Seminar Presentation 4-2

4-2 (Presentation within Topical Seminar 4):
Returning to Work Following Low Back Pain: A Model of Psychosocial Factors

Presented by: Elyssa Besen

Seminar Details

Part of Topical Seminar 4: Psychosocial Factors Involved in the RTW Process
Tuesday September 30


Besen E1, Young AE1, Shaw WS1

  1. Center for Disability Research, Liberty Mutual Research Institute for Safety, USA



Low back pain (LBP) is one of the leading causes of work disability, and psychosocial factors are associated with returning to work after an episode of LBP. However, the complex and overlapping effects between psychosocial variables have been difficult to assess using traditional linear modeling techniques. The aim of this paper is to develop and test a model of direct and indirect relationships among psychosocial predictors of return-to-work (RTW) outcomes following the onset of LBP. By exploring the potential for indirect, as well as direct relationships with RTW outcomes, we hope to better understand the RTW process and why pain does not always directly lead to outcomes.


Secondary analysis of a larger study of adults seeking treatment for work-related back pain with recent onset. In total, 241 participants who completed a baseline survey, a short follow-up survey, and a longer follow-up survey after 3 months were included in our analyses. The participants were required to have LBP with onset of less than 14 days, be 18 years or older, and be fluent in English or Spanish. The analyses utilized structural equation models to test the direct and indirect relationships among the variables and RTW outcomes at 3 months.


Our results indicated a good fit for our model (χ2=69.59, df=45, p<.05; RMSEA=.05; CFI=.95; WRMR=.61). Pain, catastrophizing, fear-avoidance beliefs, organizational support, and RTW confidence were all found to have indirect relationships with the outcomes. RTW confidence and RTW expectations were found to have direct relationship with the outcomes.


The process of returning to work after an episode of LBP is a complex process involving many interrelated factors. The experience of pain alone does not directly lead to work disability. Understanding the relationships among critical factors in the RTW process may be important for the treatment and rehabilitation of those with LBP. Results suggest that if injured workers are struggling with fear avoidance, pain catastrophizing and confidence issues, they might benefit from the application of CBT techniques.