Predictors of Sickness Absence in Patients with a New Episode of Low Back Pain in Primary Care

Abstract

Introduction Although there is a call for early risk prediction of sickness absence, specific prognostic factors of low back pain (LBP) related sickness absence have not yet been established in either clinical or research settings. This study examines predictors of sickness absence in patients presenting to a health practitioner with acute/subacute LBP. The aims of our study were twofold: (1) To identify baseline variables that detect patients with a new LBP episode at risk of sickness absence; and (2) To identify prognostic models for sickness absence at different time points after initial presentation. Materials and Methods Prospective cohort study investigating 310 patients presenting to a health practitioner with a new episode of LBP at baseline, 3-, 6-, 12-week, 6-month follow-up, addressing work-related, psychological, and biomedical factors. Multivariate logistic regression analysis was performed to identify baseline predictors of sickness absence at different time points. Results The best prognostic model comprised “job control”, “depression,” and “functional limitation” as predictive baseline factors of sickness absence at 6-week follow-up (sensitivity 43.5; specificity 96.5; overall predictive value 89.0) with “job control” being the best single predictor (OR 0.49; 95% CI, 0.27–0.89). This model explained 46% of variance of sickness absence at 6-week follow-up ( p < 0.001). The second best model included “job control” (OR 0.64; 95% CI, 0.42–0.96) as the only significant predictive baseline factor for sickness absence at 3-week follow-up (sensitivity 45.2; specificity 94.7; overall predictive value 83.9). This model explained 39% of variance of sickness absence ( p < 0.001). Sickness absence at a time point beyond 6 weeks could not be predicted. Conclusion For patients with acute/subacute LBP, the model has the greatest predictive ability for sickness absence at 6 weeks after initial presentation to a health practitioner. The prediction of sickness absence beyond 6 weeks is limited, and health practitioners should re-assess patients at 6 weeks, especially if they have previously been identified as at risk of sickness absence. This would allow timely intervention with measures designed to reduce the likelihood of prolonged sickness absence. Further research is warranted investigating assessment at different time points, to identify the optimal time at which to reassess at risk acute/subacute LBP patients to accurately predict sickness absence. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared