Investigating decisions to absent from work with low back pain: A study combining patient and GP factors

BACKGROUND: Determinants of who is and who is not sick-listed following an initial consultation for LBP have received little attention. Both patient and practitioner factors are suggested to be predictive but the interaction has not been investigated. AIMS: To investigate patient and GP factors which determine sickness certification for low back pain. METHODS: Thirty-four General Practitioners recruited 126 patients into the study. Patients completed questionnaires including work status; LBP history; pain; disability, mood and beliefs about back pain. RESULTS: No differences between sick-listed and non-sick-listed groups were observed for age; back beliefs; anxiety; depression or fear-avoidance beliefs about physical activity. Those sick-listed demonstrated greater pain intensity (p=0.009); perceived disability (p=0.040); and fear-avoidance beliefs about work (p<0.000). Regression analyses for GP factors only; patient factors only; and combined GP and patient factors were performed. The ability of the models to correctly classify subjects ranged from 69% for GP variables only; 75% for patient variables only and 82% for the combined model. DISCUSSION: Whether a sickness certificate is issued following an initial consultation for LBP was best explained by combining GP and patient factors. The implications for this in managing absence from work are discussed.