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People Factors
The impact of expectations on return to work

At a glance:
If workers with low back pain had good expectations about their recovery, they returned to work after fewer days on sick leave than those with poor expectations about recovery.
Expectations affect recovery and the ability to return to normal activities. This may sound obvious, however, this study found that people's expectations about return to normal activity did not match with levels of pain or function at the time the measure was taken.

This implies that expectations may not be related to pain, or level of function. Expectations are more likely to relate to the person's understanding of their condition, and their beliefs about the problem.

There are many common misunderstandings about back pain and other 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.
 problems. One is that activity is bad. This is not the case, in most instances the quickest possible return to normal activities is the best way to recover. Misunderstanding can negatively affect outcomes. People avoid activity if they believe it will cause them harm. In turn, their return to work is slower. When progress is slower, both employee and employer experience frustrations, which in turn can have other negative long-term effects.

It is vital that you are up-to-date with best practice information about your condition. This will increase your confidence about your health and ability to function. Talk to your doctor about your situation.
What people expect to occur influences what actually occurs.

If they believe they will do well in a return to work, then that can influence the outcome.

Encourage people to get the best advice about their condition, and establish positive expectations in the workplace.

Work with people by understanding their expectations, beliefs, and situation.
Ask people about their expectations for recovery and a return to work. If they have poor expectations it is worth the effort to understand why. Expectations can be modified, typically by giving them the best information, based on the evidence.

There are many negative beliefs and misunderstanding about medical conditions. People can be worried about activity doing harm, or about their abilities to return to activity, which in turn feeds longer term concerns and increased anxiety. It is important to address theses issues.
Ask people about their expectations. If they don't think they are going to be able to return to their position, it's important to understand why they have that belief. Sound medical reasons and plans should be put in place to manage the situation appropriately.

However, if the person's expectation is based on misunderstanding, encourage them to get the best advice to clear up any concerns.
Original Article, Authors & Publication Details:
D. P. Gross1 and M. C. Battié1 (2005).

Work-related recovery expectations and the prognosis of chronic
continuing a long time or recurring frequently
 low back pain within a workers compensation setting.
Journal of Occupational and Environmental Medicine; 47:428-433

1Department of Physical Therapy, University of Alberta, Workers' Compensation Board Alberta/Millard Health, Edmonton, Alberta, Canada.
Background, Study Objectives, How It Was Done:
Positive expectations about recovery are associated with better health outcomes for a number of conditions, including long term pain. Beliefs also influence recovery. A person's belief about their ability to achieve their goals is called, “self-efficacy'. Previous studies have linked a faster recovery from low back pain with good expectations for recovery, a belief that the condition wasn't severe, and good self-efficacy.
An impression that one is capable of performing in a certain manner or attaining certain goals. Belief that one can manage whatever life brings.

This study examined the link between expectations for recovery and likelihood of return to work, severity of pain and disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 in workers on long-term sick leave.

Files from the Alberta Workers' Compensation Board, were used to identify possible study participants. Claimants who were receiving sickness benefits due to low back injury for at least 6 weeks, and who had completed a return to work assessment at a rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 centre, were asked to participate.

Patient's work-related recovery expectations were assessed by asking them to rate the following three questions on a scale of 1-5 (1=strongly disagree, 5=strongly agree):

I believe that I am physically capable of returning to my usual work activities
I believe that my symptoms would become worse if I were to return to my usual work activities
I believe that my injury will interfere with my ability to do my usual work activities

The scoring system was set up so that a lower score indicated more positive expectations.

Participants' health outcomes were measured by:

How many continuous days on sick leave they had before returning to work
If they had another sickness absence in the next 12 months
If they were still receiving any benefits 12 months after their assessment

Participants were contacted by phone for follow-up one year after their return to work assessment and asked about their:

Current work status and work duties
Intensity of pain (0-10; 0=no pain, 10=worst pain imaginable)
Physical ability to function/disability
Study Findings:
97 injured workers were included in the study. 63% were male and the average age was 42. Most participants had low back pain, with an average time since injury of 6 months. After their return to work assessment, the average time participants took to return to work was 48 days, and only two participants were still receiving sickness benefits after 12 months. 16 participants had another sickness absence within a year, whilst 13 started a new workers' compensation claim, with 24% of participants having a recurrence of pain.

46% of participants (45) were available for phone interview one year after their assessment. Of those contacted most were working, but reported moderate levels of pain and disability. The researchers used the information from the initial assessment and work outcomes and examined the connection. They found that the poorer a person's expectations for recovery, the less likely they were to stop receiving sickness benefits and return to work. This relationship was still apparent after taking into account other factors that can affect return to work, such as physical capacity, work demands, age, gender, duration of injury, number of previous claims, and employment status at time of assessment and salary.

People with poor expectations for recovery also took longer to settle their compensation claims.

Poor expectations for recovery were not associated with increased risk of pain recurring. No clear relationship between recovery expectations, pain, and disability was reported after 12 months.
If workers with low back pain had good expectations about their recovery they returned to work after fewer days on sick leave than those with poor recovery expectations.

For every point of poor expectation score (3 questions on a scale of 1-5, 15 points in total), workers were found to be about 26% less likely to have returned to work 12 months after their assessment.

Doctors should ask patients with low back pain their beliefs about returning to work in the future in order to identify potential barriers to recovery. It may be possible to change negative beliefs and expectations, and therefore improve a person's likelihood of recovering and returning to work.

Most patients did return to work in the year following their return to work assessment, although many were performing modified duties and some had recurrent episodes of back pain. Despite the majority having returned to work, most patients reported moderate levels of persisting pain and disability after 12 months, whether they were working or not. This finding is consistent with other studies and suggests that few patients recover fully from their symptoms once low back pain has become long-term.
PubMed Abstract
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