Predicting the long term course of low back pain and its consequences for sickness absence and associated work disability

Background: Low back pain is characterised by a dynamic pattern of episodes and recovery but little is known about the long term course of back pain due to lack of cohort studies with sufficiently long follow up periods. Methods: A cohort of 523 workers in nursing homes and homes for the elderly was followed for two years. Physical load was measured by observations at the workplace. Psychosocial factors at work, individual characteristics, and low back pain were determined by questionnaire once a year. The effect of work load on low back pain and the transition of low back pain into sickness absence was calculated with logistic regression analysis. A Markov model was used to construct a hypothetical cohort of workers with follow up of 40 years (40 cycles of 1 year) with transitional probabilities between no complaints, low back pain, and sickness due to low back pain. Permanent disability was used as end state of health. Results: The transitional probability from no complaints to low back pain varied between p = 0.25 and p = 0.29, from low back pain to sickness absence between p = 0.09 and p = 0.25, and recurrence of sickness absence varied between p = 0.27 and p = 0.50, depending on the level of physical load. During a 40 year career, total sickness absence due to low back pain was approximately 140 weeks (6.6%) among workers with high physical load and about 30 weeks (1.4%) among those with low physical load. Conclusion: The Markov approach illustrated the potential impact of physical load on (permanent) disability due to low back pain among workers with exposure to physical load. These consequences may go unnoticed in cohort studies with follow up periods of a few years.