Are components of a comprehensive medical assessment predictive of work disability after an episode of occupational low back trouble?

Study Design. One hundred fifty-nine subacute low back work-injured patients completed a full medical assessment at baseline. A full repear examination was performed 3 months later, when return-to-work status was determined. Objective. To determine the prognostic value of a comprehensive medical assessment for the prediction of return-to-work status. Summary of Background Data. A systematic review of the work disability prediction literature of low back trouble prognosis revealed that no high-quality studies included a full medical history and physical examination in the design. The results of studies included in the systematic review were equivocal with respect to predictive usefulness of medical variables. Methods. Participants completed medical history questionnaires and then were clinically examined by one of six experienced examiners (three physicians and three physio-therapists). Return-to-work status was measured 3 months later, and predictive validity was evaluated using logistic regression modeling. Results. Medical variables (i.e., medical history sub-scales, physical examination subscales, and lumbar range-of-motion tests) showed modest correct classification rates varying between 61.6% and 69.1% for participants. Conclusions. Comprehensive medical assessments play a crucial role in the early identification of serious pathology after low back trouble. We were unable to identify, however, any medical evaluation variables that would account for significant proportions of variance in return to work. The weight of evidence obtained in this study suggests that injured workers' subjective interpretations and appraisals may be more powerful predictors of the course of postinjury recovery than exclusively medical assessments.