Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: Prospective study with clinical implications

Study Design: Prospective cohort study with 18-month follow-up. Objective: To investigate if long-term sick listed persons’ own predictions of their future return to work (RTW) have an impact on their RTW when controlling for other established factors. Method: Postal questionnaires at baseline were sent to persons who had been on sick leave for more than 90 days, and were employed in five municipalities and four county councils in Sweden. A follow-up regarding their RTW was performed 18 months later. Results: After 18 months 135 out of 508 persons (27%) had returned to work, full or part-time. In a multivariate logistic regression, the sick listed persons’ own prediction of their RTW proved to be highly significant (OR=8.28, 95% CI: 3.31–20.69). Only six out of 132 persons with a negative view of their RTW did return to wok. Other predictive factors that were found for RTW were: being on sick leave for a period of less than 1 year (OR=2.09, 95% CI: 1.19–3.67), having less pain than persons in the quartile with most pain (OR=2.65, 95% CI: 1.21–5.81), perceiving that one was welcome back to work (OR=1.98, 95% CI: 1.10–3.58), and being under 55 years of age (OR=2.37, 95% CI: 1.07–5.23 for age between 45 and 54 years and the same trend for age below 45 years OR=1.85, 95% CI: 0.82–4.20). Conclusion: Persons with a positive prediction should get help to realise their potential for RTW. Offering traditional rehabilitation measures to a person with a negative prediction of his/her RTW, could be a waste of resources if done ahead of improving self-confidence and view of what is possible. The problems in this group might decrease or be easier to handle if decisions about the future are taken within a year.