Introduction
Methods
Study Design
Recruitment and Data Collection
Study Population
Primary Outcome
Biopsychosocial and Compensation Policy Variables
Patient characteristics |
Gender, country, age, education and Quetelet index |
Health-related characteristics |
General health (subscale of SF-36), active coping, passive coping, co-morbidity (interference with work resumption), pain intensity (von Korff pain intensity scale), sciatic pain, sick leave history due to back pain (in the last year), patient functional limitations (Hannover ADL) |
Job characteristics |
Working hours, job duration, firm company size, work ability, attitude towards work, physical job demands, social support, job strain (Karasek Theorell’s demand-support-control scale) |
Medical interventions |
Surgery, pain medication, passive treatment, exercise therapy (training, gymnastics), back school |
Work interventions |
Adaptation workplace, job redesign, working hours adaptation, therapeutic work resumption, job training, sheltered workshop |
DNK | GER | ISR | NLD | SWE | USA | |
---|---|---|---|---|---|---|
Income lossa
| + | + | + | − | + | + |
Waiting daysb
| − | − | + | − | + | + |
Medical certificates needed for a sickness benefitc
| − | + | + | − | + | + |
High minimum (≥50%) of work incapacity needed for a long term disability benefitd
| + | + | − | − | − | + |
Risk of dismissale
| + | − | + | − | + | + |
No or late entitlement to a long term disability benefitf
| − | − | + | + | − | + |
Statistical Data Analysis
Results
Cross-National Differences in Medical Interventions and Work Interventions
DNK | GER | ISR | NLD | SWE | USA | Total | |
---|---|---|---|---|---|---|---|
N | 563 (%) | 358 (%) | 316 (%) | 426 (%) | 374 (%) | 460 (%) | 2,825 (%) |
Medical intervention | |||||||
Surgery | 12.7 | 10.7 | 15.6 | 23.7 | 9.2 | 35.1 | 17.5 |
Pain relieving medication | 78.9 | 58.5 | 86.9 | 67.0 | 62.6 | 72.1 | 70.4 |
Passive treatment | 1.9 | 41.7 | 6.4 | 7.5 | 5.2 | 7.4 | 10.7 |
Exercise therapy | 57.5 | 47.6 | 29.7 | 63.0 | 36.8 | 73.1 | 51.9 |
Back schools | 28.5 | 28.8 | 3.7 | 12.4 | 27.8 | 14.0 | 20.6 |
Work intervention | |||||||
Adaptation workplace | 11.0 | 2.7 | 10.1 | 23.9 | 9.0 | 15.1 | 11.9 |
Job redesign | 27.6 | 6.1 | 43.7 | 35.4 | 10.0 | 27.5 | 23.7 |
Working hours adaptation | 20.5 | 6.6 | 39.8 | 49.2 | 9.8 | 28.9 | 24.2 |
Job/vocational training | 16.1 | 5.6 | 5.8 | 7.7 | 18.0 | 12.8 | 12.0 |
Therapeutic work resumption | 1.6 | 1.0 | 0.9 | 59.7 | 19.8 | 4.3 | 14.6 |
Differences Between Countries in Sustainable RTW
Explaining Biopsychosocial and Compensation Policy Variables for Differences in RTW Between Countries
Sig. | HRR | 95% CI | ||
---|---|---|---|---|
Lower | Upper | |||
Health characteristics | ||||
Co morbidity | .000 | 1.51 | 1.197 | 1.892 |
Pain intensity (von Korff) | .004 | 0.95 | .924 | .985 |
Functional limitationsa
| .000 | 1.01 | 1.005 | 1.012 |
Job characteristics | ||||
Longer tenure at T1 | .002 | 0.99 | .982 | .996 |
Work ability at T1 | .000 | 1.14 | 1.107 | 1.182 |
Physical job demands at T1b
| .000 | 1.24 | 1.124 | 1.361 |
Job strain at T1c
| .003 | 0.77 | .644 | .912 |
Medical interventions | ||||
Surgery T0–T2 | .007 | 0.81 | .696 | .943 |
Surgery T2–T3 | .060 | 1.37 | .986 | 1.910 |
Pain medication T0–T2 | .000 | 0.67 | .546 | .809 |
Pain medication T2–T3 | .003 | 0.81 | .700 | .927 |
Exercise therapy T0–T2 | .007 | 0.82 | .706 | .945 |
Work interventions | ||||
Adaptation workplace | .000 | 0.61 | .524 | .711 |
Job redesign | .000 | 0.57 | .491 | .664 |
Working hours adaptation | .000 | 0.67 | .565 | .778 |
Therapeutic work resumption | .000 | 0.65 | .545 | .779 |
Compensation policy variables | ||||
≥50% work incapacity needed for a long term disability benefit | .000 | 1.34 | 1.157 | 1.558 |
Entitlement to long term disability benefit ≥3 months after onset claim | .001 | 0.77 | 0.669 | 0.894 |
Medical certificates needed for a sickness benefit | .071 | 0.88 | 0.764 | 1.011 |