Investigating risk factors for chronicity: The importance of distingushing between return-to-work status and self-report measures of disability

Objective: The objective of this study was to examine whether the outcome of psychosocial risk factor analyses varied as a function of whether the outcome variable was return-to-work status or self-reported functional disability. Methods: Participants were 255 workers who sustained a soft tissue injury to the back and participated in a community-based secondary prevention program. Assessment of psychologic risk factors (pain severity, pain catastrophizing, fear of movement/reinjury, depression) was conducted at pretreatment. Results: Logistic regression revealed that pain catastrophizing (odds ratio [OR], 0.53; 95% confidence interval [CI] = 0.32-0.88) and pain severity (OR, 0.65; 95% CI = 0.45-0.94) were significant predictors of return to work. However, when change in self-reported disability was used as the outcome variable, none of the psychosocial risk factors emerged as significant predictors. Conclusions: Given the important theoretical, clinical, and policy implications of the outcome of risk factor research, more research is needed to further clarify the respective advantages and limitations to using self-reported versus return to work-based measures of disability.