Work restrictions and outcome of nonspecific low back pain

Spine (Phila Pa 1976). 2003 Apr 1;28(7):722-8. doi: 10.1097/01.BRS.0000051909.18567.F8.


Study design: Retrospective cohort study was conducted.

Objective: To evaluate the association of prescribed work restrictions with work absenteeism and recurrence in cases of nonspecific low back pain.

Summary of background data: The efficacy of commonly prescribed work restrictions in limiting sickness-related absence because of back pain has not been evaluated.

Methods: Employees who had back pain-related sickness absence were identified from medical records of a utility company. The workers were grouped into those who had received a work restriction for their back pain and those who had not. The duration of work disability was compared between the two groups. Employees who returned back to regular, full duty within 1 year of onset were followed for one additional year to determine rates of recurrence. The Cox Proportional Hazards model was used to generate hazard ratios adjusted for age, gender, and job category.

Results: Restrictions were given to 43% of the workers. Sickness absence duration did not differ between those who had received restrictions and those who had not (adjusted hazard ratio, 1.12; P = 0.41). The median duration of restricted duty was 32.5 days. For 22% of the workers, restricted duty was never lifted. Recurrence appeared less likely to occur among those who had work restrictions in their initial episode. However, this difference was not statistically significant (adjusted hazard ratio, 0.77; P = 0.48).

Conclusions: No evidence of an association between a prescription of work restriction and early return to work was found. More research is needed to clarify the utility of restricted duty in promoting a positive outcome for work-related low back pain.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Absenteeism*
  • Adult
  • Cohort Studies
  • Female
  • Humans
  • Industry / statistics & numerical data
  • Low Back Pain* / diagnosis
  • Male
  • Middle Aged
  • New York City
  • Odds Ratio
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Prognosis
  • Proportional Hazards Models
  • Recurrence
  • Retrospective Studies
  • Workload*