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APHA Scientific Session and Event Listing

Recorded presentation

Marjorie L. Baldwin, PhD¹, Richard J. Butler, PhD², William G. Johnson, PhD¹, and Pierre Côté, PhD³. (1) School of Health Management and Policy, Arizona State University, PO Box 874506, Tempe, AZ 85287-4506, 480-965-7868, marjorie.baldwin@asu.edu, (2) Depatment of Economics, Brigham Young University, 183 Faculty Office Building, Provo, UT 84602-2363, (3) Institute for Work and Health, 481 University Avenue, Toronto, ON MSG 2E9, Canada

BACKGROUND: Numerous studies have tested an array of biopsychosocial factors to identify the best indicators of work disability following onset of back pain. Self-reported severity measures add significant predictive power to the models, but the strength and significance of associations vary according to time frame and outcome studied. We test the validity of alternative severity measures in predicting the likelihood of four distinct patterns of post-injury employment in the first year after onset. METHODS: The sample includes 959 participants in the ASU Healthy Back Study, a prospective cohort study of workers with occupational back pain. The severity measures include: intensity of back/leg pain, Roland-Morris scale, mental and physical components of the SF-12. We estimate a series of multinomial logistic models to examine the validity of the severity measures in predicting subsequent patterns of return to work, and to identify those that are measuring overlapping constructs. RESULTS: All severity measures have significant predictive power on work outcomes even after one year, but pain intensity is almost never significant in the presence of other measures. The Roland-Morris and physical SF-12 are fairly interchangeable for estimating work outcomes. The mental SF-12 is relatively robust to alternate specifications, consistently statistically significant, and has the lowest probability significance level in explaining patterns of employment at one year. IMPLICATIONS: It is important to look beyond the first return to work in predicting outcomes of occupational back pain. The long-term prognosis has a behavioral health component that should be addressed in programs designed to improve work outcomes.

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