Systematic Review of Prognostic Factors for Return to Work in Workers with Sub Acute and Chronic Low Back Pain.
Ivan A Steenstra, Claire Munhall, Emma Irvin and 5 others
PMID 27647141WHAT IT FOUND
For workers with subacute or chronic low back pain, pain intensity and function do not predict return to work.
Instead, delay in referral, attorney involvement, workers compensation issues, lower socioeconomic status, and poor recovery expectations predict delayed return.
Key findings
01Delay in referral to intervention was associated with a delay in return to work in the chronic phase.
02Attorney involvement and workers compensation policies were strongly associated with delayed return to work in the chronic phase.
03Pain intensity and functional status showed no strong association with return to work in the subacute phase, contrasting with acute-phase findings.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Heterogeneity in how prognostic factors and outcomes were measured across studies prevented meta-analysis. Many psychosocial and workplace factors were understudied or lacked high-quality evidence. Prognostic studies cannot determine intervention effectiveness due to potential biases like immortal time bias. The definition of subacute and chronic phases relies on arbitrary cut-offs (6 and 12 weeks) which may not apply universally. The search was limited to studies up to 2012.
Declared interests
Funded by the Workplace Research and Innovation Program of the Workers Compensation Board of Manitoba.
The easy way to misread this
Do not interpret the associations with intervention or modified duties as evidence of treatment effectiveness. Prognostic studies are not designed to test interventions, and observed associations may be due to bias or confounding factors rather than the treatment itself.