720 Prognostic factors for work participation in patients with sciatica: a systematic review

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IntroductionSciatica is usually self-limiting with pain and disability decreasing over time, but not all patients fully recover. Prognostic evidence could assist clinicians to better define high risk groups and inform both clinicians and patients with regard to counselling and treatment choices to promote return to work. The objective of this study was to review and summarise prognostic factors of work participation in patients with sciatica.MethodsWe searched MEDLINE, CINAHL, EMBASE and PsycINFO till May 2016. Cohort studies, using a measure of work participation as outcome, were included. We used the QUIPS tool for risk of bias assessment and GRADE to rate the quality of the evidence.ResultsBased on five studies describing four cohorts (n=983 patients) that assessed 19 potential prognostic factors, favourable factors for return to work at long term-term follow up (up to 10 years) included: younger age, better general health, less low back pain or sciatica bothersomeness, better physical function, positive SLR-test, a physician expecting surgery to be beneficial, better pain coping, less depression and mental stress, low physical work load. Study results could not be pooled. Using GRADE, the quality of the evidence ranged from moderate to very low.DiscussionFive studies describing four cohorts identified a wide range of factors: general health, pain and disability, psychological factors and work related factors. Although the number of studies was low and the quality of evidence ranged from moderate to very low, prognostic (modifiable) factors may be used to assist clinicians and occupational healthcare professionals in guiding high risk patients and consider referral for additional care or vocational rehabilitation, or in managing patients’ expectations regarding return to work.

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