Worker Recovery Expectations and Fear-Avoidance Predict Work Disability in a Population-Based Workers’ Compensation Back Pain Sample

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Study Design.

Prospective, population-based cohort study.


To examine whether worker demographic, pain, disability, and psychosocial variables, assessed soon after work-related back pain disability onset, predict 6-month work disability.

Summary of Background Data.

Greater age, pain, and physical disability, and certain psychosocial characteristics may be risk factors for prolonged back pain-related work disability, although many studies have been small, findings have been inconsistent, and some psychosocial variables have not been examined prospectively.


Workers (N = 1,068) completed telephone interviews assessing demographic, pain, disability, and psychosocial variables 18 days (median) after submitting Workers’ Compensation back pain disability claims. Administrative measures of work disability 6 months after claim submission were obtained.


At 6 months, 196 workers (18.4%) were receiving work disability compensation. Age, race, education, and baseline pain and disability were significant predictors of 6-month disability. Adjusting for baseline demographics, pain, disability, and other psychosocial variables, high work fear-avoidance (odds ratio, 4.6; 95% confidence interval, 1.6–13.7) and very low recovery expectations (odds ratio, 3.1, 95% confidence interval, 1.5–6.5) were significant independent predictors.


Among individuals with acute work-related back pain, high pain and disability, low recovery expectations, and fears that work may increase pain or cause harm are risk factors for chronic work disability.

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