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Prediction model for unsuccessful return to work after hospital-based intervention in low back pain patients

Ole Kudsk Jensen1*, Kristian Stengaard-Pedersen2, Chris Jensen34 and Claus Vinther Nielsen3

Author Affiliations

1 The Spine Center, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark

2 Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark

3 Department of Clinical Social Medicine, Institute of Public Health, University of Aarhus, Aarhus, Denmark

4 National Centre for Occupational Rehabilitation, Rauland, Norway

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BMC Musculoskeletal Disorders 2013, 14:140  doi:10.1186/1471-2474-14-140

Published: 19 April 2013



Many studies on low back pain (LBP) have identified prognostic factors, but prediction models for use in secondary health care are not available. The purpose of this cohort study, based on a randomised clinical study, was to identify risk factors for unsuccessful return to work (U-RTW) in sick-listed LBP patients with or without radiculopathy and to validate a prediction model for U-RTW.


325 sick-listed LBP patients with or without radiculopathy were included in an intervention study and followed for one year. Afterwards, 117 other LBP patients were recruited similarly, included in a validation study and also followed for one year. All patients were subjected to identical procedures and interventions and received a brief intervention by the same rehabilitation doctor and physiotherapist. Half of them received case manager guidance within a multidisciplinary setting. At baseline, they completed a questionnaire and went through a clinical low-back examination. Sciatica was investigated by magnetic resonance imaging (MRI). U-RTW was registered in a national database both initially and at 1-year.


Neither initial U-RTW (24.0%) nor one-year U-RTW (38.2%) were statistically significantly different in the two intervention groups nor in patients with and without radiculopathy. Multivariate logistic regression analysis identified two clinical and five psychosocial baseline predictors for one-year U-RTW (primary outcome). The clinical predictors included pain score (back+leg pain) and side-flexion. The five psychosocial predictors included ‘bodily distress’ ‘low expectations of RTW’, ‘blaming the work for pain’, ‘no home ownership’ and ‘drinking alcohol less than once/month’. These predictors were not statistically significantly different in patients with and without radiculopathy, and they also predicted initial U-RTW (secondary outcome). Obesity and older age were only supplementary predictors in patients with radiculopathy. A prediction model was established and tested in the validation study group. The model predicted one-year U-RWT in patients with intermediate and high risk, but only partially in patients with low risk. The model predicted all three risk categories in initial U-RTW.


A prediction model combining baseline clinical and psychosocial risk factors predicted patients with low, intermediate and high risk for unsuccessful return to work, both initially and at 1-year.

Low back pain; Prediction model; Range of motion; Radiculopathy; Return to work; Lumbar disc herniation; Psychological distress; Validation