Skip to main content
PMC home page
Occupational and Environmental Medicine logoLink to Occupational and Environmental Medicine
. 2003 Apr;60(4):244–253. doi: 10.1136/oem.60.4.244

Early prognostic factors for duration on temporary total benefits in the first year among workers with compensated occupational soft tissue injuries

S Hogg-Johnson 1, D Cole 1
PMCID: PMC1740514  PMID: 12660372

Abstract

Aims: To develop a model of prognosis for time receiving workers' compensation wage replacement benefits in the first year.

Methods: A prospective cohort of 907 injured workers off work because of soft tissue injuries was followed for one year through structured telephone interviews and administrative data sources. Workers were recruited at workers' compensation claim registration. Only those still off work at four weeks post-registration were included in the analysis. Data from several domains (demographics, clinical factors, workplace factors, recovery expectations) were collected at approximately two weeks and a subset again at four weeks. Outcome was duration on total temporary wage replacement benefits. Variable selection was carried out in two steps using content experts and backward elimination with the Cox model.

Results: Body region specific functional status, change in pain, workplace offers of arrangements for return to work, and recovery expectations were independently predictive of time on benefits. Change in pain and workplace offers interacted, so the largest mutual association occurred for those whose pain was getting worse—that is, reduction in median duration from 112.5 to 32.5 days. Across observed values, widely different recovery profiles of groups of workers resulted; for example, at four months, only one third of the highest risk group had gone off benefits while over 95% of the lowest risk group had done so.

Conclusions: Focus on a relatively small set of prognostic factors should enable occupational health practitioners to triage injured workers within the first month and concentrate on those requiring additional assistance to return to work.

Full Text

The Full Text of this article is available as a PDF (230.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abenhaim L., Suissa S. Importance and economic burden of occupational back pain: a study of 2,500 cases representative of Quebec. J Occup Med. 1987 Aug;29(8):670–674. [PubMed] [Google Scholar]
  2. Beaton D. E., Richards R. R. Measuring function of the shoulder. A cross-sectional comparison of five questionnaires. J Bone Joint Surg Am. 1996 Jun;78(6):882–890. doi: 10.2106/00004623-199606000-00011. [DOI] [PubMed] [Google Scholar]
  3. Beaton D., Richards R. R. Assessing the reliability and responsiveness of 5 shoulder questionnaires. J Shoulder Elbow Surg. 1998 Nov-Dec;7(6):565–572. doi: 10.1016/s1058-2746(98)90002-7. [DOI] [PubMed] [Google Scholar]
  4. Bellamy N., Buchanan W. W., Goldsmith C. H., Campbell J., Stitt L. W. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 Dec;15(12):1833–1840. [PubMed] [Google Scholar]
  5. Brooker A. S., Cole D. C., Hogg-Johnson S., Smith J., Frank J. W. Modified work: prevalence and characteristics in a sample of workers with soft-tissue injuries. J Occup Environ Med. 2001 Mar;43(3):276–284. doi: 10.1097/00043764-200103000-00017. [DOI] [PubMed] [Google Scholar]
  6. Cats-Baril W. L., Frymoyer J. W. Identifying patients at risk of becoming disabled because of low-back pain. The Vermont Rehabilitation Engineering Center predictive model. Spine (Phila Pa 1976) 1991 Jun;16(6):605–607. doi: 10.1097/00007632-199106000-00001. [DOI] [PubMed] [Google Scholar]
  7. Cheadle A., Franklin G., Wolfhagen C., Savarino J., Liu P. Y., Salley C., Weaver M. Factors influencing the duration of work-related disability: a population-based study of Washington State workers' compensation. Am J Public Health. 1994 Feb;84(2):190–196. doi: 10.2105/ajph.84.2.190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cole D. C., Hudak P. L. Prognosis of nonspecific work-related musculoskeletal disorders of the neck and upper extremity. Am J Ind Med. 1996 Jun;29(6):657–668. doi: 10.1002/(SICI)1097-0274(199606)29:6<657::AID-AJIM10>3.0.CO;2-Z. [DOI] [PubMed] [Google Scholar]
  9. Cole Donald C., Mondloch Michael V., Hogg-Johnson Sheilah, Early Claimant Cohort Prognostic Modelling Group Listening to injured workers: how recovery expectations predict outcomes--a prospective study. CMAJ. 2002 Mar 19;166(6):749–754. [PMC free article] [PubMed] [Google Scholar]
  10. Coste J., Delecoeuillerie G., Cohen de Lara A., Le Parc J. M., Paolaggi J. B. Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice. BMJ. 1994 Feb 26;308(6928):577–580. doi: 10.1136/bmj.308.6928.577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Frank J. W., Brooker A. S., DeMaio S. E., Kerr M. S., Maetzel A., Shannon H. S., Sullivan T. J., Norman R. W., Wells R. P. Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine (Phila Pa 1976) 1996 Dec 15;21(24):2918–2929. doi: 10.1097/00007632-199612150-00025. [DOI] [PubMed] [Google Scholar]
  12. Frank J. W., Kerr M. S., Brooker A. S., DeMaio S. E., Maetzel A., Shannon H. S., Sullivan T. J., Norman R. W., Wells R. P. Disability resulting from occupational low back pain. Part I: What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine (Phila Pa 1976) 1996 Dec 15;21(24):2908–2917. doi: 10.1097/00007632-199612150-00024. [DOI] [PubMed] [Google Scholar]
  13. Frank J., Sinclair S., Hogg-Johnson S., Shannon H., Bombardier C., Beaton D., Cole D. Preventing disability from work-related low-back pain. New evidence gives new hope--if we can just get all the players onside. CMAJ. 1998 Jun 16;158(12):1625–1631. [PMC free article] [PubMed] [Google Scholar]
  14. Fransen Marlene, Woodward Mark, Norton Robyn, Coggan Carolyn, Dawe Martin, Sheridan Nicolette. Risk factors associated with the transition from acute to chronic occupational back pain. Spine (Phila Pa 1976) 2002 Jan 1;27(1):92–98. doi: 10.1097/00007632-200201010-00022. [DOI] [PubMed] [Google Scholar]
  15. Gatchel R. J., Polatin P. B., Mayer T. G. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine (Phila Pa 1976) 1995 Dec 15;20(24):2702–2709. doi: 10.1097/00007632-199512150-00011. [DOI] [PubMed] [Google Scholar]
  16. Goertz M. N. Prognostic indicators for acute low-back pain. Spine (Phila Pa 1976) 1990 Dec;15(12):1307–1310. doi: 10.1097/00007632-199012000-00013. [DOI] [PubMed] [Google Scholar]
  17. Harrell F. E., Jr, Califf R. M., Pryor D. B., Lee K. L., Rosati R. A. Evaluating the yield of medical tests. JAMA. 1982 May 14;247(18):2543–2546. [PubMed] [Google Scholar]
  18. Harrell F. E., Jr, Lee K. L., Califf R. M., Pryor D. B., Rosati R. A. Regression modelling strategies for improved prognostic prediction. Stat Med. 1984 Apr-Jun;3(2):143–152. doi: 10.1002/sim.4780030207. [DOI] [PubMed] [Google Scholar]
  19. Hazard R. G., Haugh L. D., Reid S., Preble J. B., MacDonald L. Early prediction of chronic disability after occupational low back injury. Spine (Phila Pa 1976) 1996 Apr 15;21(8):945–951. doi: 10.1097/00007632-199604150-00008. [DOI] [PubMed] [Google Scholar]
  20. Infante-Rivard C., Lortie M. Prognostic factors for return to work after a first compensated episode of back pain. Occup Environ Med. 1996 Jul;53(7):488–494. doi: 10.1136/oem.53.7.488. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Klenerman L., Slade P. D., Stanley I. M., Pennie B., Reilly J. P., Atchison L. E., Troup J. D., Rose M. J. The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine (Phila Pa 1976) 1995 Feb 15;20(4):478–484. doi: 10.1097/00007632-199502001-00012. [DOI] [PubMed] [Google Scholar]
  22. Lanier D. C., Stockton P. Clinical predictors of outcome of acute episodes of low back pain. J Fam Pract. 1988 Nov;27(5):483–489. [PubMed] [Google Scholar]
  23. Laupacis A., Wells G., Richardson W. S., Tugwell P. Users' guides to the medical literature. V. How to use an article about prognosis. Evidence-Based Medicine Working Group. JAMA. 1994 Jul 20;272(3):234–237. doi: 10.1001/jama.272.3.234. [DOI] [PubMed] [Google Scholar]
  24. Lindström I., Ohlund C., Eek C., Wallin L., Peterson L. E., Fordyce W. E., Nachemson A. L. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Phys Ther. 1992 Apr;72(4):279–293. doi: 10.1093/ptj/72.4.279. [DOI] [PubMed] [Google Scholar]
  25. Loisel P., Abenhaim L., Durand P., Esdaile J. M., Suissa S., Gosselin L., Simard R., Turcotte J., Lemaire J. A population-based, randomized clinical trial on back pain management. Spine (Phila Pa 1976) 1997 Dec 15;22(24):2911–2918. doi: 10.1097/00007632-199712150-00014. [DOI] [PubMed] [Google Scholar]
  26. Roland M., Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 1983 Mar;8(2):141–144. doi: 10.1097/00007632-198303000-00004. [DOI] [PubMed] [Google Scholar]
  27. Roland M., Morris R. A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine (Phila Pa 1976) 1983 Mar;8(2):145–150. doi: 10.1097/00007632-198303000-00005. [DOI] [PubMed] [Google Scholar]
  28. Rossignol M., Suissa S., Abenhaim L. Working disability due to occupational back pain: three-year follow-up of 2,300 compensated workers in Quebec. J Occup Med. 1988 Jun;30(6):502–505. [PubMed] [Google Scholar]
  29. Schemper M. The relative importance of prognostic factors in studies of survival. Stat Med. 1993 Dec 30;12(24):2377–2382. doi: 10.1002/sim.4780122413. [DOI] [PubMed] [Google Scholar]
  30. Sinclair S. J., Hogg-Johnson S. H., Mondloch M. V., Shields S. A. The effectiveness of an early active intervention program for workers with soft-tissue injuries. The Early Claimant Cohort Study. Spine (Phila Pa 1976) 1997 Dec 15;22(24):2919–2931. doi: 10.1097/00007632-199712150-00015. [DOI] [PubMed] [Google Scholar]
  31. Spitzer W. O., Skovron M. L., Salmi L. R., Cassidy J. D., Duranceau J., Suissa S., Zeiss E. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine (Phila Pa 1976) 1995 Apr 15;20(8 Suppl):1S–73S. [PubMed] [Google Scholar]
  32. Von Korff M., Ormel J., Keefe F. J., Dworkin S. F. Grading the severity of chronic pain. Pain. 1992 Aug;50(2):133–149. doi: 10.1016/0304-3959(92)90154-4. [DOI] [PubMed] [Google Scholar]
  33. Yassi A., Tate R., Cooper J. E., Snow C., Vallentyne S., Khokhar J. B. Early intervention for back-injured nurses at a large Canadian tertiary care hospital: an evaluation of the effectiveness and cost benefits of a two-year pilot project. Occup Med (Lond) 1995 Aug;45(4):209–214. doi: 10.1093/occmed/45.4.209. [DOI] [PubMed] [Google Scholar]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES