Long-term prognosis of acute low back pain in patients seen in general practice: a 1-year prospective follow-up study. Prediction of return-to-work of low back pain patients sicklisted for 3–4 months Patients at risk for long-term sick leave because of low back pain. Potential Risk Factors of Persistent Low Back Pain Developing from Mild Low Back Pain in Urban Japanese Workers Low Back Pain in Primary Care: Costs of Care and Prediction of Future Health Care Utilization Assessment of psychosocial risk factors for the development of non-specific chronic disabling low back pain in Japanese workers—findings from the Japan Epidemiological Research of Occupation-related Back Pain (JOB) study Prognostic occupational factors for persistent low back pain in primary care Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care? Persistence and Change in Nonspecific Low Back Pain Among Adolescents: A 3-Year Prospective Study A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. Occupational, Personal and Psychosocial Resources for Preventing Persistent Low Back Pain Physical performance, pain, pain behavior and subjective disability in patients with subacute low back pain. Risk Factors for Sick Leave Due to Low Back Pain: A Prospective Study Cost-effectiveness of providing patients with information on managing mild low-back symptoms in an occupational health setting Incidence and Course of Low Back Pain Episodes in the General Population Work factors as predictors of intense or disabling low back pain; a prospective study of nurses’ aides Cost-minimisation analysis of three conservative treatment programmes in 180 patients sick-listed for acute low-back pain.
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 & NA ; The purpose of this Dutch prospect i ve population ‐based study was to identify prognostic factors for return‐to‐work of employees with 3–4 months sick leave due to low back pain ( LBP ) . A cohort of 328 employees was formed and baseline data were collected . One year after the first day of the sick leave , 91 % of the original cohort participated in a second interview ( n=298 ) . During the baseline measurement , information was collected about health status , history of LBP , occupational variables , job characteristics and social economic variables . At the second interview , 66 % of the employees had returned to work ( n=198 ) . Return‐to‐work was independently predicted by having a better general health status ( OR 1.53 ; 95 % CI 1.30–1.80 ) , having better job satisfaction ( OR 1.26 ; 95 % CI 1.11–1.44 ) , being a bread winner ( OR 2.46 ; 95 % CI 1.37–4.40 ) , having a lower age ( OR 0.70 ; 95 % CI 0.52–0.93 ) and reporting less pain ( OR 0.85 ; 95 % CI 0.73–0.99 ) all measured at cohort entry . This study shows that psycho‐social aspects of health and work in combination with economic aspects have a significantly larger impact on return‐to‐work when compared to relatively more physical aspects of disability and physical requirements of the job . This suggests that interventions aim ed at return‐to‐work of employees sicklisted with LBP should predominantly be focused on these psycho‐social aspects such as health behavior and job satisfaction , and on the ( lack of ) economic incentives for return‐to‐work BACKGROUND CONTEXT Ten percent of patients with low back pain ( LBP ) are not able to resume work within 3 months of sick leave , accounting for 90 % of all medical and indemnity costs . PURPOSE To quantify the relative contribution of sociodemographic , clinical , occupational , and psychological risk factors in determining the non-return to work after 3 months of compensated LBP and to develop a screening tool to identify patients who require further guidance and rehabilitation . STUDY DESIGN / SETTING A 6-month prospect i ve cohort study of disabled workers applying for compensation benefit because of LBP during a 6-month period in the Belgian compulsory health insurance system . PATIENT SAMPLE Three hundred and forty-six patients . OUTCOME MEASURES Patients unable to resume work within 3 months of sick leave were classified as bad outcomes . METHODS Consecutively , injured workers applying for income replacement benefits between October 2003 and March 2004 because of LBP were followed 6 months after the start of the sick leave period . All subjects underwent a st and ardized physical examination and completed a battery of 12 self-report question naires . RESULTS Forty-seven percent of the population had not resumed work 3 months after the start of the sick leave period . The risk factors for sickness absence more than 3 months were Oswestry disability index ( odds ratio for each point increase : 1.04 ; 95 % confidence interval : 1.02 - 1.06 ) , fear of avoidance severity score ( odds ratio for each point increase : 1.05 ; confidence interval : 1.02 - 1.09 ) , blue collar worker ( odds ratio : 2.18 ; confidence interval : 1.21 - 3.92 ) , LBP for less than 12 weeks before sick leave ( odds ratio : 0.32 ; confidence interval : 0.17 - 0.64 ) , and pain behavior ( odds ratio for each point increase : 1.72 ; confidence interval : 1.25 - 2.39 ) . A multivariate screening test based on five questions identified 80 % of the patients unable to resume work after 3 months of sick leave ( specificity : 56.6 ; cut off : 0.4 ) . CONCLUSIONS A question naire comprising a limited set of items allows a practical screening of LBP patients unlikely to resume work Study Design Two-year , prospect i ve cohort data from the Japan epidemiological research of occupation-related back pain study in urban setting s were used for this analysis . Objective To examine the association between aggravated low back pain and psychosocial factors among Japanese workers with mild low back pain . Summary of Background Data Although psychosocial factors are strongly indicated as yellow flags of low back pain ( LBP ) leading to disability , the association between aggravated LBP and psychosocial factors has not been well assessed in Japanese workers . Methods At baseline , 5,310 participants responded to a self-administered question naire including questions about individual characteristics , ergonomic work dem and s , and work-related psychosocial factors ( response rate : 86.5 % ) , with 3,811 respondents completing the 1-year follow-up question naire . The target outcome was aggravation of mild LBP into persistent LBP during the follow-up period . Incidence was calculated for the participants with mild LBP during the past year at baseline . Logistic regression was used to explore risk factors associated with persistent LBP . Results Of 1,675 participants who had mild LBP during the preceding year , 43 ( 2.6 % ) developed persistent LBP during the follow-up year . Multivariate analyses adjusted for individual factors and an ergonomic factor found statistically significant or almost significant associations of the following psychosocial factors with persistent LBP : interpersonal stress at work [ adjusted odds ratio ( OR ) : 1.96 and 95 % confidence interval ( 95%CI ) : 1.00–3.82 ] , job satisfaction ( OR : 2.34 , 95%CI : 1.21–4.54 ) , depression ( OR : 1.92 , 95%CI : 1.00–3.69 ) , somatic symptoms ( OR : 2.78 , 95%CI : 1.44–5.40 ) , support from supervisors ( OR : 2.01 , 95%CI : 1.05–3.85 ) , previous sick-leave due to LBP ( OR : 1.94 , 95%CI : 0.98–3.86 ) and family history of LBP with disability ( OR : 1.98 , 95%CI : 1.04–3.78 ) . Conclusions Psychosocial factors are important risk factors for persistent LBP in urban Japanese workers . It may be necessary to take psychosocial factors into account , along with physical work dem and s , to reduce LBP related disability Study Design . Cost of illness study alongside a r and omized controlled trial . Objective . To describe the costs of care for patients with low back pain ( 1 ) and to identify patient characteristics as predictors for high health care cost during a 1-year follow-up ( 2 ) . Summary of Background Data . Low back pain ( LBP ) is one of the leading causes of high health care costs in industrialized countries ( Life time prevalence , 70 % ) . A lot of research has been done to improve primary health care and patients ′ prognosis . However , the cost of health care does not necessarily follow changes in patient outcomes . Methods . General practitioners ( n = 126 ) recruited 1378 patients consulting for LBP .  Sociodemographic data , pain characteristics , and LBP-related cost data  were collected by interview at baseline and after 6 and 12 months . Costs were evaluated from the societal perspective . Predictors of high cost during the subsequent year were studied using logistic regression analysis . Results . Mean direct and indirect costs for LBP care are about twice as high for patients with chronic LBP compared to acutely ill patients . Indirect costs account for more than 52 % to 54 % of total costs . About 25 % of direct costs refer to therapeutic procedures and hospital or rehabilitational care .  Patients with high disability and limitations in daily living  show a 2- to 5-fold change for subsequent high health care costs . Depression seems to be highly relevant for direct health care utilization . Conclusion . Interventions design ed to reduce high health care costs for LBP should focus on patients with severe LBP and depressive comorbidity . Our results add to the economic underst and ing of LBP care and may give guidance for future actions on health care improvement and cost reduction To investigate the associations between psychosocial factors and the development of  chronic disabling low back pain ( LBP ) in Japanese workers . A 1 yr prospect i ve cohort of the Japan Epidemiological Research of Occupation-related Back Pain ( JOB ) study was used . The participants were office workers , nurses , sales/marketing personnel , and manufacturing engineers . Self-administered question naires were distributed twice : at baseline and 1 yr after baseline . The outcome of interest was the development of chronic disabling LBP during the 1 yr follow-up period . Incidence was calculated for the participants who experienced disabling LBP during the month prior to baseline . Logistic regression was used to assess risk factors for chronic disabling LBP . Of 5,310 participants responding at baseline ( response rate : 86.5 % ) , 3,811 completed the question naire at follow-up . Among 171 eligible participants who experienced disabling back pain during the month prior to baseline , 29 ( 17.0 % ) developed chronic disabling LBP during the follow-up period . Multivariate logistic regression analysis implied reward to work ( not feeling rewarded , OR : 3.62 , 95%CI : 1.17–11.19 ) , anxiety ( anxious , OR : 2.89 , 95%CI : 0.97–8.57 ) , and daily-life satisfaction ( not satisfied , ORs : 4.14 , 95%CI : 1.18–14.58 ) were significant . Psychosocial factors are key to the development of chronic disabling LBP in Japanese workers .  Psychosocial interventions may reduce the impact of LBP in the workplace Purpose To reduce the socio-economic burden of persistent low back pain ( LBP ) , factors influencing the progression of acute/subacute LBP to the persistent state must be identified at an early stage . Methods Prospect i ve inception cohort study of patients attending a health practitioner for their first episode of acute/subacute or recurrent LBP . Patients were assessed at baseline addressing occupational , psychological , biomedical and demographic/lifestyle factors and followed up over 6 months . Multivariate logistic regression analysis was performed separately for the variables groups of the four different domains , controlling for age , gender and body mass index . The overall predictive value was calculated for the full regression models of the different domains . Finally , all significant variables from the different domains were combined into a final predictor model . Results The final four-predictor model predicted 51 % of variance of persistent LBP and included ‘ resigned attitude towards the job ’ ( OR 1.73 ; 95 % CI 1.16–2.59 ) , ‘ social support at work ’ ( OR 0.54 ; 95 % CI 0.32–0.90 ) , ‘ functional limitation ’ ( OR 1.05 ; 95 % CI 1.01–1.10 ) and ‘ duration of LBP ’ ( OR 1.04 ; 95 % CI 1.02–1.06 ) . The accuracy of the model was 83 % , with 92 % of non-persistent and 67 % of persistent LBP patients correctly identified . Conclusions In this study of patients with acute/subacute LBP , ‘ resigned attitude towards the job ’ increased the likelihood of persistent LBP at 6 month . Addressing this factor with workplace interventions has the potential to modify the outcome . In patients experiencing ‘ social support at work ’ , the development of persistent LBP was less likely and might therefore be considered as potential re source for prevention of persistent LBP & NA ; Few studies have investigated whether prognostic indicators , which contribute to the transition from acute to chronic low back pain ( LBP ) , are also those which contribute to continuing persistence of chronic LBP . We compared the contribution of physical , psychological and social indicators to predicting disability after one year between consulters with LBP of less than 3 months duration and more than 3 months duration . Data from two large prospect i ve cohort studies of consecutive patients consulting with LBP in general practice s were merged , providing complete data for 258 cases with acute/subacute LBP and 668 cases with chronic LBP at 12 months follow‐up . There were significant differences between the two LBP groups in baseline characteristics and clinical course of disability , assessed by Rol and Morris Disability Question naire , during the year of follow‐up . Adjusted associations between potential prognostic indicators and disability at 12 months were carried out in the two LBP subgroups . The final multivariable regression models showed that being non‐employed , having widespread pain , a high level of Chronic Pain Grade , and catastrophising were the strongest prognostic indicators for disability at 12 months in both LBP groups . Fear of pain was significantly associated with disability in chronic LBP . Importantly , beyond baseline disability , the effect size of the other prognostic indicators for poor outcome was rather low . These findings must continue to challenge research ers to identify useful early predictors of outcome in persons with disabling back pain , as screening and targeted treatment approaches are dependent upon prognostic indicators with clinical significance Study Design . This is a 3-year prospect i ve study of juvenile low back pain ( LBP ) . Objectives . To investigate persistence and change in LBP . Summary of Background Data . Earlier episodes of LBP are a strong risk factor for LBP in adults , while the persistence of LBP through adolescence is not known . Methods . The material comprised all pupils in eighth and ninth grade s ( N = 105 , mean age 14.7 years ) , living within two geographic areas in Eastern Norway in January 1997 . The analyses included 88 adolescents at baseline , and 85 at follow-up . The question naire , which identified LBP as pain or ache in the low back during the preceding year , was answered at baseline in the classroom and at follow-up by post . Results . LBP was reported by 58 % at baseline and by 39 % at follow-up , and LBP provoked by manual work by 40 % at baseline and 26 % at follow-up . Thirty-one percent reported LBP at both occasions . LBP more than 7 days was reported by 32 % at baseline , by 26 % at follow-up , and by 18 % at both occasions . Twenty-two percent of those reporting LBP at baseline rejected ever LBP at follow-up . Baseline reports of LBP predicted corresponding reports of LBP at follow-up : Odds ratio was 4.7 ( 95 % confidence interval 1.7–12.7 ) for LBP generally , 9.1 ( 3.0–27.2 ) for LBP more than 7 days , 9.2 ( 2.9–28.8 ) for LBP provoked by manual work , and 3.8 ( 1.3–11.3 ) for LBP provoked by sitting at school . Conclusion . The findings indicate a persistent , but changeable , trend in LBP from midadolescence until late adolescence . The consistency and the high rates of reports of LBP provoked by manual work and sitting imply needs for more research on the persistence of LBP , and on relevant interventions during school age Introduction The Multinational Musculoskeletal Inception Cohort Study ( MMICS ) Statement is a consensus statement aim ed at improving the quality of prospect i ve investigations into the transition from early stages of low back pain ( LBP ) to persistent problems . The statement aims to help improve the quality of such studies by recommending an agreed minimal list of measures for inclusion in baseline data collection . The MMICS Statement is primarily aim ed at research ers who want to investigate prognosis in LBP , and this will allow data from cohorts to be pooled and will facilitate comparisons between different health care systems . One approach to preventing acute new episodes of LBP ( up to 3 weeks from onset ) from developing into persistent disabling pain is to identify those individuals with LBP who are most likely to progress to chronic disability . Targeting interventions at those at highest risk could reduce the population burden of chronic LBP . A wide range of baseline parameters have been associated with poor outcome in inception cohort studies ( 1–6 ) . Few existing studies have been of sufficient size and method ologic rigor to produce conclusive findings . Even in method ologically robust studies , baseline factors only account for a small proportion of the variance in outcome ( 7 ) , typically around 30 % . Systematic review s of the literature could not pool data because studies used different measurements ( 1–3 ) . Despite some information on physical , psychosocial , and work-related risk factors , it has not been possible to adequately estimate the comparative impact of individual psychosocial and societal factors on the transition from acute to persistent disabling LBP . How to address this problem was one focus of the VI International Forum for Primary Care Research in Low Back Pain held in April 2003 . A steering group for the collaboration was appointed , and 8 national team leaders volunteered to recruit teams of national experts . Three additional team leaders were recruited by the steering group ( Australia , France , and Germany ) . Independent experts were invited to advise on the quality of the MMICS process . The MMICS steering group , located in the UK , met regularly and included expert research ers in clinical and outcome factors in back pain ( AB ) , work-related issues in back pain ( AKB ) , psychosocial aspects of back pain ( TP and RS ) , and general practice aspects of back pain ( MU ) . The MMICS Statement set out to include 1 ) a minimal but comprehensive number of predictor factors based on current evidence and theory ; 2 ) appropriate measurement instruments for agreed predictor factors based on their clinometric properties , availability , and practical characteristics ; and 3 ) a minimum set of followup measures , including recommendations about measurement and timing The aim of this prospect i ve cohort study was to identify modifiable protective factors of the progression of acute/subacute low back pain ( LBP ) to the persistent state at an early stage to reduce the socioeconomic burden of persistent LBP .  Patients attending a health practitioner for acute/subacute LBP were assessed at baseline addressing occupational , personal and psychosocial factors , and followed up over 12 weeks . Pearson correlations were calculated between these baseline factors and the presence of nonpersistent LBP at 12-week follow-up . For those factors found to be significant , multivariate logistic regression analyses were performed . The final 3-predictor model included job satisfaction , mental health and social support . The accuracy of the model was 72 % , with 81 % of nonpersistent and 60 % of persistent LBP patients correctly identified . Further research is necessary to confirm the role of different types of social support regarding their prognostic influence on the development of persistent LBP 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 The objectives of this prospect i ve study were to identify predictive factors for  sick leave of 8 days or more due to low back pain ( LBSL ) and to compare them with predictive factors for low back pain with no or shorter sick leave ( LB ) in a cohort of French workers . The predictive factors for LBSL were a past history of low back pain ( odds ratio [ OR ] , 7.2 ; 95 % confidence interval [ CI ] , 4.1 to 13 ) , a low employment grade ( OR , 4.3 ; 95 % CI , 1.7 to 11 ) , heavy smoking ( OR , 5.5 ; 95 % CI , 2.3 to 13 ) , a pain score different from zero ( OR , 4.9 ; 95 % CI , 2.5 to 9.7 ) , required bending backward or forward at work every day repetitively ( OR , 7.4 ; 95 % CI , 2.3 to 23 ) , overall social integration ( OR , 2.0 ; 95 % CI , 1.3 to 3.3 ) , and low social support at work ( OR , 3.4 ; 95 % CI , 1.6 to 7.3 ) . Low social support at work and bending backward or forward at work were more strongly associated with LBSL than with LB ( P = 0.02 and P < 0.01 , respectively ) . The implication s of the results of this prospect i ve study are that both the level of biomechanical exposure and the psychosocial work environment , especially social support , represents important dimensions to consider in the reduction of work absenteeism Background Evidence shows that low back specific patient information is effective in sub-acute low back pain ( LBP ) , but effectiveness and cost-effectiveness ( CE ) of information in early phase symptoms is not clear . We assessed effectiveness and CE of patient information in mild LBP in the occupational health ( OH ) setting in a quasi-experimental study . Methods A cohort of employees ( N = 312 , aged < 57 ) with non-specific , mild LBP ( Visual Analogue Scale between 10–34 mm ) was selected from the respondents of an employee survey ( N = 2480 ; response rate 71 % ) . A r and om sample , representing the natural course of LBP ( NC , N = 83 ; no intervention ) , was extracted as a control group . Remaining employees were invited ( 181 included , 47 declined , one excluded ) into a r and omised controlled study with two 1:1 allocated parallel intervention arms ( “ Booklet ” , N = 92 ; “ Combined ” , N = 89 ) . All participants received the “ Back Book ” patient information booklet and the Combined also an individual verbal review of the booklet  . Physical impairment ( PHI ) , LBP , health care ( HC ) utilisation , and all-cause sickness absence ( SA ) were assessed at two years . CE of the interventions on SA days was analysed by using direct HC costs in one year , two years from baseline . Multiple imputation was used for missing values . Results Compared to NC , the Booklet reduced HC costs by 196 € and SA by 3.5 days per year . In 81 % of the bootstrapped cases the Booklet was both cost saving and effective on SA . Compared to NC , in the Combined arm , the figures were 107 € , 0.4 days , and 54 % , respectively . PHI decreased in both interventions . Conclusions Booklet information alone was cost-effective in comparison to natural course of mild LBP . Combined information reduced HC costs . Both interventions reduced physical impairment . Mere booklet information is beneficial for employees who report mild LBP in the OH setting , and is also cost saving for the health care system . Trial registration Clinical Trials.gov Study Design . Population -based , prospect i ve cohort . Objectives . To estimate incidence and course of severity- grade d low back pain ( LBP ) episodes in adults . Summary of Background Data . Past studies report variable estimates that do not differentiate LBP severity . Methods . An incidence cohort of 318 subjects free of LBP and a course cohort of 792 prevalent cases was formed from respondents to a mailed survey .  Incident , recurrent , persistent , aggravated , improved , and resolved episodes were defined by the Chronic Pain Question naire . The follow-up at 6 and 12 months was 74 % and 62 % , respectfully . Annual estimates were age and sex st and ardized . Results . The cumulative incidence was 18.6 % ( 95 % confidence interval [ CI ] , 14.2%–23.0 % ) . Most LBP episodes were mild . Only 1.0 % ( 95 % CI , 0.0%–2.2 % ) developed intense and 0.4 % ( 95 % CI , 0.0%–1.0 % ) developed disabling LBP . Resolution occurred in 26.8 % ( 95 % CI , 23.7%–30.0 % ) , and 40.2 % ( 95 % CI , 36.7%–43.8 % ) of episodes persisted . The severity of LBP increased for 14.2 % ( 95 % CI , 11.5%–16.8 % ) and improved for 36.1 % ( 95 % CI , 29.7%–42.2 % ) . Of those that recovered , 28.7 % ( 95 % CI , 21.2%–36.2%)had a recurrence within 6months , and 82.4 % of it was mild LBP . Younger subjects were less likely to have persistent LBP ( incidence rate ratio , 0.88 ; 95 % CI , 0.80–0.97 ) and more likely to have resolution ( incidence rate ratio , 1.26 ; 95 % CI , 1.02–1.56 ) . Conclusions . Most new and recurrent LBP episodes are mild . Less than one third of cases resolve annually , and more than 20 % recur within 6 months . LBP episodes are more recurrent and persistent in older adults Aims : To identify the work factors that predict  intense low back pain ( LBP ) and LBP related sick leaves in nurses ’ aides . Methods : The sample comprised 4266 r and omly selected Norwegian nurses ’ aides , not bothered or only a little bothered by LBP during the previous three months , and not on sick leave when completing a mailed question naire in 1999 . Of these , 3808 ( 89.3 % ) completed a second question naire 3 months later and 3651 ( 85.6 % ) completed a third question naire 15 months later . Intensity of low back symptoms and certified sick leaves attributed to LBP during the observation period were assessed by self reports at the follow ups . Results : After adjustments for LBP during the three months prior to baseline , baseline health complaints , demographic and familial factors , and a series of physical , psychological , and social work factors , logistic regression analyses revealed the following associations : intense low back symptoms were predicted by frequent positioning of patients in bed , perceived lack of support from immediate superior , and perceived lack of pleasant and relaxing culture in the work unit . LBP related sick leaves were predicted by frequent h and ling of heavy objects , medium level of work dem and s , perceived lack of supportive and encouraging culture in the work unit , working night shifts , and working in a nursing home . Long term LBP related sick leaves were associated with changes of work or work tasks during the observation period that result ed in a perceived reduction of support and encouragement at work . Conclusions : Not only frequent mechanical exposures , but also organisational , psychological , and social work factors , such as night shift work , perceived lack of support from superior , and perceived lack of a pleasant and relaxing or supporting and encouraging culture in the work unit , are associated with an increased risk of intense low back symptoms and LBP related sick leaves in nurses ’ aides OBJECTIVE To perform a cost-minimization analysis of three conservative treatment regimes for acute low-back pain ( LBP ) . DESIGN A prospect i ve r and omized clinical trial . Patients were assigned at r and om to one of three treatment programmes : General Practitioner Programme ( GPP- ) controls , Manual Therapy Programme ( MTP ) or Intensive Training Programme ( ITP ) . SETTING Primary care and physiotherapists in Stockholm , Sweden . PATIENTS 180 patients sick-listed for acute LBP . MAIN OUTCOME MEASURES Direct , indirect and total costs for three treatment programmes . RESULTS The direct costs for treatment were lowest in the GPP group -- 2744 Swedish crowns ( SEK ) per patient . More patients in the MTP and ITP underwent operations for disk hernia and radiological investigations than in the GPP . Indirect costs , defined as sick-leave for LBP represent about 90 % of the total cost . CONCLUSIONS With respect to total costs , the findings were similar between the three treatment programmes . The GPP had the lowest direct costs . It is not possible to conclude which treatment programme is to be recommended as a least cost alternative . The strong effect of indirect costs on the total cost stresses that further studies should focus on methods of shortening sick-leave
Specific LBP , higher disability levels , older age , female gender , more social dysfunction and more social isolation , heavier work , and receiving higher compensation were identified as predictors for a longer duration of sick leave .
A history of LBP , job satisfaction , educational level , marital status , number of dependants , smoking , working more than 8 hour shifts , occupation , and size of industry or company do not influence duration of sick leave due to LBP .
Many different constructs were measured to identify psychosocial predictors of long term sick leave , which made it impossible to determine the role of these factors
BACKGROUND The percentages of patients with acute low back pain ( LBP ) that go on to a chronic state varies between studies from 2 % to 34 % .
In some of these cases low back pain leads to great costs .
AIMS To evaluate the evidence for prognostic factors for return to work among workers sick listed with acute LBP .