Can Cross Country Differences in Return-to-Work After Chronic Occupational Back Pain be Explained? An Exploratory Analysis on Disability Policies in a Six Country Cohort Study
Open Access
- 18 September 2009
- journal article
- research article
- Published by Springer Nature in Journal of Occupational Rehabilitation
- Vol. 19 (4), 419-426
- https://doi.org/10.1007/s10926-009-9202-3
Abstract
Introduction There are substantial differences in the number of disability benefits for occupational low back pain (LBP) among countries. There are also large cross country differences in disability policies. According to the Organization for Economic Cooperation and Development (OECD) there are two principal policy approaches: countries which have an emphasis on a compensation policy approach or countries with an emphasis on an reintegration policy approach. The International Social Security Association initiated this study to explain differences in return-to-work (RTW) among claimants with long term sick leave due to LBP between countries with a special focus on the effect of different disability policies. Methods A multinational cohort of 2,825 compensation claimants off work for 3–4 months due to LBP was recruited in Denmark, Germany, Israel, the Netherlands, Sweden, and the United States. Relevant predictors and interventions were measured at 3 months, one and 2 years after the start of sick leave. The main outcome measure was duration until sustainable RTW (i.e. working after 2 years). Multivariate analyses were conducted to explain differences in sustainable RTW between countries and to explore the effect of different disability policies. Results Medical and work interventions varied considerably between countries. Sustainable RTW ranged from 22% in the German cohort up to 62% in the Dutch cohort after 2 years of follow-up. Work interventions and job characteristics contributed most to these differences. Patient health, medical interventions and patient characteristics were less important. In addition, cross-country differences in eligibility criteria for entitlement to long-term and/or partial disability benefits contributed to the observed differences in sustainable RTW rates: less strict criteria are more effective. The model including various compensation policy variables explained 48% of the variance. Conclusions Large cross-country differences in sustainable RTW after chronic LBP are mainly explained by cross-country differences in applied work interventions. Differences in eligibility criteria for long term disability benefits contributed also to the differences in RTW. This study supports OECD policy recommendations: Individual packages of work interventions and flexible (partial) disability benefits adapted to the individual needs and capacities are important for preventing work disability due to LBP.Keywords
This publication has 23 references indexed in Scilit:
- Health of the working age populationBMJ, 2008
- Multidisciplinary Rehabilitation for Subacute Low Back Pain: Graded Activity or Workplace Intervention or Both?Spine, 2007
- The effectiveness of ergonomic interventions on return-to-work after low back pain; a prospective two year cohort study in six countries on low back pain patients sicklisted for 3–4 monthsOccupational and Environmental Medicine, 2004
- Low Back Pain After Traffic CollisionsSpine, 2003
- Ineffective disability management by doctors is an obstacle for return-to-work: a cohort study on low back pain patients sicklisted for 3–4 monthsOccupational and Environmental Medicine, 2002
- ABC of psychological medicine: Musculoskeletal painBMJ, 2002
- The Effects of Common Medical Interventions on Pain, Back Function, and Work Resumption in Patients With Chronic Low Back PainSpine, 2000
- Effect of Eliminating Compensation for Pain and Suffering on the Outcome of Insurance Claims for Whiplash InjuryNew England Journal of Medicine, 2000
- Workers with Disabling Back PainNew England Journal of Medicine, 1997
- Measures of dependence for censored survival dataBiometrika, 1988