Worker recovery expectations and fear-avoidance predict work disability in a population-based workers' compensation back pain sample

Spine (Phila Pa 1976). 2006 Mar 15;31(6):682-9. doi: 10.1097/


Study design: Prospective, population-based cohort study.

Objectives: To examine whether worker demographic, pain, disability, and psychosocial variables, assessed soon after work-related back pain disability onset, predict 6-month work disability.

Summary of background data: Greater age, pain, and physical disability, and certain psychosocial characteristics may be risk factors for prolonged back pain-related work disability, although many studies have been small, findings have been inconsistent, and some psychosocial variables have not been examined prospectively.

Methods: Workers (N = 1,068) completed telephone interviews assessing demographic, pain, disability, and psychosocial variables 18 days (median) after submitting Workers' Compensation back pain disability claims. Administrative measures of work disability 6 months after claim submission were obtained.

Results: At 6 months, 196 workers (18.4%) were receiving work disability compensation. Age, race, education, and baseline pain and disability were significant predictors of 6-month disability. Adjusting for baseline demographics, pain, disability, and other psychosocial variables, high work fear-avoidance (odds ratio, 4.6; 95% confidence interval, 1.6-13.7) and very low recovery expectations (odds ratio, 3.1, 95% confidence interval, 1.5-6.5) were significant independent predictors.

Conclusions: Among individuals with acute work-related back pain, high pain and disability, low recovery expectations, and fears that work may increase pain or cause harm are risk factors for chronic work disability.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Avoidance Learning
  • Cohort Studies
  • Disability Evaluation*
  • Fear / psychology*
  • Female
  • Humans
  • Interviews as Topic
  • Low Back Pain / epidemiology*
  • Low Back Pain / psychology*
  • Low Back Pain / rehabilitation
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Recovery of Function*
  • Risk Factors
  • Workers' Compensation*