer
A range of factors influence employees' return to work.

Employers can improve return to work outcomes by:

         Encouraging employees to have a good understanding of their condition and its expected course
         Helping employees gain confidence in their abilities
         Improving job satisfaction and social support in the workplace.
Treater
Patients' expectations influence their return to work outcomes. It is important that patients are given a clear understanding of their medical condition, its natural history, and evidence based restrictions. 

Attempts to care for patients and minimise pain can result in overprotection, leading to the avoidance of too many activities by the patient. It can also set up expectations about needing to remain on restricted duties into the long term. While this may be necessary in some cases, many employers will not accommodate long-term modified duties, resulting in the person losing their job after a few years.
Insurer
A range of factors influence return to work outcomes. Some of these can be addressed by good medical and treatment information; others must be addressed in the workplace. 

Encourage people to talk with their treater so that they can have a complete and confident understanding of their condition and how it will affect their work. This often increases an employee's confidence in their abilities and improves their expectations. Encourage partnership between employer and employees regarding return to work.
Original Article, Authors & Publication Details:
M. W. Heymans1,2,3, H. C. W. de Vet3, D. L. Knol4, P. M. Bongers1,2,3,5, B. W. Koes6 and W. van Mechelen1,2,3 (2006). 

Workers' beliefs and expectations affect return to work over 12 months.  Journal of Occupational Rehabilitation; 16:685-695

1Body@Work, Research Center Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands
2Department of Public and Occupational Health, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
3Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
4Department 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, The Netherlands
5Quality of Life, Hoofddorp, The Netherlands
6Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
Background, Study Objectives, How It Was Done:
Low back pain is a common problem in Western countries. Most people recover from low back pain within 4 to 8 weeks, but a small proportion of people recover very slowly or not at all.

Identifying the risk-factors for developing a long-term problem may improve treatment outcomes and reduce healthcare costs. Risk factors identified by previous research include: a previous episode of back pain, severity of pain and job-related factors. These include the physical demands of the job and job satisfaction. Psychological factors that play a role in prolonged back pain include fear, avoidance of pain, overstating the problem, and expectations of recovery.

This study investigated a range of factors that influence long-term sick leave due to back pain. Personal, work-related, pain-related, psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 and social factors were considered.

This study was conducted in the Netherlands. A questionnaire was given to workers with low back pain, who had been on sick leave for 3-6 weeks and who had visited an occupational health service between October 2000 and November 2002. Patients were excluded from the study if they had previously taken a period of sick leave due to low back pain, or if they had a specific disease that caused their pain.  299 workers agreed to participate.

The following information was collected in the questionnaire:

         Gender, age, level of education, smoker/non-smoker
         Work status
         Physical work factors (lifting, bending/twisting, using vibrating tools)
         Psychosocial work factors (job control, job demands, social support) 
         Job satisfaction
         When they expected to return to full-time work and whether they were certain they would be working full-time in 6 months
         Expectations about their treatment 
         Beliefs about the cause of their back pain
         Fear of exercise causing re-injury
         Pain intensity and level of function
         History of low back pain
         Physical activity at work, sport and leisure
         Quality of life

The study participants were followed up over 12 months and their first return to work and lasting return to work were recorded. Their first return to work was their first full day back at work since the beginning of their sick leave. Lasting return to work meant they had returned to work full time for at least four weeks without interruption. 
Study Findings:
On average, participants took 71 days to first return to work, and 76 days to return to lasting work.

Factors that significantly affected lasting return to work were:

         Pain intensity
         Self-prediction of when they would return to work
         Job satisfaction
         Radiation of pain into the leg

Secondary influences included:

         Expectations about the success of treatment
         Social support at work

The same factors were important in the patients' first return to work. This showed that most workers who return to work for at least a day will have a lasting return to work.
Conclusions:
This study identified several factors that increased the time it took for a person to return to full-time work after they had been on sick leave for low back pain. These included:

         Pain intensity
         Radiation of pain into the leg
         Low job satisfaction
         Expecting to take a longer time to return to work
         Poor expectations about the success of treatment
         Lacking social support at work

These factors did not have a strong influence on return to work, however. The time it took the study participants to return to work varied by only 20%.

The factors identified in this study can be used to identify people at risk of being on long-term sick leave.  An individual's beliefs and expectations should be taken into account when prescribing treatment, in order to increase the likelihood of complete recovery.
References:
PubMed Abstract
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