Concerns and expectations about returning to work with low back pain: Identifying themes from focus groups and semi-structured interviews

Purpose. Studies of occupational low back pain (OLBP) have shown that return to work after injury is influenced by workers' concerns and expectations; however, these theoretical constructs have not been explored. The specific aim of this study was to identify themes related to self-efficacy and outcome expectancy for returning to work using qualitative research methods.

Method. Twenty-eight individuals who recently returned to work (<6 months) after an onset of OLBP responded to a newspaper advertisement and participated in focus groups. In a second phase of the study, patients with OLBP and an impending return to work (n=23) were referred by their physiotherapists and interviewed to provide more immediate accounts of their concerns and experiences. Notes and recordings from both sources were searched for utterances describing beliefs about self-efficacy or outcome expectancy for returning to work.

Results. Two primary self-efficacy constructs emerged: self-efficacy for resuming physical activity and self-efficacy for resuming work. Self-efficacy for resuming physical activity included 8 sub-domains: lift, carry, sit, stand, push/pull, bend, climb, and reach. Self-efficacy for resuming work included 3 sub-domains: pain control, obtaining help, and meeting job demands. Outcome expectancy included four sub-domains: financial/job security, re-injury, workplace support, and self-image.

Conclusions. Hesitation to return to work after OLBP involves not only concerns about pain and re-injury, but also the perceived ability to perform physical tasks, meet role expectations, obtain workplace support, and maintain job security.