Investigating risk factors for chronicity: the importance of distinguishing between return-to-work status and self-report measures of disability.

Abstract

The objective of this study was to examine whether the outcome of psychosocial risk factor analyses varied as a function of whether the outcome variable was return-to-work status or self-reported functional disability. Participants were 255 workers who sustained a soft tissue injury to the back and participated in a community-based secondary prevention program. Assessment of psychologic risk factors (pain severity, pain catastrophizing, fear of movement/reinjury, depression) was conducted at pretreatment. Logistic regression revealed that pain catastrophizing (odds ratio [OR], 0.53; 95% confidence interval [CI] = 0.32-0.88) and pain severity (OR, 0.65; 95% CI = 0.45-0.94) were significant predictors of return to work. However, when change in self-reported disability was used as the outcome variable, none of the psychosocial risk factors emerged as significant predictors. Given the important theoretical, clinical, and policy implications of the outcome of risk factor research, more research is needed to further clarify the respective advantages and limitations to using self-reported versus return to work-based measures of disability.