Factors that predict the Probability of patients with Sciatica returning to work

In comparison to individuals experiencing nonspecific low back pain, patients with sciatica encounter more intense pain, endure extended periods of absence, and exhibit reduced rates of rejoining the workforce.

In contrast to individuals suffering from nonspecific low back pain, patients diagnosed with sciatica encounter heightened pain levels, extended work absences, and reduced rates of resuming work.

Surgery

Surgical discectomy is commonly performed for sciatica, offering short-term benefits but limited long-term improvement in pain and disability. Literature suggests that patients with persistent radicular pain or pain unresponsive to conservative care may be referred to secondary care. However, a randomized study found no significant impact of surgery on work status.

As part of a prospective cohort study, a study reported by the literature was conducted on patients with sciatica and disc herniation who were referred to back clinics in Southeastern Norway.

Participants did not undergo any specific interventions, but instead received information and general advice during their consultations. Surgery was performed for patients with severe symptoms based on the discretion of the individual surgeon.

Clinical Study

It examined patients aged 18 or older who had radiating pain below the knee and/or muscle weakness, and were diagnosed with lumbar disc herniation based on imaging scans.

Exclusion criteria consisted of pregnancy, spinal fracture, tumor, infection, previous disc surgery, and inability to communicate in written Norwegian. Patients recruited after October 2005 granted consent for the retrieval of sickness absence data from the National Sickness Benefit Register, which encompasses the entire Norwegian population.

Mailing a questionnaire to patients, who completed it at home and returned it, was part of a two-year evaluation. Follow-up measures, such as phone calls, text messages, and reminder letters, were employed to reach non-responders.

Participants self-reported their employment status at both the initial assessment and the two-year follow-up, choosing from categories like full-time employment, partial sick leave, complete sick leave, rehabilitation, disability pension, student status, job seeking, retirement, or homemaking.

Baseline data collection involved gathering demographic variables, education, and the history of back pain/sciatica. Leg and back pain were assessed using a visual analog scale, while perceived symptoms were measured with the Sciatica Bothersomeness Index.

Disability and general health were evaluated using specific questionnaires. Comorbidity, emotional distress, work-related fear-avoidance beliefs, and pain-related fear of movement/reinjury were also examined.

Clinical tests were conducted to assess straight-leg raising, sensation, reflexes, and muscle strength, with predetermined criteria for abnormal results.

The analysis specifically examined patients who were initially on sick leave or undergoing rehabilitation for back pain/sciatica, with a primary focus on their ability to return to full-time work after a two-year period.

Patients reporting full-time employment were assigned a code of 1, while those on sick leave or disability pension were assigned a code of 0. The study included participants who received compensation for sickness or were granted rehabilitation support due to back pain/sciatica, as recorded in the sickness benefit register.

The primary metric focused on measuring the duration until the first sustained RTW, indicated by a period of more than 60 days without being listed on the sick register and without receiving any related benefits.

The findings of the study reported by literature demonstrated that approximately 75% of patients with sciatica achieved full-time work within a two-year timeframe.

Factors such as reduced baseline sciatica bothersomeness, fear-avoidance work, back pain, shorter episode duration (less than 3 months), and no prior episodes were predictive of a faster return to work. In contrast, undergoing surgical therapy was associated with a slower return to work.

Moreover, younger age, better overall health, and negative results on the straight-leg-raising test were associated with higher self-reported rates of returning to work at the two-year mark.

Only two previous articles have explored prognostic factors for return to work (RTW) in patients with sciatica. The Spine Patient Outcome Research Trial (SPORT) and the Maine Lumbar Spine Study found no significant association between workers’ compensation and work status at the 2- and 4-year follow-up, respectively.

Younger age, better perceived general health at baseline, and less severe low back pain were identified as positive predictors for higher RTW rates in the Maine study. In surgical patient studies, depression, occupational mental stress, being a woman, low stature, long sickness absence duration, and strenuous work activities were linked to negative RTW outcomes.

Baseline sciatica bothersomeness has a significant independent association with both the time to sustained return to work (RTW) and RTW at the two-year mark.

However, the disability measured by the Maine-Seattle Back Questionnaire score has shown an association with RTW only in the univariate analysis and did not maintain significance in the multivariate analysis. The effectiveness of various back pain disability instruments in predicting work-related outcomes in patients with sciatica remains unclear.

Fear avoidance is believed to impede the recovery of patients with nonspecific low back pain, although its effect on work-related recovery remains uncertain.

Nonetheless, the study reported by literature indicates that fear avoidance related to work could serve as a predictive factor for return to work in patients with sciatica. The duration of compensation benefits in workers with musculoskeletal disorders may be influenced by work-related variables.

Univariate analysis demonstrated a correlation between higher scores on the Tampa Scale for Kinesiophobia and return to work, while multivariate analysis showed no association between emotional distress, psychosomatic complaints, and return to work.

Consistent with the SPORT study, the study reported by literature did not find a significant association between surgery and self-reported return to work (RTW) at the two-year follow-up.

However, surgery was linked to a slower return to sustained work. It’s important to interpret these results cautiously due to the observational design of the study and potential unmeasured variables.

Achieving a standardized operative treatment protocol for sciatica is challenging, as evidenced by high rates of nonadherence in previous randomized trials. To fully evaluate the effect of surgery on RTW in sciatica, a randomized controlled trial is needed.

The studies described in the literature established sustained return to work (RTW) as a duration exceeding 60 days without the receipt of sickness benefits. These studies considered multiple absences and provided a comprehensive assessment of work disability duration in individuals with low back pain.

By encompassing this definition, the studies effectively addressed the limitations associated with relying solely on the conclusion of the initial sickness absence episode.

While a consensus on the exact definition of sustained RTW is yet to be reached, these studies, in alignment with a prior investigation on low back pain in Norway, utilized a threshold of 60 days. An additional study, conducted by a different author, proposed that a minimum duration of 6 weeks should be used to indicate a full resumption of regular work activities.

Data collection from the sickness benefit register commenced after some patients were enrolled. However, the baseline variables and self-reported work status at 2 years were similar for patients with and without register data, indicating representative analysis.

A slight discrepancy was found between the register’s sick list status and self-reported full-time employment. Possible factors for this difference include respondent variation, uncertainty in work status reporting, or coding errors.

Only patients listed for back pain or sciatica were included, potentially leading to variations in diagnostic categories. A considerable proportion of patients with sciatica who were on sick leave did not re-enter the workforce within a two-year period.

Conclusion

Multiple factors, such as age, overall health, the level of sciatica-related discomfort, fear-related avoidance of work, results from the straight-leg-raising test, back pain intensity, episode duration, and past episodes, were identified as influencing the ability to return to work.

It is noteworthy that undergoing surgical treatment was linked to a delayed resumption of work activities.

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