Prevention of work-related disability in people with nonspecific low back pain

Work participation is important for recovery from nonspecific low back pain. A large proportion of patients are able to continue their usual work without modification or restrictions. Extended initial time off work is associated with prolonged work-related disability; fewer than half of patients who have been off work for 6 months will return to work and, after 2 years of work absenteeism, the likelihood of returning to work is negligible.

The patient’s expectation of return to work is the most important predictor of return to work. Other barriers to returning to work and recovery from nonspecific low back pain include poor relations with colleagues, work-related mental stress, heavy physical work demands, the presence of compensation claims, and inappropriate work capacity certification from health professionals. Address work-related prognostic factors early to prevent prolonged disability; suggested questions for identifying these include:

• Have you had time off work in the past with back pain?
• What do you understand is the cause of your back pain?
• What are you expecting will help?
• How are your employers, colleagues, and family responding to your back pain?
• What are you doing to cope with back pain?
• Do you think that you will return to work? When?

The optimal approach to supporting a patient to return to work includes:

• providing reassurance about returning to work and staying active
• understanding the patient’s work context and job demands in relation to their physical capacity and beliefs
• understanding the employer’s ability to accommodate the patient’s needs
• communicating with the patient’s employer to facilitate a prompt return to work; modification of the patient’s duties or hours may be required.