"Unable and useless" or "able and useful"? A before and after study in the primary care of self-rated inability to work in young immigrants having long-standing pain

Abstract

Background: Perceived inability to work predicts a negative outcome of rehabilitation. Objectives: To analyse self-rated inability to work, (SIW), before and after a rehabilitation programme in the primary care, and the risk factors for persistent SIW. Patients: Immigrant patients aged 20-45 years. Methods: Somatic status, ratings of psychosocial stressors and interviews about concepts of pain were performed. Anxiety about pain, depression, and SIW were evaluated before (SIW1) and after (SIW2) the programme consisting of conversations about pain, and daily exercise. Correlation statistics was done by non-parametric methods. The odds ratios (OR) with 95% confidence intervals (95% CI) as having SIW2 were calculated by logistic regression. Results: 49 men and 100 women with service-jobs, on the average 38 years, participated. All had pain from muscular structures in the shoulder, back and/or hip regions, 62% had a previous sick leave > 3 months, 54% had much psychosocial stress and 21% remained depressed. The frequencies of anxiety about pain decreased from 76% to 50%, and SIW from 75% to 60% ( p< 0.001). The risks as having SIW2 were increased for participants on sick leave 3 months: OR 5.4 (95% CI 2.4-12.3), with persistent anxiety about pain, OR 3.6 (1.7-8.0) or much psychosocial stress: OR 3.4 (1.5-7.8). Conclusion: The frequency of SIW remained high despite a significant decrease. Preceding long sick leave, anxiety about the pain and psychosocial stress increased the risk of persistent SIW, implying the necessity of further improving the methods of reducing anxiety and the use of only short periods of sick leave in this category of patients.