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Objective To assess the importance of psychological and culturally-influenced factors as predictors of low back pain (LBP) incidence and persistence in Spanish workers. Methods As part of the international Cultural and Psychosocial Influences in Disability (CUPID) study, 1105 Spanish nurses and office workers answered questions at baseline about LBP in the past month and past year, associated disability, occupational lifting, smoking habits, health beliefs, mental health, and distress from common somatic symptoms. At 12-month follow-up, they were asked about LBP and associated disability in the past month. Associations with LBP incidence and persistence were assessed by log binomial regression, and characterised by prevalence rate ratios (PRRs) with associated 95% CIs. Results 971 participants (87.9%) completed follow-up. Among 579 with no LBP at baseline, 22.8% reported LBP at follow-up. After adjustment for sex, age and occupation, new LBP was predicted by poor mental health (PRR 1.5, 95% CI 1.0 to 2.2), somatising tendency (PRR 1.8, 95% CI 1.2 to 2.7) and presence of LBP for >1 month in the year before baseline (PRR 4.7, 95% CI 3.1 to 6.9). Among 392 subjects who had LBP at baseline, 59.4% reported persistence at follow-up, which was associated with presence of symptoms for >1 month in the 12 months before baseline (PRR 1.4, 95% CI 1.2 to 1.7) and more weakly with somatising tendency, and with adverse beliefs about LBP work-relatedness and prognosis. Conclusions In Spain, as in northern European countries, psychological and culturally-influenced factors have an important role in LBP development and persistence.

Background Sickness absence (SA) remains a significant problem globally, notably in developed countries. Early intervention to enhance return to work has been identified as a key priority in disability and SA management and these interventions implemented in the early stages of SA episodes indicate that ‘early’ and ‘very early’ intervention may result in a quicker return to work and be cost-effective. The objective of this systematic review is to investigate the effectiveness of ‘very early’ (under 15 days) SA workplace interventions to enhance return to work. Methods A systematic literature search was conducted in Pubmed, HMIC, Cochrane library database, CINAHL, PsychInfo and Embase. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria. Randomised controlled trials, controlled trials, cluster-randomised trials, cross-over designs, before and after studies and interrupted time-series published in English until September 2014 were included if they assessed the effectiveness of workplace interventions to reduce SA in workers who were on sick leave no longer than 15 days. Primary outcome measures included rates of and time until RTW, productivity loss, and recurrences of SA. The Cochrane Collaboration tool was used to assess the risk of bias. Results We found limited available evidence on the benefits of ‘very early’ workplace interventions in terms of RTW after a SA episode compared to usual care. Only three randomised controlled trials classed as high or intermediate quality were identified. Early part-time sick leave together with appropriate job modifications led to a reduction on the duration and recurrence of SA, and increased self-perception of health and quality of life. There is evidence of benefit of intervening during the first two weeks of SA for musculoskeletal disorders and less for workers with mental health problems. Conclusion Our review identified a lack of substantive evidence from the literature at this time point to support ‘very early’ intervention compared to usual care. Consensus is required on the definition of ‘early’ and ‘very early’ interventions and further research is recommended to improve understanding of the factors influencing when and how best to intervene for maximum gain.

Occupational hazards have undergone significant changes since the middle of the 20th century. In the past, workers were exposed to serious chemical, physical and biological hazards. However, with the improvement of working conditions and reductions in harmful exposures, much of the morbidity and mortality attributable to those hazards has been reduced in high-income countries. Recently, attention has shifted to other disorders, rarely lethal and not exclusively caused by work, but which account for substantial costs and impact on workers’ well-being.1 Musculoskeletal disorders (MSDs) are a part of these ‘new’ work-related disorders. MSDs are a major cause of disability,2 affecting over 40 million West European workers, with direct costs in Europe estimated at between 0.5 and 2% of gross domestic product.3 Minimising occupational disability attributable to MSDs, and the associated costs, is one of the major challenges in industrialised countries. A growing body of evidence, based largely on administrative data, suggests a decline in the incidence of work-related MSDs over the past decade among people of working age in …

Objective To investigate the role of psychological risk factors for the development and persistence of non-disabling (NDMSP) and disabling (DMSP) musculoskeletal pain (MSP). Methods As part of the CUPID study, 1105 nurses and office workers were asked at baseline about psychological and work-related psychosocial risk factors, physical activities in the workplace and MSP in the past month and past year at ten anatomical sites (back, neck, and left and right shoulder, elbow, wrist/hand and knee). One year later, pain in the past month was again ascertained. Pain was defined as disabling if certain daily activities were difficult or impossible to perform. At baseline, pain-free anatomical sites were included in the analyses for new NDMSP and DMSP, and painful sites in the analysis for persistent NDMSP and DMSP. Analysis was based on anatomical sites and associations were explored using multilevel multinomial logistic regression modelling. Results 971 participants (87.9%) completed follow-up. Among 8083 pain-free anatomical sites at baseline, 341 (4.2%) and 412 (5.1%) were involved in new NDMSP and DMSP at follow-up. After adjustment for sex, age, occupational risk factors and pain at the same site in the past year, new DMSP was predicted by somatising tendency (OR 3.4, 95%CI 2.1–5.5). Among 1627 painful sites at baseline, 379 (23.3%) and 500 (30.7%) still had NDMSP and DMSP one-year later. Having adverse beliefs about the prognosis of MSP was associated with an increased risk of persistence of NDMSP (OR 2.3; 95%CI 1.2–4.6) and DMSP (OR 2.9; 95%CI 1.5–5.6). Conclusion Psychological risk factors may have a stronger role in the development and persistence of DMSP than of NDMSP.

Objectives To quantify the variation in rates of absence for musculoskeletal pain across 47 occupational groups (mostly nurses and office workers) from 18 countries, and to explore personal and group-level risk factors that might explain observed differences. Methods A standardised questionnaire was used to obtain information about musculoskeletal pain, sickness absence and possible risk factors from 12,416 workers (92 to 1017 per occupational group). In addition, group-level data on socioeconomic variables such as sick pay and unemployment rates were assembled by members of the study team in each country. Associations of sickness absence with risk factors were examined by Poisson regression. Results Overall, there were more than 30-fold differences between occupational groups in the 12-month prevalence of prolonged musculoskeletal sickness absence, and even among office workers carrying out similar occupational tasks, the variation was more than ten-fold. Individual-level risk factors included older age, lower educational level, tendency to somatise, physical loading at work and prolonged absence for non-musculoskeletal illness. However, these explained little of the variation between occupational groups. After adjustment for individual characteristics, prolonged musculoskeletal absence was more frequent in groups with greater time pressure at work, lower job control, and more adverse beliefs about the work-relatedness of musculoskeletal disorders. Conclusions Musculoskeletal sickness absence might be reduced by eliminating excessive time pressures in work, maximising employees’ responsibility and control, and providing flexibility of duties for those with disabling symptoms. Care should be taken not to overstate work as a cause of musculoskeletal injury.

Objectives To assess whether health beliefs, somatising tendency, mental health and history of LBP are important predictors of incidence and persistence of low back pain (LBP). Methods As part of the CUPID study, computer assisted personal interviews were performed in 1105 Spanish nurses and office workers, aged 20–59 years. At baseline, questions were asked about LBP in the past month and past year. Health beliefs, somatising tendency and mental health were assessed using questions from previously validated questionnaires. After 1 year we asked again about LBP in the past month. Associations with incidence and persistence of LBP were explored using logistic regression modeling. Results 971 participants (87.9%) completed follow-up. Among 579 with no LBP in the past month at baseline, 22.8% reported LBP at follow-up. Among the 392 who had LBP at baseline, 59.4% reported persistence of LBP at follow-up. Risk of developing new LBP after 1 year was elevated in those with high somatising tendency (OR=2.3; 95% CI 1.3 to 4.0) and worse mental health (OR=1.7; 95% CI 1.1 to 2.9). Persistence of LBP was more common among those who thought at baseline that LBP would still be a problem in 12 months, and in those who thought that LBP in general was work-related. History of LBP for > 1 month in the past year was the strongest predictor of both incidence and persistence of LBP. Conclusions Health beliefs, somatising tendency, mental health and history of LBP should be considered as predictors when assessing the prognosis of patients with LBP.

Objectives To assess the relative importance of occupational physical activities, conditions of employment and culturally determined health behaviour as determinants of sickness absence for musculoskeletal disorders, we compared patterns of absence in three categories of worker (nurses, office workers and manual workers) from culturally diverse countries. Methods The standardised CUPID questionnaire was used to collect data on sickness absence in the past year from 9347 workers in 31 occupational groups from 13 countries. Results The 1-year prevalence of sickness absence for musculoskeletal illness ranged from 3% in Japanese nurses and 6% in Japanese manual workers to 49% in Italian manual workers (in a toy factory). Rates for non-musculoskeletal disorders varied from 3% in Brazilian cane cutters to 70% in UK nurses and 73% in New Zealand postal workers. The ratio of the prevalence of absence attributed to musculoskeletal illness to that for non-musculoskeletal disorders varied more than 35-fold from 0.15 in Japanese nurses to 5.33 in Brazilian cane cutters. In general it was higher in nurses than in office workers from the same country, and more variable in manual workers than in the other occupational groups. Conclusions The large differences between occupational groups in the attribution of sickness absence to musculoskeletal as compared with other disorders are unlikely to be explained entirely by differences in the physical demands of work and in employment conditions. They may also be importantly influenced by culturally determined differences in health behaviours.