Association between pain-related fear and presenteeism among eldercare workers with low back pain

Eur J Pain. 2019 Mar;23(3):495-502. doi: 10.1002/ejp.1323. Epub 2018 Dec 10.


Background: Presenteeism (work productivity loss at work) and low back pain (LBP) are prevalent among eldercare workers. Presenteeism is a serious emerging problem in an occupational setting. While many studies report the impact of pain-related fear on absenteeism, its impact on presenteeism remains unclear.

Methods: We conducted a cross-sectional study to investigate the association between pain-related fear and presenteeism among 505 eldercare workers with LBP. We measured pain-related fear using the 11-item Tampa Scale for Kinesiophobia (TSK-11). We used the Work Limitations Questionnaire (WLQ) to estimate productivity loss due to presenteeism with items including Time Management, Mental-Interpersonal Demands, Physical Demands and Output Demands. The presenteeism was categorized into no (<5%), mild (5%-10.9%), moderate (11%-16.9%) and severe presenteeism (≥17%). We further performed ordinal logistic regression analyses, and the covariates were age, sex, pain intensity, pain disability and psychosocial factors. Multiple imputation was conducted to provide informed estimates for observations with missing data.

Results: After adjustment, a higher TSK score was significantly associated with a higher presenteeism (proportional OR = 1.10, 95% CI = 1.06-1.15). A significant association of TSK with all WLQ subscales was retained even after the adjustment (Time Management: proportional OR = 1.04, 95% CI = 1.01-1.08; Mental-Interpersonal Demands: proportional OR = 1.08, 95% CI = 1.04-1.12; Physical Demands: proportional OR = 1.04, 95% CI = 1.01-1.08; and Output Demands: proportional OR = 1.06, 95% CI = 1.02-1.10).

Conclusions: Our findings suggest that pain-related fear is an important factor related to presenteeism among eldercare workers with LBP.

Significance: This study describes an independent association of pain-related fear with presenteeism among eldercare workers with low back pain. Pain-related fear could be considered a vital factor of presenteeism in addition to absenteeism.

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Fear / psychology*
  • Female
  • Health Personnel / psychology*
  • Health Services for the Aged*
  • Humans
  • Low Back Pain / complications
  • Low Back Pain / psychology*
  • Male
  • Middle Aged
  • Presenteeism*
  • Prevalence
  • Surveys and Questionnaires