# Health-related measures and subjective prognosis of gainful employment among patients with non-specific chronic low back pain in multidisciplinary orthopedic rehabilitation

## TL;DR

This study explores how psychosocial factors affect employment prognosis in patients with chronic low back pain undergoing rehabilitation.

## Contribution

The study identifies psychosocial risk factors linked to poor employment prognosis in chronic low back pain patients.

## Key findings

- Unfavorable employment prognosis is associated with higher job strain and chronic stress.
- Lower pain self-efficacy and work ability predict poor employment outcomes.
- Patients with unfavorable prognosis often show clinical signs of depression and stress.

## Abstract

Non-specific chronic low back pain (CLBP) restricts participation in society
and employment also due to the high psychosocial burden of this condition.
Thus, there is an urgent need for rehabilitation of patients with CLBP,
which must be determined by a valid diagnosis of psychosocial risk factors.
The subjective prognosis of gainful employment (SPE) is considered to
indicate the need for medical rehabilitation for back pain. The present
study investigated the association between SPE and psychosocial risk factors
among individuals with non-specific CLBP undergoing inpatient
multidisciplinary orthopedic rehabilitation (MOR).

This cross-sectional observational study included 925 individuals aged 20 to
65 with non-specific CLBP at admission to inpatient MOR (M=52.2 years,
SD=7.2; 77.5% female; ICD-10: M51/53/54). Associations of the SPE total
score with psychological, pain-related, and work-related measures were
examined by using correlation and regression analyses. Moreover, moderated
associations of the SPE categorical score were tested using one-way analyses
of variance with the independent factor self-reported prognosis of
employment (favorable vs. unfavorable). Additionally, the frequency
distributions of scores within the clinical range for depressive symptoms,
chronic stress, and subjectively assessed work ability stratified by
self-reported prognosis of employment were investigated.

A less favorable self-reported prognosis of employment was predicted by
higher job strain and chronic stress as well as lower pain self-efficacy and
subjective physical work ability. In particular, individuals with an
unfavorable self-reported prognosis of employment showed a risk pattern and
were frequently in the clinical range for depressive symptoms, chronic
stress, and subjective work ability.

The results supported a high need for rehabilitation for this target group,
especially for patients with non-specific CLBP and unfavorable self-reported
prognosis of employment. Early assessment of sociomedical criteria, in
addition to pain and psychodiagnosis as well as targeted referral to
needs-based interdisciplinary multimodal treatment approaches could reduce
the risk of further chronification of pain and the development of mental
disorders.