Psychosocial stress factors among patients with lumbar disc herniation,scheduled for disc surgery in comparison with patients scheduled for arthroscopic knee surgery

Returning to work after disc surgery appears to be more heavily influenced by psychological aspects of work than by MR-identified morphological alterations. It is still not known whether psychosocial factors of importance for outcome after disc surgery are present preoperatively or develop in the postoperative phase. The aim of this study was to investigate the presence of work-related stress, life satisfaction and demanding life events, among patients undergoing first-time surgery for lumbar disc herniation in comparison with patients scheduled for arthroscopic knee surgery. Sixty-nine patients with disc herniation and 162 patients awaiting arthroscopy were included in the study, during the time period March 2003 to May 2005. Sixty-two percent of the disc patients had been on sick leave for an average of 7.8 months and 14 percent of the knee patients had been on sick leave for an average of 4.2 months. The psychosocial factors were investigated preoperatively using a questionnaire, which was a combination of the questionnaire of quality of work competence (QWC), life satisfaction (LiSat9) and life events as a modification of the social readjustment scale. There were no significant differences between the two groups in terms of work-related stress or the occurrence of demanding life events. The disc patients were significantly less satisfied with functions highly inter-related to pain and discomfort, such as present work situation, leisure-time, activities of daily living (ADL) function and sleep. Patients with disc herniation on sick leave were significantly less satisfied with their present work situation than knee patients on sick leave; this sub-group of patients with disc herniation also reported significantly higher expectations in relation to future job satisfaction than knee patients. The results indicate that psychosocial stress is not more pronounced preoperatively in this selected group of disc patients, without co-morbidity waiting for first-time disc surgery, than among knee patients awaiting arthroscopy. It was notable that the disc patients had high expectations in terms of improved job satisfaction after treatment by surgery.     

Psychological problems arising from disaster work

A case study is presented of a problem-solving exercise with UK police officers who experienced psychological problems after their duties in connection with the Bradford fire disaster of May 11 1985. It is argued that they typify the ‘forgotten victims’ of disasters: official helpers of one kind or another whose experiences may lead to significant psychological disturbance. Out of the 399 officers who had been involved with the fire, 234 (59 per cent) completed a screening questionnaire and 34 attended a series of confidential counselling sessions. Their specific problems included performance guilt, reconstruction anxiety, generalized irritability, focused resentment and motivational changes. Treatment interventions were tailored to these problems. A second administration of the screening questionnaire three weeks after counselling, and a follow-up approximately nine months after the disaster, indicated a satisfactory level of recovery in the officers.     

Psychiatric and social aspects of brittle asthma.

BACKGROUND--Many studies have shown that emotional factors play a part in asthma, but few have compared patients with differing severities of asthma. It was our impression that patients with "brittle" asthma (BA; more than 40% diurnal variation in peak flow on 15 or more days a month over a period of at least six months, and persistent symptoms despite multiple drug treatment) had greater psychosocial morbidity than asthmatic patients with less variable asthma. METHODS--Twenty patients with BA and a control group of less severe asthmatic subjects matched for age, sex, and duration of illness were asked to complete the General Health Questionnaire (GHQ), a screening test for psychiatric disorders, the Eysenck Personality Inventory which measures extraversion and neuroticism, and to participate in a life events interview and a structured clinical interview (SCID) to diagnose psychiatric disorder. RESULTS--The mean (SD) age was 45.6 (12.3) years for the BA group, and 45.7 (13.1) years for the control group. All patients were receiving inhaled steroids and regular beta 2 agonists; nine patients with BA but no control patients were taking oral steroids, and 12 of the patients with BA but no controls were receiving beta 2 agonists by subcutaneous infusion or injection. Eight of the patients with BA scored more than 11 on the GHQ compared with five of the control group (NS). Significantly more subjects with BA (12/20) than controls (5/20) had intercurrent or past psychiatric disorder, and 7/20 subjects with BA had a lifetime history of anxiety disorder compared with 3/20 controls. Life events analysis showed no overall difference in the total number, but the patients with BA had significantly more life events related to asthma. There was no difference in personality profiles between the two groups. CONCLUSIONS--The results suggest that patients with "brittle" asthma have greater psychiatric morbidity than those with less severe asthma, but that their personality profiles and overall life event experiences are similar.     

Stress and burnout among colorectal surgeons and colorectal nurse specialists working in the National Health Service

Background It has been suggested that changes to the organization of the National Health Service (NHS) and clinical practices in dealing with cancer are associated with increased stress and burnout in healthcare professionals. The aim of this study, therefore, was to evaluate stress and burnout in colorectal surgeons (surgeons) and colorectal clinical nurse specialists (nurses) working in the NHS. Method A list of all consultant surgeons and nurses was obtained from The Association of Coloproctology of Great Britain and Ireland. Participants were sent a questionnaire booklet consisting of standardized measures [General Health Questionnaire (GHQ), Maslach Burnout Inventory (MBI), Coping Questionnaire] and various ad hoc questions to obtain information about demographics, cancer workload and job satisfaction. Independent predictors of clinically significant distress and burnout were identified using logistic regression. Results Four hundred and fifty‐five surgeons and 326 nurses were sent booklets. The response rate was 55.6% in surgeons and 54.3% in nurses. The mean age of the nurses was lower than that of surgeons (42.8 vs 47.7, P < 0.001). Psychiatric morbidity was similar in the surgeons and nurses as assessed using the GHQ (30.2% and 30.3% respectively). On the MBI, compared with nurses, surgeons had significantly higher levels of depersonalization (17.4%vs 7.4%, P = 0.003) and lower personal accomplishment (26.6%vs 14.2%, P = 0.002). Seventy‐seven per cent of surgeons and 63.4% of nurses stated their intention to retire before the statutory retirement age. Coping strategies, especially those in which respondents isolated themselves from friends and family, were associated with higher psychiatric morbidity and burnout. Dissatisfaction with work, intention to retire early, intention to retire as soon as affordable and poor training in communication and management skills were also significantly associated with high GHQ scores and burnout in both groups. Discussion We found high levels of psychiatric morbidity and burnout in this national cohort of surgeons and nurses working in the NHS. However, psychiatric morbidity and burnout were unrelated to cancer workload. Nurses have lower burnout levels than surgeons and this may be related to their different working practices, responsibilities and management structure.     

Randomised trial of an asthma self-management programme for adults.

BACKGROUND--A hospital based, community service asthma education programme for adults to improve asthma knowledge, promote compliance with medication, and reduce morbidity was evaluated. METHODS--The programme was evaluated using a randomised experimental and control group design with repeated measurements over 12 months. A volunteer community sample of 192 respondents was recruited of whom 116 satisfied the inclusion criteria. At the 12 month follow up some data were obtained for all subjects. Intervention subjects attended four 2.5 hour education sessions at weekly intervals. An asthma knowledge questionnaire was administered and compliance was assessed from diary records. Morbidity was assessed retrospectively by questionnaire, prospectively by diary, and objectively by spirometry and serial peak expiratory flow rate monitoring. The adequacy of medical treatment was also assessed. Data were collected at baseline, immediately after the intervention, and at three, six, nine, and 12 months after intervention. RESULTS--Improvements occurred in knowledge and compliance in the intervention group but the impact on morbidity was modest; this was due, at least in part, to the inadequacy of medical treatment. CONCLUSIONS--Treatment of asthma should be reviewed and optimised in conjunction with self-management programmes in order to improve health outcomes.     

Assessment of subjective stress in the municipal police force of the city of Rome

The aim of the study was to perform a dimensional assessment of subjective stress in the Municipal Police of the City of Rome. We assessed two random samples of 590 traffic police and 590 clerical police officers of both sexes for subjective stress through the administration of the ‘Rapid Stress‐Assessment Scale’ (RSA), a self‐rated tool; subjects completed the questionnaire during a non‐working day. Subsequently, from each sample we randomly included two subsamples of 115 subjects each, to whom we administered the RSA at the beginning and at the end of their shift. Significant differences between traffic and clerical police officers were found in the RSA total score, which was higher among traffic agents. Traffic police officers were found significantly more often in the ‘high stress class’. Gender differences analysis showed higher scores among women. The analysis of the subsample of 230 persons showed a significantly greater degree of the RSA ‘depression’ cluster at the end of the shift only in traffic police officers. The assessment of over‐the‐counter drug use (NSAID, analgesics, etc.) showed that, among police officers habitually using such drugs, only the traffic police subgroup scored higher on the RSA. Our results could be taken to mean that the stress response of Municipal Police officers who work outdoors is more maladaptive than that of officers working in the office; this could be compatible with the existence of different occupational stressors between the two groups. Copyright © 2002 John Wiley & Sons, Ltd.     

THE PERCEIVED IMPACT OF POLICE WORK ON POLICE OFFICERS' SPOUSES AND FAMILIES

Over 400 spouses of police officers were surveyed by questionnaire to assess the impact of police work on the welfare and functioning of these spouses and their families. The results suggest that police work has an adverse impact, particularly in terms of spouses' social life. The main culprits are long hours, shiftwork and cancelled leave. Dangerous duties and working with the opposite sex did not usually have an injurious effect on those at home. The methods used by the officers to combat work-induced stress may create additional difficulties for their spouses and families.     

Morbidity and short term results in a randomised trial of open compared with closed treatment of chronic pilonidal sinus.

OBJECTIVE--To evaluate the morbidity and short term results after open compared with closed treatment of chronic pilonidal sinus. DESIGN--Randomised control trial. SUBJECTS--120 of 164 patients with chronic pilonidal sinus treated between April 1987 and April 1989. INTERVENTIONS--60 patients were treated by excision and primary suture, and 60 by excision and open packing. MAIN OUTCOME MEASURES--Incidence of early complications (bleeding that needed treatment, wound breakdown, infection, haematoma, or wound pain), number of postoperative visits required, and length of sick leave taken. RESULTS--Those patients who underwent excision and suture had slightly but not significantly fewer early complications (16/60, 27%, compared with 23/60, 38%). Most of the early complications were the result of infection (8, 13% compared with 18, 30%, respectively). They also required fewer followup visits and less sick leave, and their wounds healed more quickly. At one year the numbers of late complications were 19 (32%) and 14 (23%), respectively. CONCLUSION--Excision and primary closure of chronic pilonidal sinus causes less morbidity and is more cost effective than excision and open packing. We plan a three year follow-up to see if these results are maintained.     

On-call stress among Finnish anaesthetists

We investigated on-call stress and its consequences among anaesthetists. A questionnaire was sent to all working Finnish anaesthetists (n = 550), with a response rate of 60%. Four categories of on-call workload and a sum variable of stress symptoms were formed. The anaesthetists had the greatest on-call workload among Finnish physicians. In our sample, 68% felt stressed during the study. The most important causes of stress were work and combining work with family. The study showed a positive correlation between stress symptoms and on-call workload (p = 0.009). Moderate burnout was present in 18%vs 45% (p = 0.008) and exhaustion in 32% and 68% (p = 0.015), in the lowest vs highest workload category, respectively. The symptoms were significantly associated with stress, gender, perceived sleep deprivation, suicidal tendencies and sick leave. Being frequently on call correlates with severe stress symptoms and these symptoms are associated with sick leave.     

Risk factors for sickness absence due to low back pain and prognostic factors for return to work in a cohort of shipyard workers

The purpose of this study was to determine risk factors for the occurrence of sickness absence due to low back pain (LBP) and to evaluate prognostic factors for return to work. A longitudinal study with 1-year follow-up was conducted among 853 shipyard workers. The cohort was drawn around January 2004 among employees in the shipyard industry. Baseline information was obtained by questionnaire on physical and psychosocial work load, need for recovery, perceived general health, musculoskeletal complaints, sickness absence, and health care use during the past year. During the 1-year follow-up for each subject medical certifications were retrieved for information on the frequency and duration of spells of sickness absence and associated diagnoses. Cox regression analyses were conducted on occurrence and on duration of sickness absence with hazard ratios (HR) with 95% confidence interval (95% CI) as measure of association. During the 1-year follow-up period, 14% of the population was on sick leave at least once with LBP while recurrence reached 41%. The main risk factors for sickness absence were previous absence due to a health problem other than LBP (HR 3.07; 95%CI 1.66–5.68) or previous sickness absence due to LBP (HR 6.52; 95%CI 3.16–13.46). Care seeking for LBP and lower educational level also hold significant influences (HR 2.41; 95%CI 1.45–4.01 and HR 2.46; 95%CI 1.19–5.07, respectively). Living with others, night shift and supervising duties were associated with less absenteeism due to LBP. Workers with a history of herniated disc had a significantly decreased rate of returning to work, whereas those who suffered from hand-wrist complaints and LBP returned to work faster. Prior sick leave due to LBP partly captured the effects of work-related physical and psychosocial factors on occurrence of sick leave. Our study showed that individual and job characteristics (living alone, night shift, lower education, sick leave, or care seeking during the last 12 months) influenced the decision to take sick leave due to LBP. An increased awareness of those frequently on sick leave and additional management after return to work may have a beneficial effect on the sickness absence pattern.     

Factors associated with variability in length of sick leave because of acute low back pain in Chile

Background contextAcute low back pain (LBP) is a frequent cause of physician visits and sick leave. Patients with longer sick leave account for most costs associated with LBP. Most research on risk factors for prolonged sick leave because of LBP has been done in Anglo-Saxon or Northern European populations with occupational LBP. Few studies have been conducted in less affluent Latin countries.PurposeTo investigate the prevalence of acute LBP as a cause of sick leave and the variables associated with longer work absence (WA) because of acute LBP in Chile.Study designA retrospective study of nonoccupational sick leave certificates issued in a 1-year period by the Chilean Public Health System.Patient sampleTen thousand cases with nonoccupational sick leave certificates issued with the diagnosis of acute LBP.Outcome measuresPrevalence of acute LBP as a cause of sick leave, days of WA, and subsidy payment.MethodsA review of sick leave certificates from patients with different diagnoses was done to determine the prevalence of acute LBP as a cause of sick leave. We investigated whether age, gender, history of at least one episode of sick leave in the previous year because of acute LBP or because of other diagnoses, stipendiary subsidy paid (converted to US $), work activity, occupation, and the specialty of the attending physician influenced the length of sick leave.ResultsAcute LBP represented 5.4% of cases causing sick leave. Patients with acute LBP who had significantly longer sick leave than the rest of the population were patients with an episode of WA because of LBP in the previous year (14% longer sick leave than patients without that history), manual workers (35% longer than nonmanual workers), and patients seen by orthopedic surgeons (43% longer than patients seen by other medical specialists). Nonpregnant women and men had similar durations of sick leave because of acute LBP.ConclusionsPhysicians who treat patients with LBP should be aware of these variables associated with longer sick leave because of acute LBP, which represents a significant burden to any society and is an important epidemiologic problem.     

Prospective randomized study comparing the medicoeconomic benefits of Hylan GF-20 vs. conventional treatment in knee osteoarthritis

OBJECTIVES: In a previous study, we determined the costs over 6 months to the French public health insurance system of Hylan GF-20 (Synvisc) in 66 patients with knee osteoarthritis. Here, we compared the medicoeconomic benefits over 9 months in 506 patients given Hylan GF-20 or conventional treatment for knee osteoarthritis. PATIENTS AND METHODS: This prospective randomized study was conducted from October 1998 to February 2000. Clinical status was evaluated using the Lequesne index, the WOMAC index, and the SF12 quality-of-life questionnaire. Medical and sick leave costs to the public health insurance system were determined. RESULTS: Effectiveness criteria were evaluable in all 506 patients. Significant clinical improvements were noted from the first month to the end of the 9-month study period in the Synvisc group. A mean 2-point difference in the Lequesne index area-under-the-curve was found in favor of Synvisc (P < 0.0001). Mean medical and sick leave costs per patient over 9 months were 829.10 in the Synvisc group and 829.40 in the conventional treatment group. CONCLUSION: This study carried out over 9 months in a large population confirms that Synvisc viscosupplementation is more effective than conventional treatment, at no additional cost. It takes a step toward answering the request of international experts for medicoeconomic data on viscosupplementation for osteoarthritis.     

Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial

Intensive group training using principles of graded activity has been proven to be effective in occupational care for workers with chronic low back pain. Objective of the study was to compare the effects of an intensive group training protocol aimed at returning to normal daily activities and guideline physiotherapy for primary care patients with non-specific chronic low back pain. The study was designed as pragmatic randomised controlled trial with a setup of 105 primary care physiotherapists in 49 practices and 114 patients with non-specific low back pain of more than 12 weeks duration participated in the study. In the intensive group training protocol exercise therapy, back school and operant-conditioning behavioural principles are combined. Patients were treated during 10 individual sessions along 20 group sessions. Usual care consisted of physiotherapy according to the Dutch guidelines for Low Back Pain. Main outcome measures were functional disability (Roland Morris disability questionnaire), pain intensity, perceived recovery and sick leave because of low back pain assessed at baseline and after 6, 13, 26 and 52 weeks. Both an intention-to-treat analysis and a per-protocol analysis were performed. Multilevel analysis did not show significant differences between both treatment groups on any outcome measures during the complete follow-up period, with one exception. After 26 weeks the protocol group showed more reduction in pain intensity than the guideline group, but this difference was absent after 52 weeks. We finally conclude that an intensive group training protocol was not more effective than usual physiotherapy for chronic low back pain.     

Psychosexual and psychosocial sequelae of closed head injury

A series of 36 patients who had been hospitalized following closed head injury (CHI) were followed up 4.06 (SD 3.71) years after the injury. Measures were taken of degree of psychosexual dysfunction (Golombok Rust Inventory of Sexual Satisfaction-GRISS), general psychiatric morbidity (General Health Questionnaire-GHQ), and clinical anxiety and depression (Hospital Anxiety and Depression Scale-HAD). These measures were completed by patients and partners. Resulting data revealed that 50% of male patients with current sexual partners produced psychosexual profiles that fell within the dysfunctional range. For both male patients and their partners, the chief psychosexual complaint was infrequency. Of the patients studied, 61% were classified (using the GHQ) as having degrees of emotional distress that would fall within the range of psychiatric 'caseness', while 25% of patients achieved HAD criteria for clinical anxiety and 22% met HAD criteria for depression. Of the partners, 41% met GHQ criteria for psychiatric 'caseness', 18% being classified using the HAD as anxiety cases and 6% as depression cases. No effects of severity of injury were observed on any of the main outcome measures. Age and time since injury were related to measures of psychosexual dysfunction. These results are discussed in relation to the existing literature on psychosocial outcome in closed head injury, and recommendations for therapeutic intervention are made.     

A screening questionnaire to predict no return to work within 3 months for low back pain claimants

The objective of the present study was to develop a short prediction questionnaire for estimating the risk of no return to work (RTW) within 3 months of sick leave to facilitate triage and management of a patient population of subacute low-back pain (LBP) sufferers. We conducted a prospective study with a 3-month follow-up on 186 patients with LBP introducing a claim for sickness benefits to the largest sickness fund in Belgium. Patients completed a screening questionnaire within 2 weeks after claim submission. All patients were invited for clinical assessment, at 6–8 weeks of sick leave, by the medical adviser. Patients’ work status was recorded by the sickness fund. About 20% of the patients did not resume work at 3 months’ sick leave. They were more likely to experience pain below the knee, to have an own previous prediction of a 100% no RTW and to have a severe interference of pain on daily activities. The screening tool based on these three items correctly classified 73.7% of the non-resumers and 78.4% of the resumers at a cut-off score of 0.22. The findings of this study provide evidence of the utility of a short screening questionnaire for future use in intervention studies in a social security setting.     

Sustainability of return to work in sick-listed employees with low-back pain. Two-year follow-up in a randomized clinical trial comparing multidisciplinary and brief intervention

ABSTRACT: BACKGROUND: Sick-listed employees with low back pain had similar return to work (RTW) rates at one-year follow-up in a randomized trial comparing two interventions, but the effects were modified by specific workplace related factors. The present study addressed the sustainability of the intervention effects by performing a two-year follow-up and by using different outcome measures. METHODS: A total of 351 employees sick-listed for 3--16 weeks due to LBP were recruited from their general practitioners and were randomly allocated to a hospital-based brief or multidisciplinary intervention. Outcome measures were based on sick leave registered in a national database of social and health-related benefits. RTW rates, RTW status, sick leave weeks and sick leave relapse were studied. RESULTS: During the two-year follow-up 80.0% and 77.3% had RTW for at least four weeks continuously, and the percentages with RTW at the 104th week were 61.1% and 58.0% in the brief and multidisciplinary intervention groups, respectively. At the 104th week 16.6% and 18.8% were on sick leave in the two groups, respectively, and about 12% were employed in modified jobs or participated in job training. The number of weeks on sick leave in the first year was significantly lower in the brief intervention group (median 14 weeks) than in the multidisciplinary intervention group (median 20 weeks), but during the second year the number of weeks on sick leave were not significantly different between intervention groups. Subgroups characterised by specific work related factors modified the effect of the intervention groups on RTW rates (p = 0.017). No difference in sick leave relapse was found between the intervention groups. CONCLUSION: The effects of the brief and multidisciplinary interventions at the two-year follow-up were in general similar to the effects at one-year follow-up.Trial RegistrationCurrent Controlled Trials ISRCTN18609003.     

Prescribing of Sick Leave by Surgeons: A Survey Based on Hypothetical Patient Cases

Background

Physicians regard the tasks of sick-listing and work ability assessments problematic and among the most challenging duties in their practice. Few studies have analyzed sick leave prescribing practices, and the practices have been shown to vary among physicians. The aim of this study was to examine the prescribing of sick leave by surgeons and factors that affect these prescribing practices.

Methods

A questionnaire study with 19 hypothetical patient cases was conducted among 338 Finnish surgeons. The effects of both physician-related and local structural background variables on sick leave prescribing were studied using univariate and multiple linear regression models. The economic consequences of the variation in sick leave prescribing were estimated.

Results

The overall number of days of sick leave prescribed for the entire group of 19 patient cases averaged 281.4 days (range = 134–490 days). With the same diagnosis, surgeons prescribed more days of sick leave for patients who do physical work than for those who work in an office. Older surgeons with more working experience and those working in smaller municipalities or in smaller hospitals prescribed longer sick leave than others. Clinical specialists tended to prescribe longer sick leave than those still in specialty training.

Conclusion

Structured education for surgeons on prescribing sick leave, together with defined guidelines, could produce more uniform practices and improve equality among patients.     

A prospective, randomized 5-year follow-up study of functional restoration in chronic low back pain patients

A functional restoration (FR) program, dealing with a combination of intensive physical and ergonomic training, psychological pain management, and patient education, was tested in two randomized, parallel group studies. In one of these patients following the FR program were compared with a non-treated control group (project A), and in the other with patients on two less intensive treatment programs (project B). A total of 238 chronic low back pain patients participated in the two studies, 106 entering project A and 132 project B. Patients from the two projects were comparable except that the patients in project A were recruited from all over the country, whereas patients in project B all were living in and around Copenhagen. Thirteen patients never started any treatment, and 20 patients (9%) dropped out during the treatment period. Of the 207 who completed treatment, 89% returned a mailed questionnaire 5 years later. This was the case for 55% of the drop-outs. The questions referred to work situation, pain level, activities of daily living, days of sick leave, contact with health care professionals, physical activity, use of medication, and a subjective overall assessment. The results show that in project A the treated group reported significantly fewer contacts with the health care system and significantly fewer days of sick leave over the 5-year follow-up period compared to the control group. In all other parameters, including work ability, there was no statistically significant difference between the two groups. In project B, patients treated in the FR program did significantly better in most measured parameters, except in leg pain, use of pain medication and sport activity, where no significant differences were found between groups. The overall result shows a positive long-term effect of the FR program, but it also shows the necessity of testing a given treatment in different projects and designs, among other things due to statistical variations. Received: 7 May 1997 Revised: 20 October 1997 Accepted: 5 November 1997     

Patients at risk for long-term sick leave because of low back pain

Background contextTen percent of patients with low back pain (LBP) are not able to resume work within 3 months of sick leave, accounting for 90% of all medical and indemnity costs.PurposeTo quantify the relative contribution of sociodemographic, clinical, occupational, and psychological risk factors in determining the non–return to work after 3 months of compensated LBP and to develop a screening tool to identify patients who require further guidance and rehabilitation.Study design/settingA 6-month prospective cohort study of disabled workers applying for compensation benefit because of LBP during a 6-month period in the Belgian compulsory health insurance system.Patient sampleThree hundred and forty-six patients.Outcome measuresPatients unable to resume work within 3 months of sick leave were classified as bad outcomes.MethodsConsecutively, injured workers applying for income replacement benefits between October 2003 and March 2004 because of LBP were followed 6 months after the start of the sick leave period. All subjects underwent a standardized physical examination and completed a battery of 12 self-report questionnaires.ResultsForty-seven percent of the population had not resumed work 3 months after the start of the sick leave period. The risk factors for sickness absence more than 3 months were Oswestry disability index (odds ratio for each point increase: 1.04; 95% confidence interval: 1.02–1.06), fear of avoidance severity score (odds ratio for each point increase: 1.05; confidence interval: 1.02–1.09), blue collar worker (odds ratio: 2.18; confidence interval: 1.21–3.92), LBP for less than 12 weeks before sick leave (odds ratio: 0.32; confidence interval: 0.17–0.64), and pain behavior (odds ratio for each point increase: 1.72; confidence interval: 1.25–2.39). A multivariate screening test based on five questions identified 80% of the patients unable to resume work after 3 months of sick leave (specificity: 56.6; cut off: 0.4).ConclusionsA questionnaire comprising a limited set of items allows a practical screening of LBP patients unlikely to resume work.