Outcome Determinants of Subacute Low Back Pain Predictors and Modifiers of Treatment Effect Influencing Sick Leave in Subacute Low Back Pain Patients Screening to Identify Patients at Risk: Profiles of Psychological Risk Factors for Early Intervention Clinical course and prognostic factors in acute neck pain: an inception cohort study in general practice. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Prognostic Factors for Duration of Sick Leave Due to Low-Back Pain in Dutch Health Care Professionals Mini-Intervention for Subacute Low Back Pain: A Randomized Controlled Trial Mini-Intervention for Subacute Low Back Pain: Two-Year Follow-up and Modifiers of Effectiveness Long-term prognosis of acute low back pain in patients seen in general practice: a 1-year prospective follow-up study. Should treatment of (sub)acute low back pain be aimed at psychosocial prognostic factors? Cluster randomised clinical trial in general practice Is the interleukin-6 haplotype a prognostic factor for sciatica? A prediction rule for shoulder pain related sick leave: a prospective cohort study Prognostic factors for poor recovery in acute whiplash patients Expectations, perceptions, and physiotherapy predict prolonged sick leave in subacute low back pain The association between pelvic girdle pain and sick leave during pregnancy; a retrospective study of a Norwegian population A controlled, multicentre trial of manual therapy in low-back pain. Initial status, sick-leave and pain score during follow-up. The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders - a randomized controlled trial Does Early Intervention With a Light Mobilization Program Reduce Long-Term Sick Leave for Low Back Pain? A prospective study of prognostic factors for duration of sick leave after endoscopic carpal tunnel release A cognitive–behavioral return-to-work program: effects on pain patients with a history of long-term versus short-term sick leave
Study Design . Descriptive prognostic study . Objectives . To identify outcome determinants of subacute low back pain . Summary of Background Data . The factors predicting recovery from prolonged back pain among working adults are largely unknown . Material s and Methods . One hundred sixty-four employed patients with subacute ( duration of pain 4–12 weeks ) daily low back pain were recruited from primary health care to a r and omized study . Data on potential predictive factors were collected before r and omization . In multiple regressions using repeated measures analysis , the treatment received was adjusted when determining the impact of the predictive factors . Dependent outcome variables used were pain , perceived functional disability , generic health-related quality of life , satisfaction with care , days on sick leave , use of health care , and costs of health care consumption measured , at 3- , 6- , and 12-month follow-ups . Results . Age and intensity of pain at baseline predicted most of the outcomes . The perceived risk of not recovering was a stronger determinant of outcome than gender , education , or self-rated health status ( which did not have any predictive value ) or body mass index , expectations of treatment effect , satisfaction with work , or the presence of radicular symptoms below the knee ( only slight predictive value ) . The only factors predicting the duration of sick leave were the duration of sick leave at baseline and the type of occupation . Conclusion . Age and intensity of pain are the strongest predictors of outcome . Accumulation of days on sick leave is predicted by the duration of sick leave at entry and the type of work , but not by pain , perceived disability , or satisfaction with work Study Design . Modifying effects in multivariate analyses of a r and omized controlled trial . Objectives . To identify prognostic factors for the effect of a brief intervention ( “ modifiers ” ) at a spine clinic on return to work in patients with subacute low back pain . Summary of Background Data . A previous study of a brief intervention showed significant reduction of sick leave , compared with usual primary healthcare treatment . R and omized controlled trials give data only on the group as an average . Identifying prognostic factors that interact with the treatment ( “ modifiers ” ) may identify specific groups requiring this or other types of treatment . Methods . A total of 457 patients who had been sick-listed 8 to 12 weeks for low back pain were r and omized into an intervention group ( spine clinic with medical examination , information , reassurance , encouragement to engage in physical activity , n = 237 ) , and a control group ( primary health care , n = 220 ) . All subjects filled out question naires . Logistic regression and tests for interaction were used to identify prognostic factors and modifiers for return to work in the two groups , at 3 and 12 months of follow-up . Results . At 3 months of follow-up , the strongest modifying effect on return to work was the perception of constant back strain when working and beliefs about reduced ability to work . At 12 months , gastrointestinal complaints were the strongest modifier for the effect of the intervention . Conclusion . The spine clinic intervention seems to have a main effect on work absenteeism via interacting with the concerns of being unable to work There is a serious need to provide effective early interventions that prevent the development of persistent pain and disability . Identifying patients at risk for this development is an important step . Our aim was to explore whether distinct subgroups of individuals with similar response patterns on a screening question naire exist . Moreover , the objective was to then relate these groups to future outcomes , for example , sick leave as an impetus for developing tailored interventions that might better prevent chronic problems . A total of 363 patients seeking primary care for acute or subacute spinal pain completed the Örebro Musculoskeletal Pain Screening Question naire  and were then followed to determine outcome . Cluster analysis was used to identify subgroups . Validity was tested using 3 methods including the split-half technique . The subgroups were compared prospect ively on outcome measures obtained 1 year later . Using pain intensity , fear-avoidance beliefs , function , and mood , we found 4 distinct profiles : Fear-Avoidant , Distressed Fear-Avoidant , Low Risk , and Low Risk-Depressed Mood . These 4 subgroups were also robust in all 3 of the validity procedures . The 4 subgroups were clearly related to outcome . Although the low risk profiles had virtually no one developing long-term sick leave , the Fear-Avoidant profile had 35 % and the Distressed Fear-Avoidant profile 62 % developing long-term sick leave . Our results suggest that fear-avoidance and distress are important factors in the development of pain-related disability and may serve as a key for early identification . Providing interventions specific to the factors isolated in the profiles should enhance the prevention of persistent pain and disability OBJECTIVE To describe the natural course of patients with acute neck pain presenting in general practice and to identify prognostic factors for recovery and sick leave . DESIGN We conducted a prospect i ve cohort study with a 1-year follow-up in general practice . Question naires were collected at baseline and after 6 , 12 , 26 , and 52 weeks . Days of sick leave were dichotomized into two groups : below and above 7 days of sick leave . Logistic regression was used to identify prognostic factors for recovery and sick leave . PATIENTS Consecutive patients with nonspecific neck pain lasting no longer than 6 weeks were invited to participate . RESULTS One hundred eighty-seven patients were included and 138 ( 74 % ) provided follow-up data . After 1 year , 76 % of the patients stated to be fully recovered or much improved , although 47 % reported to have ongoing neck pain . Almost half of the patients on sick leave at baseline returned to work within 7 days . Multivariate analysis showed that the highest association with recovery was the advice of the general practitioner ( GP ) " to wait and see " ( odds ratio [ OR ] 6.7 , 95 % confidence interval [ CI ] 1.6 - 31.8 ) . For sick leave , referral by the GP , for physical therapy or to a medical specialist , showed the highest association ( OR 2.8 , 95 % CI 1.0 - 8.4 ) . CONCLUSION Acute neck pain had a good prognosis for the majority of patients , but still a relatively high proportion of patients reported neck pain after 1-year follow-up . The advice given by the GP " to wait and see " was associated with recovery , and " referral " was associated with prolonged sick leave OBJECTIVES Because musculoskeletal pain is the second most frequent reason for seeking health care , the aims of this study were to determine the value of psychosocial variables in evaluating risk for developing chronic back pain problems and to develop a screening methodology to identify patients likely to have a poor prognosis . STUDY DESIGN A prospect i ve study was conducted on consecutive patients with acute or subacute back pain , in which patients completed a screening question naire and were then followed up for 6 months to determine outcome . The primary outcome variable was accumulated sick leave . METHODS One hundred forty-two consecutive patients were asked to complete a question naire design ed for this study . This question naire contained 24 items concerning psychosocial aspects of the problem . Six months later , patients were contacted to complete outcome questions about accumulated sick leave .  RESULTS A total of 97 % of the patients completed both question naires . Although patients , on average , improved greatly , 18 % had 1 - 30 days and 20 % had fewer than 30 days of sick leave during the follow-up period . Five variables were found to be the strongest predictors of sick leave outcome ( fear-avoidance work beliefs , perceived improvement , problems with work function , stress , and previous sick leave ) , correctly classifying 73 % of the patients as opposed to a chance rate of 33 % . A total score was evaluated as a means of judging risk and found to be strongly related to outcome . CONCLUSION Potent psychosocial risk factors associated with future sick absenteeism were identified . Because the total score was related to outcome , the instrument may have use in screening patients with acute or subacute spinal pain in clinical situations Background : Information on prognostic factors for duration of sick leave  due to low-back pain ( LBP ) is growing . In this prospect i ve cohort study prognostic factors for duration of sick leave and course of disability were identified in a very early stage of sick leave due to LBP in an occupational health care setting . Methods : A total of 615 workers calling in sick from work due to LBP at an occupational health service ( OHS ) of one institution completed a question naire . Duration of follow-up was 26 weeks . Prognostic factors were identified by means of Cox regression analysis and multiple linear regression analysis , and explained variance was calculated . Results : Median time to first return to work ( RTW ) was 5 days ( Inter Quartile Range ( IQR ) = 2–12 ) . Median time to lasting return to work ( LRTW ) was 6 days ( IQR = 3–13 ) . The final model for delayed RTW included self-reported  expected duration of sick-leave  , treatment by GP or specialist , care-seeking , diminished mobility , and the interaction between care-seeking and diminished mobility . The final model for LRTW included : self-reported expected duration of sick-leave  ,  treatment by GP or specialist  , care-seeking , the interaction between the self-reported  expected duration of sick-leave and seeking care at OHS , complaints due to job stress , diminished mobility , and the interactions between expected duration of more then 10 days and seeking OP care and diminished mobility . Median total days on sick leave ( TDSL ) was 6 days ( IQR = 3–13 days ) . The final model for TDSL included : age , expected duration of sick leave , treatment by GP or medical specialist , seeking OP care , complaints due to physical load , and diminished mobility . Explained variance ( R2 ) of these models ranged from 30 to 35 % . Conclusions : Poor prognosis for duration of sick leave can be identified by means of a simple question naire administered on the first day of sick leave . Workers at high risk for longer duration of sick leave ( all outcomes ) expected to stay off work longer , were already being treated by a MD , sought OP care , and had diminished mobility . In case of delayed LRTW workers reported job stress as a possible cause of sick leave . Interactions were found in both RTW and LRTW between care-seeking and diminished mobility and in LRTW between expected duration of sick leave and seeking OP care . Older age increased TDSL with borderline significance Study Design . R and omized controlled trial . Objectives . To investigate the effectiveness and costs of a mini-intervention , provided in addition to the usual care , and the incremental effect of a work site visit for patients with subacute disabling low back pain . Summary of Background Data . There is lack of data on cost-effectiveness of brief interventions for patients with prolonged low back pain . Methods . A total of 164 patients with subacute low back pain were r and omized to a  mini-intervention group ( A ) , a work site visit group ( B ) , or a usual care group ( C ) . Groups A ( n = 56 ) and B ( n = 51 ) underwent one assessment by a physician plus a physiotherapist . Group B received a work site visit in addition . Group C served as controls ( n = 57 ) and was treated in municipal primary health care . All patients received a leaflet on back pain . Pain , disability , specific and generic health-related quality of life , satisfaction with care , days on sick leave , and use and costs of health care consumption were measured at 3- , 6- , and 12-month follow-ups . Results . During follow-up , fewer subjects had daily pain in Groups A and B than in Group C ( Group A vs. Group C , P = 0.002 ; Group B vs. Group C , P = 0.030 ) . In Group A , pain was less bothersome ( Group A vs. Group C , P = 0.032 ) and interfered less with daily life ( Group A vs. Group C , P = 0.040 ) than among controls . Average days on sick leave were 19 in Group A , 28 in Group B , and 41 in Group C ( Group A vs. Group C , P = 0.019 ) . Treatment satisfaction was better in the intervention groups than among the controls , and costs were lowest in the mini-intervention group . Conclusions . Mini-intervention reduced daily back pain symptoms and sickness absence , improved adaptation to pain and patient satisfaction among patients with subacute low back pain , without increasing health care costs . A work site visit did not increase effectiveness Study Design . R and omized controlled trial . Objectives . To Investigate the long-term effectiveness , costs , and effect modifiers of a mini-intervention , provided in addition to the usual care , and the incremental effect of a worksite visit for patients with subacute disabling low back pain ( LBP ) . Summary of Background Data . A mini-intervention was earlier proved to be an effective treatment for subacute LBP . Whether the beneficial effect is sustained is not known . Furthermore , modifiers of a treatment effect are largely unknown . Methods . A total of 164 patients with subacute LBP r and omized into a mini-intervention  ( A , n = 56 ) ,  a mini-intervention plus a worksite visit  ( B , n = 51 ) , or the  usual care  ( C , n = 57 ) . Mini-intervention consisted of a detailed assessment of the patients ’ history , beliefs , and physical findings by a physician and a physiotherapist , followed by recommendations and advice . The usual care patients received the conventional care .  Pain , disability , health-related quality of life , satisfaction with care , days on sick leave , and health care consumption and costs were measured during a 24-month follow-up . Thirteen c and i date modifiers were tested for each outcome . Results . There were no differences between the three treatment arms regarding the intensity of pain , the perceived disability , or the health-related quality of life . However , mini-intervention decreased occurrence of daily ( A vs. , C , P = 0.01 ) and bothersome ( A vs. C , P < 0.05 ) pain and increased treatment satisfaction . Costs result ing from LBP were lower in the intervention groups ( A 4670 Euros , B 5990 Euros ) than in C ( C 9510 Euros ) ( A vs. C , P = 0.04 ; and B vs. C , not significant ) . The average number of days on sick leave was 30 in A , 45 in B , and 62 in C ( A vs. C , P = 0.03 ; B vs. C , not significant ) . The perceived risk for not recovering was the strongest modifier of treatment effect . Mental and mental-physical workers in A and B were less often on sick leave than those in C. Conclusions . Mini-intervention is an effective treatment for subacute LBP . Despite lack of a significant effect on intensity of low back pain and perceived disability , mini-intervention , including proper recommendations and advice , according to the “ active approach , ” is able to reduce LBP-related costs . The perceived risk of not recovering was the strongest modifier of treatment effect . In alleviating pain , the intervention was most effective among the patients with a high perceived risk of not recovering OBJECTIVES We aim ed to examine the prognosis of acute low back pain ( LBP ) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP . METHOD We conducted a prospect i ve cohort study in general practice in Denmark . The patients were those aged 18 - 60 years consulting their GP due to an episode of LBP lasting less than 2 weeks . The GPs collected data regarding 34 exposure variables , including their global assessment of the likelihood of chronic LBP . Outcome variables were collected from the patients after 1 , 6 and 12 months . The outcome measures were days on sick leave , and functional or complete recovery from LBP . RESULTS In total , 503 ( 96 % ) patients were followed during the whole study period . Fifty per cent of the patients on sick leave returned to work within 8 days ; after 1 year , only 2 % remained on sick leave . At the 1-year follow-up , 45 % of the patients continued to complain of LBP . Logistic regression analyses showed that the factors most significantly associated with poor long-term LBP outcome were ( i ) severity of LBP at inclusion , ( ii ) assessment s by the GP of susceptibility to develop chronic LBP and ( iii ) a history of LBP having caused previous sick leave . CONCLUSIONS LBP in general practice has a good prognosis with regard to sick leave , but a high proportion of patients continue to complain of LBP . We were not able to identify objective measures that strongly predict the prognosis of the individual LBP patient . The overall assessment by the GPs seems to be the most important predictor associated with the long-term outcome Abstract Objective To compare the effects of a minimal intervention strategy aim ed at assessment and modification of psychosocial prognostic factors and usual care for treatment of (sub)acute low back pain in general practice . Design Cluster r and omised clinical trial . Setting 60 general practitioners in 41 general practice s. Participants 314 patients with non-specific low back pain of less than 12 weeks ' duration , recruited by their general practitioner . Interventions In the minimal intervention strategy group the general practitioner explored the presence of psychosocial prognostic factors , discussed these factors , set specific goals for reactivation , and provided an educational booklet . The consultation took about 20 minutes . Usual care was not st and ardised . Main outcome measures Functional disability ( Rol and -Morris disability question naire ) , perceived recovery , and sick leave because of low back pain assessed at baseline and after 6 , 13 , 26 , and 52 weeks . Results The dropout rate was 8 % in the minimal intervention strategy group and 9 % in the usual care group . Multilevel analyses showed no significant differences between the groups on any outcome measure during 12 months of follow-up in the whole group or in relevant subgroups ( patients with high scores on psychosocial measures at baseline or a history of frequent or prolonged low back pain ) . Conclusion This study provides no evidence that ( Dutch ) general practitioners should adopt our new treatment strategy aim ed at psychosocial prognostic factors in patients with (sub)acute low back pain . Further research should examine why our new strategy was not more effective than usual care AIMS We have shown in a cross-sectional setting that an IL6 haplotype ( GGGA ) is associated with intervertebral disc disease ( IDD ) characterized by sciatica . The aim of this study was to evaluate the prognostic role of the GGGA haplotype in IDD . METHODS DNA from 153 sciatica patients who participated in a r and omized controlled trial of periradicular infiltration  was analysed for IL6 variations rs1800797 ( -596A > G ) , rs1800796 ( -572G > C ) , rs1800795 ( -174G > C ) , and rs13306435 ( + 15T > A ) . The patients recorded back and leg pain intensity and duration , disability by Oswestry Index and back-related sickness absence over a three-year follow-up . Repeated measures and univariate analysis of variance with adjustment for age , gender and physical work load were used in statistical analyses for the last two-years of the follow-up . RESULTS The prevalence of the GGGA haplotype was 9 % ( 14/153 ) . Subjects with the GGGA haplotype did not differ from those without the haplotype with respect to pain intensity , or disability score , but days with back and leg pain and days on sick leave were significantly higher among subjects with the IL6 haplotype after adjustment for occupation ( p=0.006 , 0.001 and 0.002 , respectively ) . An interaction between the IL6 haplotype and physical work load was significant for the duration of back and leg pain and sick leave ( p=0.038 , 0.011 and 0.006 , respectively ) . CONCLUSIONS This is the first observation of any prognostic genotype among sciatica patients . The IL6 haplotype GGGA predicted the number of days with back or leg pain and also sickness absence . Subjects with the IL6 haplotype may be more vulnerable when doing physically dem and ing jobs Background Shoulder pain is common in primary care , and has an unfavourable outcome in many patients . Information about predictors of shoulder pain related sick leave in workers is scarce and inconsistent . The objective was to develop a clinical prediction rule for calculating the risk of shoulder pain related sick leave for individual workers , during the 6 months following first consultation in general practice . Methods A prospect i ve cohort study with 6 months follow-up was conducted among 350 workers with a new episode of shoulder pain . Potential predictors included the results of a physical examination , sociodemographic variables , disease characteristics ( duration of symptoms , sick leave in the 2 months prior to consultation , pain intensity , disability , comorbidity ) , physical activity , physical work load , psychological factors , and the psychosocial work environment . The main outcome measure was sick leave during 6 months following first consultation in general practice . Results Response rate to the follow-up question naire at 6 months was 85 % . During the 6 months after first consultation 30 % ( 89/298 ) of the workers reported sick leave . 16 % ( 47 ) reported 10 days sick leave or more . Sick leave during this period was predicted in a multivariable model by a longer duration of sick leave prior to consultation , more shoulder pain , a perceived cause of strain or overuse during regular activities , and co-existing psychological complaints . The discriminative ability of the prediction model was satisfactory with an area under the curve of 0.70 ( 95 % CI 0.64–0.76 ) . Conclusion Although 30 % of all workers with shoulder pain reported sick leave during follow-up , the duration of sick leave was limited to a few days in most workers . We developed a prediction rule and a score chart that can be used by general practitioners and occupational health care providers to calculate the absolute risk of sick leave in individual workers with shoulder pain , which may help to identify workers who need additional attention . The performance and applicability of our model needs to be tested in other working population s with shoulder pain to enable valid and reliable use of the score chart in everyday practice & NA ; The objective of our prospect i ve inception cohort study was to identify prognostic factors for poor recovery in patients with whiplash‐associated disorders grade 1 or 2 who still had neck pain and accompanying complaints 2 weeks after the accident . The study was carried out in a primary health care setting in The Netherl and s and included 125 patients . The primary outcome measure was functional recovery defined in terms of neck pain intensity or work disability without medication use . The secondary outcome measures included neck pain intensity , work disability and sick leave . The outcomes were assessed at 4 , 12 and 52 weeks after the accident . Prognostic factors were identified by logistic regression analyses . One year after the injury , 64 % of the patients were recovered . Factors related to poor recovery were female gender , a low level of education , high initial neck pain , more severe disability , higher levels of somatisation and sleep difficulties . Neck pain intensity and work disability proved to be the most consistent predictors for poor recovery . The accuracy of the predictions of the prognostic models was high , meaning that the models adequately distinguished patients with poor recovery from those regarded as recovered . These findings add to the growing body of evidence , indicating that socio‐demographic , physical and psychological factors affect short‐ and long‐term outcome after whiplash injury . Our findings also indicate that care providers can easily identify patients at risk for poor recovery with a visual analogue scale for initial pain intensity and work‐related activities Background Brief intervention programs for subacute low back pain ( LBP ) result in significant reduction of sick leave compared to treatment as usual . Although effective , a substantial proportion of the patients do not return to work . This study investigates predictors of return to work in LBP patients participating in a r and omized controlled trial comparing a  brief intervention program ( BI ) with BI and physical exercise . Methods Predictors for not returning to work was examined in 246 patients sick listed 8 - 12 weeks for low back pain . The patients had participated in a r and omized controlled trial , with BI ( n = 122 ) and BI + physical exercise ( n = 124 ) . There were no significant differences between the two intervention groups on return to work . The groups were therefore merged in the analyses of predictors . Multiple logistic regression analysis was used to identify predictors for non return to work at 3 , 12 , and 24 months of follow-up . Results At 3 months of follow-up , the strongest predictors for not returning to work were pain intensity while resting ( OR = 5.6 ; CI = 1.7 - 19 ) , the perception of constant back strain when working ( OR = 4.1 ; CI = 1.5 - 12 ) , negative expectations for return to work ( OR = 4.2 ; CI = 1.7 - 10 ) , and having been to a physiotherapist prior to participation in the trial ( OR = 3.3 ; CI = 1.3 - 8.3 ) . At 12 months , perceived reduced ability to walk far due to the complaints ( OR = 2.6 ; CI = 1.3 - 5.4 ) , pain during activities ( OR = 2.4 ; CI = 1.1 - 5.1 ) , and having been to a physiotherapist prior to participation in the trial ( OR = 2.1 ; CI = 1.1 - 4.3 ) were the strongest predictors for non return to work . At 24 months age below 41 years ( OR = 2.9 ; CI = 1.4 - 6.0 ) was the only significant predictor for non return to work . Conclusion It appears that return to work is highly dependant on individual and cognitive factors . Patients not returning to work after the interventions were characterized by negative expectations , perceptions about pain and disability , and previous physiotherapy treatment . This is the first study reporting that previous treatment by physiotherapists is a risk factor for long-term sick leave . This has not been reported before and is an interesting finding that deserves more scrutiny Background The incidence of pelvic girdle pain ( PGP ) in pregnancy is wide ranged depending on definition , the utilised diagnostic means , and the design of the studies . PGP during pregnancy has negative effects on activities of daily living and causes long sick leave , which makes it a major public health issue . Our objectives were to explore the frequency of sick leave  in pregnancy due to PGP , assess the relationship between different types of pain-related activities of daily living , examine physical workload , type of work in relation to sick leave , and to explore factors that make women less likely to take sick leave for PGP . Methods All women giving birth at the maternity ward of Stavanger University Hospital , Norway , were asked to participate and complete a question naire on demographic features , PGP , pain-related activities of daily living , sick leave in general and for PGP , frequency of exercising before and during pregnancy . Drawings of pelvic girdle and low back area were used for the localization of pain . PGP intensity was then rated retrospectively on a numerical rating scale . Non-parametric tests , multinomial logistic regression and sequential linear regression analysis were used in the statistical analysis . Results PGP is a frequent and major cause of sick leave during pregnancy among Norwegian women , which is also reflected in activities of daily living as measured with scores on all Oswestry disability index items . In the multivariate analysis of factors related to sick leave and PGP we found that work satisfaction , problems with lifting and sleeping , and pain intensity were risk factors for sick leave . In addition , women with longer education , higher work satisfaction and fewer problems with sitting , walking and st and ing , were less likely to take sick leave in pregnancy , despite the same pain intensity as women being on sick leave . Conclusions A coping factor in pregnant women with PGP was discovered , most likely dependant on education , associated with work situation and /or work posture , which decreases sick leave . We recommend these issues to be further examined in a prospect i ve longitudinal study since it may have important implication s for sick leave frequency during pregnancy 101 out patients with acute or subacute low-back pain were r and omly allocated to one of two treatment groups . One group was given st and ardized conventional but optimal activating treatment by primary health care teams . The other group received manual treatment such as manipulation , specific mobilization , muscle stretching , auto-traction , and cortisone injections . The two groups were similar in most of the pretrial variables , including age , sex , previous low-back pain problems , sick-leave , previous treatment , findings at the physical examination , quality -of-life score , disability rating , and pain score . After one month in the study , the proportion of patients on sick-leave was six times larger in the conventionally treated group than in the group receiving the specific manual treatment . The difference diminished over time but was still significant after eight months . Two slightly different pain scores ( " pain at the moment " and " pain during the last weeks " ) , initially similar in the two groups , diminished in both groups but were significantly lower in the manual treatment group during the study . The group receiving specific manual treatment thus had a significantly better outcome than the group receiving conventional treatment as far as sick-leave and pain score are concerned Objective : To evaluate the effects of a physical training programme which is supervised and tailored to meet the needs of patients with subacute whiplash-associated disorders . Design : A r and omized controlled trial with follow-up at three and nine months after r and omization . Setting : An interdisciplinary rehabilitation centre . Subjects : Forty-seven patients with subacute disorders following a whiplash trauma . Interventions : Patients were r and omized to a supervised training group or a self-administered home training group . Main measures : Primary outcome measures were the Self-Efficacy Scale , the Tampa Scale for Kinesiophobia and the Pain Disability Index . Secondary outcome measures were neck pain intensity , sensory and affective dimensions of pain , pain location and duration , muscle tenderness , grip strength , cervical mobility , sick leave and analgesic consumption . Results : Forty patients ( 85 % ) completed the intervention period , and the drop-outs were followed up by intention-to-treat . The results showed that supervised training was significantly more favourable than home training , with a more rapid improvement in self-efficacy ( P=0.03 ) , fear of movement/(re)injury ( P=0.03 ) and pain disability ( P=0.03 ) at three months . Further , supervised training significantly reduced the frequency of analgesic consumption ( P=0.03 ) . The improvements were partly maintained at nine months , even though there was no amelioration in pain and physical disorders . Despite the favourable outcome , supervised intervention did not reduce sick leave . Conclusions : The findings indicate a treatment approach that is feasible in the rehabilitation of patients with subacute whiplash-associated disorders in the short term , but additional research is needed to extend these findings and eluci date treatment strategies that also are cost effective Study Design . A controlled r and omized clinical trial was performed . Objective . To investigate the effect of a light mobilization program on the duration of sick leave for patients with subacute low back pain . Summary of Background Data . Early intervention with information , diagnostics , and light mobilization may be a cost-effective method for returning patients quickly to normal activity . In this experiment , patients were referred to a low back pain clinic and given this simple and systematic program as an outpatient treatment . Methods . In this study , 457 patients sick-listed 8 to 12 weeks for low back pain , as recorded by the National Insurance Offices , were r and omized into two groups : an intervention group ( n = 237 ) and a control group  ( n = 220 ) . The intervention group was examined at a spine clinic and given information and advice to stay active . The control group was not examined at the clinic , but was treated with conventional primary health care . Results . At 12-month follow-up assessment , 68.4 % in the intervention group had returned to full-duty work , as compared with 56.4 % in the control group . Conclusions . Early intervention with examination , information , and recommendations to stay active showed significant effects in reducing sick leave for patients with low back pain Background Endoscopic carpal tunnel release with a single portal technique has been shown to reduce sick leave compared to open carpal tunnel release , cl aim ing to be a less invasive procedure and reducing scar tenderness leading to a more rapid return to work , and the purpose of this study was to identify prognostic factors for prolonged sick leave after endoscopic carpal tunnel release in a group of employed Danish patients . Methods The design was a prospect i ve study including 75 employed patients with carpal tunnel syndrome operated with ECTR at two hospitals . The mean age was 46 years ( SD 10.1 ) , the male/female ratio was 0.42 , and the mean preoperative duration of symptoms 10 months ( range 6 - 12 ) . Only 21 ( 28 % ) were unable to work preoperatively and mean sick leave was 4 weeks ( range 1 - 4 ) . At base-line and at the 3-month follow-up , a self-administered question naire was collected concerning physical , psychological , and social circumstances in relation to the h and problem . Data from a nerve conduction examination were collected at baseline and at the 3-month follow-up . Significant prognostic factors were identified through multiple logistic regression analysis . Results After the operation , the mean functional score was reduced from 2.3 to 1.4 ( SD 0.8 ) and the mean symptom score from 2.9 to 1.5 ( SD 0.7 ) . The mean sick leave from work after the operation was 19.8 days ( SD 14.3 ) . Eighteen patients ( 24 % ) had more than 21 days of sick leave . Two patients ( 3 % ) were still unable to work after 3 months . Significant prognostic factors in the multivariate analysis for more than 21 days of postoperative sick leave were preoperative sick leave , blaming oneself for the h and problem and a preoperative distal motor latency . Conclusion Preoperative sick leave , blaming oneself for the h and problem , and a preoperative distal nerve conduction motor latency were prognostic factors for postoperative work absence of more than 21 days . Other factors may be important ( clinical , demographic , economic , and workplace ) in explaining the great variance in the results of sick leave after carpal tunnel release between studies from different countries & NA ; A cognitive – behavioral return‐to‐work focused program was evaluated in a r and omized controlled design , and the effects were compared between two groups of women with musculoskeletal pain . One group of patients ( n=36 ) had a history of long‐term sick leave ( > 12 months ) at the start of the program and the other ( n=36 ) had a history of short‐term sick leave ( 2–6 months ) . The outpatient treatment program , conducted by a psychologist , included 12 sessions with the primary aim to help the patients return‐to‐work . The treatment first included teaching of coping strategies such as applied relaxation , stress management , grade d activity training and pacing . Thereafter the patients were taught how to manage difficulties at their return‐to‐work and how to generalize coping strategies to different risk factors at their work places . The control condition received treatment‐as‐usual . The results showed that the cognitive – behavioral return‐to‐work program  was more effective than the treatment‐as‐usual control condition in reducing the number of days on sick leave for patients on short‐term sick leave , but not for patients on long‐term sick leave . The treatment program also helped the patients on short‐term sick leave to increase their ability to control and decrease pain and to increase their general activity level compared to the control condition . These results underscore the need for an early return‐to‐work focused rehabilitation to prevent long‐term sick leave and disability
Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition .
Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients .