People Factors
Beliefs and expectations affect return to work
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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. |
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: |
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