Early disability risk factors for low back pain assessed at outpatient occupational health clinics

Study Design. Inception cohort ( less than or equal to 14 days after pain onset) with 1-month follow-up. Objective. To determine whether disability risk factors provided by patients and clinicians at a first medical visit for acute occupational low back pain predict outcomes. Summary of Background Data. Improving health and work outcomes for patients with occupational low back pain may require early identification of risk factors for persistent pain and disability. Previous studies of back pain prognosis have not assessed patients at the time of initial provider contact, and many have not differentiated between occupational and nonoccupational injuries. Method. Patients ( 183 female, 385 male) presenting to occupational health clinics with recent onset occupational low back pain ( less than or equal to 14 days duration) completed a 16-item survey of potential disability risks including demographic, injury, workplace, psychosocial, and symptom factors. After the initial visit, clinicians completed an additional 10-item questionnaire of symptoms and initial prognosis. Outcome variables of functional limitation and work status were assessed 1 month after pain onset. Results. In multivariate analyses, functional improvement and return to work were more strongly predicted by employer factors ( job tenure, physical work demands, availability of modified duty, earlier reporting to employer) and self-ratings of pain and mood than by health history or physical examination. A logistic regression model had a sensitivity of 74.3% to predict those remaining out of work and a specificity of 70.1%. Conclusions. Early screening for disability risk factors may be helpful to identify those patients at greatest risk for delayed recovery from occupational low back pain. Intervention strategies for high-risk patients might be improved by focusing on job factors, pain coping strategies, and expectations for recovery.