A systematic review on chronic low back pain (>12 wks) showed that the following factors were strongly negatively associated with return to work:

1) Fear avoidance

2) Pain catastrophising

3) Attorney involvement

4) On worker’s compensation

5) Male

6) Older age

7) Delay in referral to rehabilitation

8) Lower socio-economic status

9) Physically demanding work

So after reading these 9 factors, what is a PT to do to help return patients with chronic LBP back to work? Which one of these 9 factors can we positively influence?

I suggest starting with the only factor that we have a chance of changing which are factors #1 & 2: Fear avoidance & Pain catastrophising.

I strongly recommend some form of pain education for patients with persistent pain in order to help improve their functional recovery. I am obviously biased towards my own book, “The Pain Truth & Nothing But”.

You may purchase the books for $8 each from www.aptei.ca. I recommend the paper version of the book as patients are to complete the exercises in the book by writing stuff in the book.


Reference: Steenstra IA et al Systematic Review of Prognostic Factors for Return to Work in Workers with Sub Acute and Chronic Low Back Pain. J Occup Rehabil. 2017 Sep;27(3):369-381.

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