Outcome Determinants of Subacute Low Back Pain Predictors and Modifiers of Treatment Effect Influencing Sick Leave in Subacute Low Back Pain Patients Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Physical performance, pain, pain behavior and subjective disability in patients with subacute low back pain. The causality field (extrinsic and intrinsic factors) in industrial subacute low back pain patients. Mini-Intervention for Subacute Low Back Pain: Two-Year Follow-up and Modifiers of Effectiveness Mini-Intervention for Subacute Low Back Pain: A Randomized Controlled Trial Expectations, perceptions, and physiotherapy predict prolonged sick leave in subacute low back pain Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain: A 5- and 12-Month Follow-up Cohort Study The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Early Access to Physical Therapy Treatment for Subacute Low Back Pain in Primary Health Care: A Prospective Randomized Clinical Trial The perception of pain and pain-related cognitions in subacute whiplash-associated disorders: Its influence on prolonged disability Predictors of return to work in patients sick listed for sub-acute low back pain: a 12-month follow-up study. Screening to Identify Patients at Risk: Profiles of Psychological Risk Factors for Early Intervention Reduction of Pain-Related Disability in Working Populations: A Randomized Intervention Study of the Effects of an Educational Booklet Addressing Psychosocial Risk Factors and Screening Workplaces for Physical Health Hazards A prediction rule for shoulder pain related sick leave: a prospective cohort study A comparison of work absence periods and the associated costs for two different modes of exercise therapies for patients with longstanding subacromial pain
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 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 The aim of this paper was to study the physical performance , pain , pain behavior and disability in patients with subacute low back pain ( LBP ) . The patients were blue-collar workers and had been sick-listed for 8 weeks due to subacute low back pain . A total of 103 patients were r and omized , 51 of them to the intervention group and the other to a control group .  Recordings of physical performance and complaints of LBP were done before and after treatment in the intervention group . The proportion of patients with no complaints of LBP was significantly greater in the intervention group than in the control group at the one-year follow-up . The patients who intra-individually improved their physical performance also intra-individually decreased their complaints of LBP . The intra-individual improvements were suggested to be important for the individual return to work In a prospect i ve , r and omized study , primarily design ed to test the efficacy of activation on consecutive blue-collar workers sick-listed for 6 weeks due to subacute low back pain , 25 % of the workers were excluded for medical reasons . In the intervention study ( n = 103 ) , only a minority of cases ( 6 % ) had ' true ' subacute complaints , i.e. no prior history of low back pain .  Subjective reports on general well-being , health status and work-related ergonomic factors were significantly lower or worse in patients than in reference sample s. The r and omized intervention study could establish a significant effect of grade d activation on work return , but the effect seemed to be restricted to patients moderately disabled , i.e. one-third of the subacute low back pain patients included . A predictive four-factor model on work return increased the possibility of identifing nonresponders ( chronic low back pain ) more than threefold with a specificity ( 91 % ) and sensitivity ( 74 % ) comparable to that of clinical disc herniation . The history of a prolonged disablement process , cognitive factors , pain behavior and mentally straining ergonomic factors seemed to be of importance . Psychological reactions , or ' barriers to recovery ' , were slightly different in treatment and control groups but the type of intervention did not significantly alter the predictive model , suggesting that subsets of the study sample may benefit from other optional functional approaches . Descriptive characteristics of the study sample emphasized that subacute low back pain patients can not be conceptualized as a homogeneous group . Four sub-groups could be identified : ( a ) specific medical disorders ; ( b ) spontaneous recovery group ; ( c ) moderately disabled back pain patients ; and ( d ) nonresponders . The results support proposals that treatment should be tailored according to individual needs and that better case management should have priority for those belonging to the nonresponder group 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 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 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 Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain ( CNSLBP ) . Objective The purpose of this study was to describe the course of disability and identify clinical ly important prognostic factors of low-back-pain – specific disability in patients with CNSLBP receiving multidisciplinary therapy .  Design A prospect i ve cohort study was conducted . Methods A total of 1,760 patients with CNSLBP who received multidisciplinary therapy  were evaluated for their course of disability and prognostic factors at baseline and at 2- , 5- , and 12-month follow-ups . Recovery was defined as 30 % reduction in low back pain – specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale ( QBPDS ) was ≤20 points at follow-up . Potential prognostic factors were identified using multivariable logistic regression analysis . Results Mean patient-reported disability scores on the QBPDS ranged from 51.7 ( SD=15.6 ) at baseline to 31.7 ( SD=15.2 ) , 31.1 ( SD=18.2 ) , and 29.1 ( SD=20.0 ) at 2 , 5 , and 12 months , respectively . The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey ( SF-36 ) ( Physical and Mental Component Summaries ) at baseline . In addition , at 5-month follow-up , a shorter duration of complaints was a positive predictor , and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up . Limitations Missing values at 5- and 12-month follow-ups were 11.1 % and 45.2 % , respectively . Conclusion After multidisciplinary treatment , the course of disability in patients with CNSLBP continued to decline over a 12-month period . At 5- and 12-month follow-ups , prognostic factors were identified for a clinical ly relevant decrease in disability scores on the QBPDS The aim of this study was to determine whether grade d activity restored occupational function in industrial blue-collar workers who were sick-listed for 8 weeks because of subacute , nonspecific , mechanical low back pain ( LBP ) . Patients with LBP , who had been examined by an orthopedic surgeon and a social worker , were r and omly assigned to either an activity group ( n = 51 ) or a control group ( n = 52 ) . Patients with defined orthopedic , medical , or psychiatric diagnoses were excluded before r and omization . The grade d activity program consisted of four parts : ( 1 ) measurements of functional capacity ; ( 2 ) a work-place visit ; ( 3 ) back school education ; and ( 4 ) an individual , submaximal , gradually increased exercise program , with an operant-conditioning behavioral approach , based on the results of the tests and the dem and s of the patient 's work . Records of the amount of sick leave taken over a 3-year period ( ie , the 1-year periods before , during , and after intervention ) were obtained from each patient 's Social Insurance Office . The patients in the activity group returned to work significantly earlier than did the patients in the control group . The median number of physical therapist appointments before return to work was 5 , and the average number of appointments was 10.7 ( SD = 12.3 ) . The average duration of sick leave attributable to LBP during the second follow-up year was 12.1 weeks ( SD = 18.4 ) in the activity group and 19.6 weeks ( SD = 20.7 ) in the control group . Four patients in the control group and 1 patient in the activity group received permanent disability pensions . The grade d activity program made the patients occupationally functional again , as measured by return to work and significantly reduced long-term sick leave Objectives To evaluate the effects of early access ( EA ) to physical therapy treatment for patients with subacute low back pain compared to access with a 4-week waiting list . Design A prospect i ve , r and omized clinical trial . Setting Primary health care . Patients Sixty consecutive patients with subacute low back pain . Interventions Patients were r and omized either to EA within 2 days for physical examination and individualized physical therapy treatment ( n=32 ) or a control group with a 4-week waiting list ( n=28 ) . Outcome Measures Self-administrated question naires were used for assessment at inclusion , at discharge , and at 6 months . Primary outcome measure was pain intensity assessed by Borg category scale for ratings of perceived pain . Secondary outcomes included the Örebro musculoskeletal pain screening question naire , the Rol and and Morris disability question naire , sick-leave , visits to health care , and physical therapy . Results The results showed no significant differences in pain between the groups at discharge . At 6 months , the reduction of pain was significantly greater in the EA group compared to the control group ( P=0.025 ) . Changes in secondary outcome measures were not significantly different between groups . Conclusions This study indicated that EA to physical therapy result ed in greater improvement in perceived pain at 6 months compared to later access . In this study , EA to physical therapy could be introduced by reorganization without additional re sources Purpose . To clarify the relations between the sensory , affective and cognitive dimensions of pain and to analyse what influence these components have on  persistent disability in patients with subacute whiplash-associated disorders ( WAD ) . Method . The data was obtained from an on-going r and omised controlled trial ( RCT ) on 47 patients . The sensory dimension of pain was evaluated with a  visual analogue scale ( VAS ) diary and a Painometer ® . The affective dimension was assessed using the Painometer ® . The Tampa Scale for Kinesiophobia ( TSK ) and the Self-Efficacy Scale ( SES ) were used as measures of pain-related cognitions . The Pain Disability Index ( PDI ) was used as the outcome measure . Results . Forty patients ( 85 % ) completed the trial . The correlations between the sensory and affective dimensions of pain were non-significant , which indicates that they are two independent constructs that describe various dimensions of whiplash-related pain . High pain intensity and pain affect , more widespread pain , and high fear of movement/(re)injury corresponded to low self-efficacy . Multiple regression analyses showed that self-efficacy was the most important predictor of persistent disability contributing to 42 % of the variation in the PDI score . Conclusion . The treatment approach for patients with subacute WAD should incorporate the multidimensional nature of pain and to prevent disability special effort should be made to enhance the patient 's self-efficacy beliefs OBJECTIVE To investigate whether personal and work-related factors , physical performance and back-specific question naires predict return to work . A prospect i ve study identifying prognostic factors for return to work . SUBJECTS Ninety-three patients sick-listed for 8 - 12 weeks for non-specific sub-acute low back pain included in a r and omized controlled trial . METHODS Patients were examined with regard to demographic variables , a battery of back-specific question naires and physical tests before entering a r and omized controlled trial . A stepwise backward Cox regression model was established to identify the most powerful predictors . RESULTS During follow-up 78.5 % of the patients have returned to full-time work . Fear-avoidance beliefs for work ( relative risk ( RR ) for 1 SD change 0.49 ; 95 % confidence interval ( CI ) 0.38 - 0.64 ) , disability ( RR 1.39 , 95 % CI 1.02 - 1.88 ) and cardiovascular fitness ( RR 1.42 , 95 % CI 1.12 - 1.79 ) were identified as the best predictors for return to work . The prevalence of correct predictions was 69.3 % . CONCLUSION The predictors identified in the present study may reflect personal risk factors in a patient who gets acute low back pain . On the other h and , they may support that fear of pain and injury may be more disabling than pain itself , and that deconditioning is a result of altered behaviour reflecting attitudes towards low back pain in society , and information and advice given in primary healthcare 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 Study Design . Cluster r and omized controlled trial with 6 and 8 quarters of follow-up . Objective . To test the effects of giving evidence -based information addressing psychosocial risk factors for pain-related disability and of screening workplaces for physical health hazards at work on reducing new episodes and duration of pain-related and general absence taking . Summary of Background Data . The “ flag strategy ” for h and ling low back pain problems is recommended in many Western countries but , so far , r and omized intervention studies addressing psychosocial risk factors for disability related to low back pain show mixed results . Methods . We followed employees from 39 different work sites in western Denmark , who had received interventions consisting of either a carefully prepared booklet providing evidence -based information on common musculoskeletal pain problems alone or in combination with systematic workplace screening for physical work hazards .  Absence due to pain for at least 7 days and the cumulative numbers of absence days were the main outcome measures . General absence taking was analyzed , too . Company registration s of sickness absence in combination with self-report on the cause of a given absence spell was used to inform absence spells . Results . A total of 3808 of 4006 eligible employees provided information . Among 1063 participants in the control arm , 1458 in the information arm , and 1287 in the  information and workplace screening  arm , 4.6 % , 6.9 % , and 4.6 % , respectively , experienced pain-related absence , and 27.8 % , 27.2 % , and 24.0 % , respectively , experienced general absence taking during follow-up . No positive effect on the risk of the 2 measures of absence or on the cumulative duration of absence among cases was seen . Conclusion . Results did not support population -based interventions addressing psychosocial risk factors for pain-related disability alone or in combination with workplace screening as effective in reducing the risk of pain-related absence taking or the duration of absence 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 Abstract Background : There are no studies on economic issues concerning rehabilitation exercises for shoulder pain . Objective : The aim of the study was to investigate sick leave and the associated costs after a medical exercise therapy programme in patients with longst and ing subacromial pain/impingement . Methods : A r and omised controlled trial in which 61 patients were r and omly assigned either to a high-dosage medical exercise therapy group ( HD )  ( n=31 ) or to a low dosage exercise therapy group ( LD )  ( n=30 ) . Both groups were given three treatments a week over 3 months . The differences between the groups were number of repetitions , number of sets and time performing global aerobic exercises . Results : The outcome for the HD group was significantly ( p<0.05 ) better compared to the LD group . The reduction in costs for sick leave for the HD group was 59.1 % , whereas for the LD group , the reduction was only 42.3 % , which is a significant difference . Conclusion : In patients with longst and ing subacromial pain , HD medical exercise therapy might be an efficient treatment approach
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 .