Worker Recovery Expectations and Fear-Avoidance Predict Work Disability in a Population-Based Workers’ Compensation Back Pain Sample

In Brief Study Design. Prospective, population-based cohort study. Objectives. To examine whether worker demographic, pain, disability, and psychosocial variables, assessed soon after work-related back pain disability onset, predict 6-month work disability. Summary of Background Data. Greater age, pain, and physical disability, and certain psychosocial characteristics may be risk factors for prolonged back pain-related work disability, although many studies have been small, findings have been inconsistent, and some psychosocial variables have not been examined prospectively. Methods. Workers (N = 1,068) completed telephone interviews assessing demographic, pain, disability, and psychosocial variables 18 days (median) after submitting Workers’ Compensation back pain disability claims. Administrative measures of work disability 6 months after claim submission were obtained. Results. At 6 months, 196 workers (18.4%) were receiving work disability compensation. Age, race, education, and baseline pain and disability were significant predictors of 6-month disability. Adjusting for baseline demographics, pain, disability, and other psychosocial variables, high work fear-avoidance (odds ratio, 4.6; 95% confidence interval, 1.6–13.7) and very low recovery expectations (odds ratio, 3.1, 95% confidence interval, 1.5–6.5) were significant independent predictors. Conclusions. Among individuals with acute work-related back pain, high pain and disability, low recovery expectations, and fears that work may increase pain or cause harm are risk factors for chronic work disability. This study examined whether psychosocial and other characteristics of 1,068 workers with recently submitted Workers’ Compensation claims for back pain disability predicted work disability compensation 6 months later. Adjusting for baseline demographics, pain, and physical disability, baseline work fear-avoidance and recovery expectations were significant predictors.