Work status following a cervical spine injury: role of gender and psychosocial flag signs

Purpose Psychosocial factors are known to affect recovery and return to work, but their relationship with the work status of patients with neck pain is not well-studied. The objectives of this study were (1) to explore the characteristics of the injured workers based on the cumulative number of psychosocial flag signs, and (2) to examine the relationship between work status and gender, age, number of flag signs and perceived pain and mental well-being. Methods This study involved a review of the electronic files of consecutive workers with a neck injury. Pain intensity was measured by the numeric pain rating scale (NPRS), and anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). A gender-sensitive subgroup analysis and a forward stepwise logistic regression examined the relationship between work status and patient characteristics. Results Data of 95 patients, 36 (38%) females, mean age = 46(10) were analysed. Gender-sensitive analysis showed a differential pattern of relationship between work status and worker's attributes. Stepwise logistic regression showed that a less successful work status was associated with an older age (0.029), higher number of flag signs (p = 0.001), and higher levels of anxiety (p = 0.050) and depression (p < 0.0001). Conclusions Psychosocial flag signs have an independent relationship with work status after a neck injury. The presence of three or more flag signs is an indication that an injured worker may need additional support and targeted interventions for a successful return to work. There is a differential pattern of relationship between return to work and workers' attributes based on their gender.