Fear of movement, passive coping, manual handling, and severe or radiating pain increase the likelihood of sick leave due to low back pain

Sick leave due to low back pain (LBP-SL) is costly and compromises workforce productivity. The fear-avoidance model asserts that maladaptive pain-related cognitions lead to avoidance and disuse, which can perpetuate ongoing pain. Staying home from work is an avoidant behavior, and hence pain-related psychological features may help explain LBP-SL. We examined the relative contribution of pain catastrophizing, fear of movement, and pain coping (active and passive) in LBP-SL in addition to pain characteristics and other psychosocial, occupational, general health, and demographic factors. Two-way interactions between age and gender and candidate exposures were also considered. Our sample comprised 2164 working nurses and midwives with low back pain in the preceding year. Binary logistic regression was performed on cross-sectional data by manual backward stepwise elimination of nonsignificant terms to generate a parsimonious multivariable model. From an extensive array of exposures assessed, fear of movement (women, odds ratio [OR]=1.05, 95% confidence interval [CI] 1.02–1.08; men, OR=1.17, 95% CI 1.05–1.29), passive coping (OR=1.07, 95% CI 1.04–1.11), pain severity (OR=1.61, 95% CI 1.50–1.72), pain radiation (women, OR=1.45, 95% CI 1.10–1.92; men, OR=4.13, 95% CI 2.15–7.95), and manual handling frequency (OR=1.03, 95% CI 1.01–1.05) increased the likelihood of LBP-SL in the preceding 12months. Administrators and managers were less likely to report LBP-SL (OR=0.44, 95% CI 0.27–0.71), and age had a protective effect in individuals in a married or de facto relationship (OR=0.97, 95% CI 0.95–0.98). In summary, fear of movement, passive coping, frequent manual handling, and severe or radiating pain increase the likelihood of LBP-SL. Gender-specific responses to pain radiation and fear of movement are evident. The relative contribution of pain-related psychological features in sick leave due to low back pain is established in a large homogeneous worker cohort. Multidimensional preventive interventions are needed that address fear of movement and passive coping behaviors, promote effective pain management and optimize manual handling frequency.