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PubMedDate not supplied

Employment changes among patients following coronary bypass surgery: social, medical, and psychological correlates.

The relations of socioeconomic and psychological factors to resumption of employment following coronary artery bypass surgery were studied using a questionnaire returned by a sample of 426 men and 70 women. The sample was drawn from the membership of Mended Hearts, Inc., a nationwide voluntary organization of persons who have had heart surgery. Preoperatively, more men (92 percent) than women (59 percent) were employed. Return to work rates were high for men (81 percent) and much lower for women (58 percent). The 395 men tended to return to work an average of 3.7 months after surgery whereas the 41 women took an average of 4.8 months. Return to work following surgery was most clearly related to socioeconomic level for both sexes. In addition, for men, those most likely to return had less postoperative morbidity and held jobs requiring little physical exertion. Patients who reported that they were forced into an early retirement represent a particularly vulnerable group in that they were more likely to experience the most postoperative morbidity. As a group, they believed that their physicians had least prepared them to return to work, and they experienced the poorest emotional adjustment. Thus, women and those forced into early retirement represent two potentially high-risk groups of patients who would seem to require additional clinical and psychological management following surgery.

Adult↗
PubMed1993

Predicting long-term disability in low back injured workers presenting to a spine consultant.

Low back pain (LBP) is the most common, costly, and disabling musculoskeletal condition. Although most LBP patients recover within two months, 2-3% eventually develop disabling chronic low back pain (DCLBP). Due to the prevalence of DCLBP problems, models have been developed to predict which acute low back pain patients are predisposed to the problems associated with this condition. Many see the development of these models as a first step that must be taken before useful approaches for containing and reducing the problem can be conceptualized, implemented, and tested. A recent publication by Cats-Baril and Frymoyer considered this specific problem. While the results of their study indicate considerable success in predicting DCLBP patients, the high prediction rates they obtained may be spurious because of the characteristics of their sampled patient population in conjunction with some of the predictors they found useful in identifying DCLBP patients. The purpose of the present study was to focus on the crucial patient population (i.e., acute LBP patients who perceive their problem as work-related and who have been unable to work for more than two but less than six weeks), and evaluate the ability of various personal, medical, occupational, and psychological factors to predict predisposition to DCLBP. Fifty-five patients referred by occupational physicians were evaluated and followed successfully for at least 6 months. Patients in the study were given a physical examination that included Spratt et al's assessment of pain behavior. They were then asked to fill out an extensive battery of self-report questionnaires, addressing issues associated with personal demographics, health history, work requirements, job satisfaction, injury information, and pain/function factors. At the 6-month follow-up, a structured telephone interview was used to obtain outcome information regarding patient status, including ability to return to work and general outcomes of treatment. Average patient age was 37.2 years (range, 22-57) and 67% of the patients were male. On average, patients had been unable to work for approximately 4 weeks when initially surveyed. Overall, 12.7% of the patients returned to work within 1 month of injury, 40% returned within 2 months, 54.5% within 3 months, 69% within 4 months, 74.5% within 5 months, 76.3% within 6 months, 80% within 7 months, and 83.6% after 7 months. Approximately 16% never successfully returned to work within the follow-up period of this study. DCLBP was found to be correlated only with marital status, as married patients returned to work more quickly than single patients (P < 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2002

Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain.

In general, randomized controlled studies concerning return to work have failed to demonstrate significant treatment effects for long-lasting musculoskeletal pain, and most treatments examined have not been economically beneficial. Individuals (n=654) sick-listed for at least 8 weeks with musculoskeletal pain, selected from the Norwegian mandatory sickness insurance system and volunteering to participate, were categorized into three groups differing in a prognosis score (good, medium, poor) for return to work, based on a brief, standardized screening of psychological and physiotherapy findings. They were then randomly assigned to three outpatient treatments with three different levels of intensity (ordinary treatment, light multidisciplinary, and extensive multidisciplinary treatment). The evaluation was based on 14 months follow-up data on return to work collected from social security records. The patients with good prognosis for return to work do equally well with ordinary treatment as with the two more intensive treatments. The patients with medium prognosis benefit equally from the two multidisciplinary treatments. The patients with poor prognosis receiving extensive multidisciplinary treatment returned to work at a higher rate than patients with poor prognosis receiving ordinary treatment, 55 vs. 37% (P<0.05) at 14 months. Multidisciplinary treatment is effective concerning return to work, when given to patients who are most likely to benefit from that treatment. Measures of pain or quality of life are not included in this study. The cost-benefit analysis of the economic returns of the light multidisciplinary and the extensive multidisciplinary treatment programs yields a positive net present social value of the treatment. A simple, standardized, screening instrument including only psychological and physiotherapeutic observations may be a useful clinical tool for allocating patients with musculoskeletal pain to the right level of treatment.

Adult↗
PubMed2006

Workforce reentry for people with HIV/AIDS: intervention effects and predictors of success.

Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent and little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the effectiveness of programs to assist people with HIV/AIDS in their efforts to return to work. We used logistic regression and Kaplan-Meier survival curves to predict return to work using data from 126 individuals who participated in an HIV/AIDS return to work program. Results from the 24 month follow-up revealed that program participation, general health, benefits status, and gender, predicted successful re-entry to the workforce. We discuss these findings in the context of the need for more explicitly-defined interventions, as well as the need for additional information on factors that may hinder or facilitate workforce re-entry among people with HIV/AIDS.

Adult↗
PubMed2003

Comparison of a simulated versus work environment lifting task on L5/S1 compression forces.

Since a patient's ability to perform simulated work activities guides return-to-work decisions, a significant question to address is whether the simulated work environment accurately reflects the actual work environment. Work hardening programs have been used extensively as a method of rehabilitating workers to return to their pre-injury functioning levels. Re-training workers to lift boxes is a common method used to simulate the work environment. Although very few boxes used in the real work environment have handles, boxes with handles are often used in the simulated work environment. The difference in compression forces at the L5/S1 joint while lifting boxes with and without handles was investigated. The Lift Trak Motion Analysis system was used to estimate lumbar isometric compression forces exerted while lifting a 20-pound (9.07-kg) box. The results indicated that estimates of compression forces when lifting a box without handles were significantly different (p < 0.01) than when lifting the same box with handles. Based on these results, it is recommended that work hardening professionals carefully re-evaluate the simulated work environments currently being used for treatment.

Adolescent↗
PubMed1989

Tinker toy test performance and vocational outcome in patients with closed-head injuries.

Fifty patients who had suffered closed-head injury with no resultant physical disabilities and 25 normal controls were administered a modified version of Lezak's Tinker Toy Test. All head-injured patients were examined at least 24 months following medical clearance to return to work. Twenty-five of the head injured had been unable to return to work or sustain normal competitive employment as a result of their head injuries. The remaining 25 had returned to their previous jobs successfully or had been employed for at least 6 months prior to assessment. Whereas all but one of the head injured who returned to work scored normally on the Tinker Toy Test, nearly half of the nonreturnees performed below the level of the worst control.

Adult↗
PubMed1993

A prospective, randomized study of lumbar fusion. Preliminary results.

One hundred, twenty-four patients undergoing lumbar or lumbosacral fusion for degenerative conditions were entered into a prospective study. The patients were randomly assigned to one of three treatment groups. Group I underwent posterolateral fusion using autogenous bone graft. Group II had autogenous posterolateral fusions supplemented by a semi-rigid pedicle screw/plate fixation system (Luque II; Danek Medical, Memphis, Tennessee). Group III patients underwent posterolateral autogenous fusion with a rigid pedicle screw/rod fixation system (Texas Scottish Rite Hospital [TSRH]-Danek Medical, Memphis, Tennessee). All the patients were operated on by the same surgeon, identical bone grafting technique was used in all, and all were treated in an identical fashion postoperatively. Fusion status was determined from the anteroposterior, oblique, and flexion-extension radiographs obtained at 1 year. Clinical results were rated as excellent if the patients were pain-free and had returned to work; good if the patients had mild backache requiring non-narcotic analgesics and had returned to work; fair if continuing back pain prevented a return to work; or poor if the pain was worse than that which the patient experienced preoperatively or the patient required revision surgery. Nine patients who were originally assigned to Group II or Group III were placed in Group I intraoperatively. This change was due to the identification of severe osteopenia and the determination that pedicle screw purchase was poor. One patient was lost to follow-up. Thus, 51 patients were in Group I, 35 in Group II, and 37 in Group III. Follow-up ranged from 9 to 28 months, averaging 16 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Effectiveness of a multidisciplinary occupational training program for chronic low back pain: a prospective cohort study.

OBJECTIVE: To evaluate the effectiveness of a 12-wk multidisciplinary occupational training program for patients with chronic low back pain and to identify prognostic factors for treatment success. DESIGN: A total of 51 participants were evaluated at baseline, at discharge, and at 1 yr after conclusion of the program. The evaluation included a physical examination and assessment of functional disability, psychological factors, and coping styles. The main target of the program is full work resumption. The central outcome measures therefore are three variables on return to work. RESULTS: Analysis of variance for repeated measures revealed significant beneficial changes during the program for all measures except for several coping-style variables. The acquired level of maximum oxygen uptake, trunk flexibility, functional disability, and catastrophizing were maintained at 1-yr follow-up. At 1-yr follow-up, >60% of the participants had fully returned to work, which is an increase of >40% compared with baseline. Regression analyses showed that sex, age, the baseline values of reinterpretation of pain sensations, and functional disability and changes in trunk flexibility scores during the program are important prognostic factors for complete return to work. CONCLUSIONS: Based on the current findings, the program seems to be efficacious in the short term. Future attention must be directed toward maintaining these results, although work resumption rates improved considerably 1 yr after conclusion of the program.

Abdominal Muscles↗
PubMed2003

Rehabilitation following first-time lumbar disc surgery: a systematic review within the framework of the cochrane collaboration.

STUDY DESIGN: A systematic review of randomized controlled trials. BACKGROUND: Although several rehabilitation programs, physical fitness programs, or protocols regarding instruction for patients to return to work after lumbar disc surgery have been suggested, little is known about the efficacy of these treatments, and there are still persistent fears of causing reinjury, reherniation, or instability. OBJECTIVES: The objective of this systematic review was to evaluate the effectiveness of active treatments that are used in the rehabilitation after first-time lumbar disc surgery. METHODS: The authors searched the MEDLINE, Embase, and Psyclit databases up to April 2000 and the Cochrane Controlled Trials Register 2001, issue 3. Both randomized and nonrandomized controlled trials on any type of active rehabilitation program after first-time disc surgery were included. Two independent reviewers performed the inclusion of studies, and two other reviewers independently performed the methodologic quality assessment. A rating system that consists of four levels of scientific evidence summarizes the results. RESULTS: Thirteen studies were included, six of which were of high quality. There is no strong evidence for the effectiveness for any treatment starting immediately postsurgery, mainly because of the lack of good quality studies. For treatments that start 4 to 6 weeks postsurgery, there is strong evidence (level 1) that intensive exercise programs are more effective on functional status and faster return to work (short-term follow-up) as compared to mild exercise programs, and there is strong evidence (level 1) that on long-term follow-up there is no difference between intensive exercise programs and mild exercise programs with regard to overall improvement. For all other primary outcome measures for the comparison between intensive and mild exercise programs, there is conflicting evidence (level 3) with regard to long-term follow-up. Furthermore, there is no strong evidence for the effectiveness of supervised training as compared to home exercises. There is also no strong evidence for the effectiveness of multidisciplinary rehabilitation as compared to usual care. There is limited evidence (level 3) that treatments in working populations that aim at return to work are more effective than usual care with regard to return to work. Also, there is limited evidence (level 3) that low-tech and high-tech exercises, started more than 12 months postsurgery, are more effective in improving low-back functional status as compared to physical agents, joint manipulations, or no treatment. Finally, there is no strong evidence for the effectiveness of any specific intervention when added to an exercise program, regardless of whether exercise programs start immediately postsurgery or later. None of the investigated treatments seem harmful with regard to reherniation or reoperation. CONCLUSIONS: There is no evidence that patients need to have their activities restricted after first-time lumbar disc surgery. There is strong evidence for intensive exercise programs (at least if started about 4-6 weeks postoperative) and no evidence they increase the reoperation rate. It is unclear what the exact content of postsurgery rehabilitation should be. Moreover, there are no studies that investigated whether active rehabilitation programs should start immediately postsurgery or possibly 4 to 6 weeks later.

Controlled Clinical Trials as Topic↗
PubMed1990

Work before and after coronary artery bypass grafting.

Of 79 male Post Office employees in the UK undergoing first coronary artery bypass grafting in 1984 and 1985, 78 per cent resumed work, most within 2-6 months. By the end of the follow-up period (median 550 days) 65 per cent were working, 84 per cent of them normally. Prior to surgery 38 per cent had been able to work, 76 per cent of them normally. Return to work was more likely in younger employees and in those working until admission for surgery or who had only a short period off before surgery. A previous myocardial infarction made little difference to the likelihood of returning to work after surgery or continued working. The effect of type of work on work capability before and after surgery was also studied. All differences could not be related to physical demands of the job. Motivational and socioeconomic factors may have accounted for some differences.

Adult↗
PubMed1983

Employment and recreation patterns in patients treated by percutaneous transluminal coronary angioplasty: a multicenter study.

Employment and recreational patterns were analyzed in 279 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) for treatment of symptomatic coronary artery disease. PTCA was successful in 180 patients (65%). When it was unsuccessful, coronary artery bypass graft surgery was usually performed (80%). Return-to-work rates were high irrespective of the outcome of PTCA. Of patients employed full-time or part-time before treatment, 98.5% of those who had successful PTCA alone and 97% of those whose PTCA was unsuccessful but who underwent uncomplicated coronary artery bypass surgery maintained or improved their work status. In a subgroup of men who had been employed in occupations requiring physical labor, 85% of the men whose PTCA was successful returned to work, compared with 68% of those whose PTCA was unsuccessful. The interval from attempted PTCA to return to work was significantly shorter in the successfully treated group; in patients with successful PTCA, the median time to return to work was 14 days, compared with 60 days in patients in whom PTCA was unsuccessful (p less than 0.001). During follow-up, patients with successful PTCA had less angina and were more active in recreational activities than patients who required alternative treatments.

Angioplasty, Balloon↗
PubMed2002

Are components of a comprehensive medical assessment predictive of work disability after an episode of occupational low back trouble?

STUDY DESIGN: One hundred fifty-nine subacute low back work-injured patients completed a full medical assessment at baseline. A full repeat examination was performed 3 months later, when return-to-work status was determined. OBJECTIVE: To determine the prognostic value of a comprehensive medical assessment for the prediction of return-to-work status. SUMMARY OF BACKGROUND DATA: A systematic review of the work disability prediction literature of low back trouble prognosis revealed that no high-quality studies included a full medical history and physical examination in the design. The results of studies included in the systematic review were equivocal with respect to predictive usefulness of medical variables. METHODS: Participants completed medical history questionnaires and then were clinically examined by one of six experienced examiners (three physicians and three physiotherapists). Return-to-work status was measured 3 months later, and predictive validity was evaluated using logistic regression modeling. RESULTS: Medical variables (, medical history subscales, physical examination subscales, and lumbar range-of-motion tests) showed modest correct classification rates varying between 61.6% and 69.1% for participants. CONCLUSIONS: Comprehensive medical assessments play a crucial role in the early identification of serious pathology after low back trouble. We were unable to identify, however, any medical evaluation variables that would account for significant proportions of variance in return to work. The weight of evidence obtained in this study suggests that injured workers' subjective interpretations and appraisals may be more powerful predictors of the course of postinjury recovery than exclusively medical assessments.

Back Injuries↗
PubMedDate not supplied

Factors influencing infant feeding practices of mothers in Vancouver.

This study describes factors influencing infant feeding choices of 434 mothers with 9-month-old infants in Vancouver. Consistent with Social Cognitive Theory, both internal personal and socio-environmental factors influence infant feeding choices. Mothers attributed the choice to breastfeed primarily to personal choice, whereas the choice to formula feed was attributed to socio-environmental factors. Among mothers who breastfed < 3 months, the choice to wean was primarily attributed to concern for baby's nutrition; compared to returning to work, concern about milk supply and concern for baby's nutrition among those who breastfed > or = 3 to < 6 months; and returning to work and personal choice among those who breastfed > or = 6 months. Among Caucasian mothers, the choice to wean was primarily attributed to returning to work, compared to concern for baby's nutrition among non-Caucasian mothers. Initiatives to facilitate further advances in breastfeeding promotion could address three areas: 1) prenatal intentions, 2) early postpartum concerns, and 3) later issues surrounding returning to work and infant nutrition.

Adult↗
PubMed2002

Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults.

BACKGROUND: Acute lateral ankle ligament injuries (ankle sprains) are common problems in acute medical care. The treatment variation observed for the acutely injured lateral ankle ligament complex suggests a lack of evidence-based management strategies for this problem. OBJECTIVES: The objective of this review was to assess the effectiveness of methods of immobilisation for acute lateral ankle ligament injuries and to compare immobilisation with functional treatment methods. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (December 2001); the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966-May 2000), EMBASE (1988-May 2000), reference lists of articles, and contacted organisations and researchers in the field. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials comparing either different types of immobilisation or immobilisation versus functional treatments for injuries to the lateral ligament complex of the ankle in adults were included. Trials which investigated the treatment of chronic instability or post-surgical treatment were excluded. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two authors. Where appropriate, results of comparable studies were pooled using fixed effects models. Individual and pooled statistics were reported as relative risks with 95% confidence intervals for dichotomous outcomes and weighted (WMD) or standardised (SMD) mean differences and 95% confidence intervals for continuous outcome measures. Heterogeneity between trials was tested using a standard chi-squared test. MAIN RESULTS: Twenty-one trials involving 2184 participants were included. The mean validity score of the included trials increased from 9.1 (SD 3.0) to 10 (SD 2.9) after retrieving further information (maximum 18 points). Statistically significant differences in favour of functional treatment when compared with immobilisation were found for seven outcome measures: more patients returned to sport in the long term (relative risk (RR) 1.86, 95% confidence interval (CI) 1.22 to 2.86); the time taken to return to sport was shorter (WMD 4.88 (days), 95% CI 1.50 to 8.25); more patients had returned to work at short term follow-up (RR 5.75, 95% CI 1.01 to 32.71); the time taken to return to work was shorter (WMD 8.23 days, 95% CI 6.31 to 10.16); fewer patients suffered from persistent swelling at short term follow-up (RR 1.74, 95% CI 1.17 to 2.59); fewer patients suffered from objective instability as tested by stress X-ray (WMD 2.60, 95% CI 1.24 to 3.96); and patients treated functionally were more satisfied with their treatment (RR 1.83, 95% CI 1.09 to 3.07). A separate analysis of trials that scored 50 per cent or more in quality assessment found a similar result for time to return to work only (WMD (days) 12.89, 95% CI 7.10 to 18.67). No significant differences between varying types of immobilisation, immobilisation and physiotherapy or no treatment were found, apart from one trial where patients returned to work sooner after treatment with a soft cast. In all analyses performed, no results were significantly in favour of immobilisation. REVIEWER'S CONCLUSIONS: Functional treatment appears to be the favourable strategy for treating acute ankle sprains when compared with immobilisation. However, these results should be interpreted with caution, as most of the differences are not significant after exclusion of the low quality trials. Many trials were poorly reported and there was variety amongst the functional treatments evaluated.

Humans↗
PubMed1999

Clinical management of carpal tunnel syndrome: a 12-year review of outcomes.

Carpal tunnel syndrome (CTS) is a disorder frequently encountered by occupational health care specialists. The health care management of this disorder has involved a diverse set of clinical procedures. The present article is a review of the literature related to CTS with an emphasis on occupational-related CTS. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycLIT, and NIOSHTIC databases from 1985-1997 were searched for treatment outcome studies related to CTS. Treatments of interest included surgery, physical therapy, drug therapy, chiropractic treatment, biobehavioral interventions, and occupational rehabilitation. A systematic review of the effects of these interventions on symptoms, medical status, function, return to work, psychological well-being, and patient satisfaction was completed. Compared to other treatments, the majority of studies assessed the effects of surgical interventions. Endoscopic release was associated with higher levels of physical functioning and fewer days to return to work when compared to open release. Limited evidence indicated: 1) steroid injections and oral use of B6 were associated with pain reduction; 2) in comparison to splinting, range of motion exercises appeared to be associated with less pain and fewer days to return to work; 3) cognitive behavior therapy yielded reductions in pain, anxiety, and depression; and, 4) multidisciplinary occupational rehabilitation was associated with a higher percentage of chronic cases returning to work than usual care. Workers' compensation status was associated with increased time to return to work following surgery. Conclusions are preliminary due to the small number of well-controlled studies, variability in duration of symptoms and disability, and the broad range of reported outcome measures. While there are several opinions regarding effective treatment, there is very little scientific support for the range of options currently used in practice. Despite the emerging evidence of the multivariate nature of CTS, the majority of outcome studies have focused on single interventions directed at individual etiological factors or symptoms and functional limitations secondary to CTS.

Analgesia↗
PubMed1995

Costs analysis of successful rotator cuff repair surgery: an outcome study. Comparison of gatekeeper system in surgical patients.

In an effort to determine the cost effectiveness of rotator cuff repair surgery in workers' compensation patients, a financial analysis of 50 consecutive patients with a "successful" result was performed. Treatment costs were analyzed from the date of initial injury through all evaluations, diagnostic studies, surgical reconstruction, physical therapy and work hardening. Additionally, all workers' compensation payments and the cost of settlement was analyzed. The average cost of medical care was $50,302.25 per patient. The average time to return to unrestricted duty from the date of injury was 11 months. However, patients referred to a specialist immediately following the diagnosis of a rotator cuff tear had total costs that averaged $25,870.64 and returned to work an average of 7 months postoperatively. Patients managed via a "gatekeeper" system averaged $100,280.10 in total costs and the average return to work was 18 months. These differences in cost and return to work were both statistically significant, P < .05. In conclusion, immediate referral of rotator cuff tears for specialized care results in decreased cost and earlier return to work.

Absenteeism↗
PubMed2004

Perceived barriers to employment among persons living with HIV/AIDS.

This study examined factors associated with contemplating returning to work among unemployed persons living with HIV/AIDS (PLHA) in a large urban city in the United States. A mailed, self-administered survey gathered information from 757 unemployed PLHA. Chi-square and logistic regression analyses were used to determine associations between contemplating returning to work and sociodemographic characteristics, health factors and perceived barriers to employment. We found that most unemployed PLHA (74%) were thinking of returning to work, but perceived significant barriers such as loss of disability income benefits (73%), loss of publicly-funded health insurance (67%) and workplace discrimination (66%). Univariate analyses indicated that contemplating returning to work was significantly associated with sociodemographic characteristics, health factors and perceived barriers to employment in the following areas: (1) availability of health insurance, (2) personal health and physical ability, (3) health concerns related to working and the work environment, and (4) current job skills. Multivariate analyses indicated that: gender, age, race/ethnicity, health insurance type, health status and the belief that health will improve if employed were independently associated with contemplating returning to work. In summary, a substantial proportion of unemployed PLHA may contemplate re-entering the workforce. Assistance is needed to help PLHA address perceived barriers that may prevent them from seeking employment.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice.

OBJECTIVE: To describe the natural course of recent acute low back pain in terms of both morbidity (pain, disability) and absenteeism from work and to evaluate the prognostic factors for these outcomes. DESIGN: Inception cohort study. SETTING: Primary care. PATIENTS: 103 patients with acute localised non-specific back pain lasting less than 72 hours. MAIN OUTCOME MEASURES: Complete recovery (disappearance of both pain and disability) and return to work. RESULTS: 90% of patients recovered within two weeks and only two developed chronic low back pain. Only 49 of 100 patients for whom data were available had bed rest and 40% of 75 employed patients lost no time from work. Proportional hazards regression analysis showed that previous chronic episodes of low back pain, initial disability level, initial pain worse when standing, initial pain worse when lying, and compensation status were significantly associated with delayed episode recovery. These factors were also related to absenteeism from work. Absenteeism from work was also influenced by job satisfaction and gender. CONCLUSIONS: The recovery rate from acute low back pain was much higher than reported in other studies. Those studies, however, did not investigate groups of patients enrolled shortly after the onset of symptoms and often mixed acute low back pain patients with patients with exacerbations of chronic pain or sciatica. Several sociodemographic and clinical factors were of prognostic value in acute low back pain. Factors which influenced the outcome in terms of episode recovery (mainly physical severity factors) were only partly predictive of absenteeism from work. Time off work and return to work depended more on sociodemographic and job related influences.

Absenteeism↗