Comparison of risk factors predicting return to work between patients with subacute and chronic non-specific low back pain: systematic review

Eur Spine J. 2009 Dec;18(12):1829-35. doi: 10.1007/s00586-009-1083-9. Epub 2009 Jun 30.


The objective of the study was to provide an inventory of predictive instruments and their constituting parameters associated with return to work in patients with subacute (2-10 weeks pain duration) and chronic (10-24 weeks pain duration) non-specific low back pain (NSLBP). Data sources included systematic review in Medline, Embase, Cinahl, Central, PEDro, Psyndex, PsychInfo/PsycLit, and Sociofile up to September 2008, in reference lists of systematic reviews on risk factors, and of included studies. For the systematic review, two reviewers independently assessed study eligibility and quality, and extracted data. Disagreements were resolved by consensus. Risk factors were inventorised and grouped into a somatic and psychosocial domain. 23 studies reporting on subacute and 16 studies reporting on chronic patients were included. The studies on subacute patients reported on a total of 56 biomedical factors out of which 35 (63%) were modifiable and 61 psychosocial factors out of which 51 (84%) were modifiable. The corresponding values in studies on chronic patients were 44 biomedical [27 (62%) modifiable] and 61 [40 (66%) modifiable] respectively. Our data suggest that the interdisciplinary approach in patients at risk to develop persistent NSLBP is justified in both, the subacute and chronic disease stages. Psychosocial interventions might be more effective in subacute stages since a higher proportion of modifiable risk factors were identified in that group.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Absenteeism*
  • Adult
  • Behavior Therapy
  • Behavioral Risk Factor Surveillance System
  • Chronic Disease
  • Disability Evaluation*
  • Female
  • Global Health
  • Humans
  • Illness Behavior
  • Interviews as Topic
  • Low Back Pain / epidemiology*
  • Low Back Pain / psychology*
  • Low Back Pain / rehabilitation
  • Male
  • Middle Aged
  • Observer Variation
  • Predictive Value of Tests
  • Prognosis
  • Psychology / statistics & numerical data
  • Psychology / trends
  • Reproducibility of Results
  • Risk Factors
  • Sex Distribution
  • Sick Leave / statistics & numerical data*
  • Sick Leave / trends
  • Sick Role
  • Somatoform Disorders / diagnosis
  • Somatoform Disorders / epidemiology
  • Somatoform Disorders / psychology