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Absence Resulting From Low Back Trouble Can Be Reduced by Psychosocial Intervention at the Work Place
Abstract
STUDY DESIGN: A 1-year prospective study in industry, assessing effects of an educational pamphlet on various psychosocial parameters and absenteeism resulting from low back trouble. OBJECTIVES: To determine the value of distributing an educational psychosocial pamphlet to reduce absenteeism resulting from back trouble. The pamphlet was designed to alter avoidance behaviors by encouraging a positive, active approach. SUMMARY OF BACKGROUND DATA: Attempts to control back-pain disability have failed. Fear of pain and activity seemingly leads to avoidance behaviors than contribute to chronicity and work loss. Avoidance behaviors are mediated by attitudes and beliefs; such attitudes and beliefs are a reasonable target for educational interventions designed to change "inappropriate" behaviors (e.g., extended absenteeism). Health education pamphlets are advocated widely but tested rarely. METHODS: Three factories participated in the study. Psychosocial data were collected by questionnaires; absence data were extracted from company records. A psychosocial pamphlet was distributed in one factory; the control subjects received either a nonspecific pamphlet or no intervention. The pamphlet emphasized a positive approach to low back trouble (reduction of negative beliefs and attitudes). RESULTS: In the company whose employees received pamphlets, a significant reduction occurred for the number of spells with extended absence and the number of days of absence (70% and 60%, respectively) compared with extrapolated values. A concomitant positive shift in beliefs concerning the locus of pain control and the inevitable consequences of low back trouble was found. CONCLUSION: A simple industrial intervention using a psychosocial pamphlet, which was designed to reduce avoidance behaviors by fostering positive beliefs and attitudes, successfully reduced extended absence resulting from low back trouble.
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“It has been demonstrated that kinesiophobia has shown to be a strong predictor for pain disability and pain chronicity in the longer term [73] associated with higher rates of sick-leaves [74], pain vigilance and disability as well as decreased physical activity levels [75–77].”
From Chronic pain and sex-differences; women accept and move, while men feel blue (2017) · cites this paper as [74]
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The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence
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BackgroundOccupational health guidelines for the management of low back pain at work: evidence review
Waddell, G. F. (2001) · Occupational Medicine · doi:10.1093/occmed/51.2.124 · Cited by 607
“C3 – There is preliminary evidence that educational interventions which specifically address beliefs and attitudes may reduce future work loss due to LBP [61].”
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Moseley, G. L., Nicholas, M. K., & Hodges, P. W. (2004) · The Clinical Journal of Pain · doi:10.1097/00002508-200409000-00007 · Cited by 537
“Two notable studies have evaluated education based on the biopsychosocial model, which acknowledges cognitive and behavioral factors.(33,34) One study compared 2 education booklets.”
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Self-citationMoseley, G. L. (2003) · Journal of Pain · doi:10.1016/s1526-5900(03)00488-7 · Cited by 530
“Education strategies focusing on currently accurate information about the behavioral response to pain have also reported effectiveness within both a management and a prevention context.(2,5,17) The current results may highlight a lack of pain science education in formal or professional training across the health profe…”
BackgroundChapter 2 European guidelines for prevention in low back pain
Burton, K. A., Balagué, F., Cardon, G., Eriksen, H. R., Henrotin, Y. E., Lahad, A., Leclerc, A., Müller, G., van der Beek, A. J., & On behalf of the COST B13 Working Group on Guidelines for Prevention in Low Back Pain (2006) · European Spine Journal · doi:10.1007/s00586-006-1070-3 · Cited by 491
“That study specifically examined the effects of information oriented toward fear avoidance beliefs/behaviour and promoting coping, and found that the information was effective in shifting beliefs compared with no intervention, and also reported a reduction in sick leave (Symonds et al. 1995) - evidence from one non-ra…”
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Moseley, L. (2002) · Australian Journal of Physiotherapy · doi:10.1016/s0004-9514(14)60169-0 · Cited by 472
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Buchbinder, R., Jolley, D., & Wyatt, M. (2001) · BMJ · doi:10.1136/bmj.322.7301.1516 · Cited by 426
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“All rights reserved. initial episode, reduces chronic disability, although the effect on chronic pain is not known (Symonds et al. 1995; Burton et al. 1999).”
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Kuoppala, J., Lamminpää, A., & Husman, P. M. (2008) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e31818dbf92 · Cited by 322
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ResultIndividual patient education for low back pain
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Intervention studies in occupational epidemiology
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“An earlier study in an industrial setting found that distributing a pamphlet designed to address fearavoidance beliefs in workers, both those with and those without back pain, reduced extended absenteeism because of low back trouble.(25) The authors postulated that adoption of this strategy on a wider scale might be e…”
BackgroundFear of movement/(re)injury, disability and participation in acute low back pain
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Self-citationConcepts Of Rehabilitation For The Management Of Common Health Problems
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Chronic pain and sex-differences; women accept and move, while men feel blue
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“It has been demonstrated that kinesiophobia has shown to be a strong predictor for pain disability and pain chronicity in the longer term [73] associated with higher rates of sick-leaves [74], pain vigilance and disability as well as decreased physical activity levels [75–77].”
BackgroundLow back pain interventions at the workplace: a systematic literature review
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“Pamphlet [56] 571 light industry pamphlet encouraging active coping, activity and early return to work after LBP distributed in intervention company; control company had neutral pamphlet; attitude and knowledge measured medium knowledge and attitude, sick leave”
BackgroundPsychologically Based Occupational Rehabilitation: The Pain-Disability Prevention Program
Sullivan, M. J. L., & Stanish, W. D. (2003) · Clinical Journal of Pain · doi:10.1097/00002508-200303000-00004 · Cited by 178
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“Mann– Whitney U-tests were used to identify differences between groups for individual BBQ items.”
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“Many back pain disability prevention strategies have aimed at changing patient beliefs.(10,11) Recent evidencebased clinical practice guidelines advocate that back pain is a benign, self-limiting condition, and recommend early management strategies involving minimal medical intervention, reassurance, and advice to sta…”
BackgroundEffects of a Media Campaign on Back Beliefs is Sustained 3 Years After Its Cessation
Buchbinder, R., & Jolley, D. (2005) · Spine · doi:10.1097/01.brs.0000164121.77862.4b · Cited by 148
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MethodInformation and Low Back Pain Management
Henrotin, Y. E., Cedraschi, C., Duplan, B., Bazin, T., & Duquesnoy, B. (2006) · Spine · doi:10.1097/01.brs.0000217620.85893.32 · Cited by 142
Workplace Prevention and Musculoskeletal Injuries in Nurses
Trinkoff, A. M., BRADY, B. A., & Nielsen, K. (2003) · JONA The Journal of Nursing Administration · doi:10.1097/00005110-200303000-00006 · Cited by 129
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Self-citationMcIntosh, A., & Shaw, C. F. M. (2003) · Health Expectations · doi:10.1046/j.1369-6513.2003.00197.x · Cited by 125
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Malingering and illness deception
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“The questionnaire enquired about the following: demographics, work-related issues, co-morbidity (same questions as used in the Eurostat survey; [4]), back and other musculoskeletal pain in the last 4 weeks [12,13,19], back pain-related restriction at work and in daily life, presence or absence of leg pain [13], diffic…”
Landers, M. R., Creger, R. V., Baker, C., & Stutelberg, K. S. (2007) · Manual Therapy · doi:10.1016/j.math.2007.01.010 · Cited by 115
Mini-Intervention for Subacute Low Back Pain
Karjalainen, K. A., Malmivaara, A. V., Pohjolainen, T., Hurri, H., Mutanen, P., Rissanen, P., Pahkajärvi, H., Levon, H., Karpoff, H., & Roine, R. P. (2003) · Spine · doi:10.1097/01.brs.0000049928.52520.69 · Cited by 112
“The mini-intervention also addressed several workplace issues that have been linked to prolonged disability,(5,19) with approaches that have been effective in other studies.(12,13,20) Each patient had a discussion about work limitations, avoidance of sick leave, how to handle physically challenging work activities, wi…”
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“This finding includes the effect of rehabilitation programs on cata-strophizing, 50,52 back beliefs, 55–57 pain self-efficacy, 20,58 fear, 21,59 and depression.”
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“Seven of the studies used a quasiexperimental design (Wood 1987, Parenmark et al. 1988, Videman et al. 1989, Wollenberg 1989, Feldstein et al. 1990, 1993, Symonds et al. 1995).”
MethodResultGreek Versions of the Oswestry and Roland-Morris Disability Questionnaires
Boscainos, P. J., Sapkas, G. S., Stilianessi, E. V., Prouskas, K., & Papadakis, S. A. (2003) · Clinical Orthopaedics and Related Research · doi:10.1097/01.blo.0000068361.47147.79 · Cited by 103
The impact of chronic low back pain is partly related to loss of social role: A qualitative study
Bailly, F., Foltz, V., Rozenberg, S., Fautrel, B., & Gossec, L. (2015) · Joint Bone Spine · doi:10.1016/j.jbspin.2015.02.019 · Cited by 108
“Some educational psychosocial booklets, like the “back book” [36] could be used to decrease the negative collective image of the disease and to increase the social support of patients, to facilitate the reintegration of LBP patients in their personal environment.”
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Elfving, B., Dedering, Å., & Németh, G. (2003) · Clinical Biomechanics · doi:10.1016/s0268-0033(03)00095-0 · Cited by 90
Whiplash associated disorders: a review of the literature to guide patient information and advice
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Risk factors for back pain incidence in industry: a prospective study
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“The importance of psychosocial factors was also shown by the positive results of a psychosocial intervention consisting of an educational pamphlet designed to alter avoidance behaviours by encouraging a positive, active approach towards back pain (Symonds et al., 1995).”
BackgroundEarly identification and intervention in the prevention of musculoskeletal pain
Linton, S. J. (2002) · American Journal of Industrial Medicine · doi:10.1002/ajim.10052 · Cited by 84
Geisser, M. E., & Roth, R. S. (1998) · Journal of Occupational Rehabilitation · doi:10.1023/a:1023060616201 · Cited by 81
“Indeed, a study by Symonds ( 75 ) found that patients suffering work-related acute low back pain who received a pamphlet designed to change attitudes toward pain (e.g., pain is not harm) evidenced significantly less absenteeism from work compared to those who did not.”
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Self-Report Outcome Measures for Low Back Pain
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Evaluation of a Canadian Back Pain Mass Media Campaign
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“Beliefs about inevitable consequences of future life with low back problems were measured using the Back Pain Beliefs Questionnaire (BBQ) (Symonds et al., 1995).”
MethodUnderstanding pain sufferers: the role of cognitive processes
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A Cross-cultural Study of the Back Pain Beliefs of Female Undergraduate Healthcare Students
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“Previous researchers have demonstrated that beliefs regarding LBP in white populations can be changed through education via teaching modules,(38) media campaign,(23) or health education pamphlets.(20) However, to date this has not been investigated in the Chinese.”
BackgroundAn evaluation of prompt access to physiotherapy in the management of low back pain in primary care
Pinnington, M. A. (2004) · Family Practice · doi:10.1093/fampra/cmh406 · Cited by 71
George, S. Z., Teyhen, D. S., Wu, S. S., Wright, A. C., Dugan, J. L., Yang, G., Robinson, M. E., & Childs, J. D. (2009) · European Spine Journal · doi:10.1007/s00586-009-1016-7 · Cited by 74
“An anatomy-based education program was not appropriate for a comparison, because prior studies have demonstrated no favorable change in LBP beliefs [8, 12, 34 ].”
BackgroundResultAssociation Between Beliefs and Care-Seeking Behavior for Low Back Pain
Mannion, A. F., Wieser, S., & Elfering, A. (2013) · Spine · doi:10.1097/brs.0b013e31828473b5 · Cited by 67
Early Occupational Health Management of Patients with Back Pain
Verbeek, J. H. A. M., van der Weide, W. E., & van Dijk, F. J. H. (2002) · Spine · doi:10.1097/00007632-200209010-00006 · Cited by 66
“Moreover, there is some evidence that information leaflets for supervisors can improve sickness absence resulting from low back pain.(30) This could have led to the favorable outcome of the trial in both the intervention and reference groups.”
BackgroundWhat Affects Return to Work for Graduates of a Pain Management Program with Chronic Upper Limb Pain?
Adams, J. H., & Williams, A. C. D. C. (2003) · Journal of Occupational Rehabilitation · doi:10.1023/a:1022599731391 · Cited by 64
“While workplace interventions can achieve the reemployment of people with back pain within a year (44,45), too little is known in the United Kingdom about reemployment of longer term work-disabled CULP patients to design a specific intervention for them.”
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Psychological and functional profiles in select subjects with low back pain
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Individuals with low back pain: how do they view physical activity?
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Measures in Chiropractic Research: Choosing Patient-Based Outcome Assessments
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The Association Between Beliefs About Low Back Pain and Work Presenteeism
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Low back pain in adolescent female rowers: a multi‐dimensional intervention study
Perich, D., Burnett, A., O’Sullivan, P., & Perkin, C. (2010) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-010-1173-6 · Cited by 53
“This questionnaire has been found to be suitable for patients with LBP and also for workers with and without LBP [ 45 , 46].”
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“We used data from a representative sample of the population of Japan to study discrepancies between pain and disability in people with LBP.”
MethodInfluentialLow Back Pain Among Medical Students
Amelot, A., Mathon, B., Haddad, R., et al. (2019) · Spine · doi:10.1097/brs.0000000000003067 · Cited by 50
Kent, P. M., & Kjær, P. (2012) · Manual Therapy · doi:10.1016/j.math.2012.02.008 · Cited by 48
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Wong, W., Kwok, H. H. Y., Luk, K., Chow, Y., Mak, K., Tam, B., Wong, E., & Fielding, R. (2010) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-0575 · Cited by 42
“Conversely, a number of intervention studies show that lowering pain-related fear is associated with reduced work absence (12) and compensation costs (13), improved functional abilities (14, 15) and increased physical activity levels (16).”
BackgroundBack Pain Beliefs Are Related to the Impact of Low Back Pain in 17-Year-Olds
Smith, A. J., O’Sullivan, P., Beales, D. J., & Straker, L. M. (2012) · Physical Therapy · doi:10.2522/ptj.20110396 · Cited by 41
Is ergonomic intervention alone sufficient to limit musculoskeletal problems in nurses?
Burton, K. A., Symonds, T. L., Zinzen, E., Tillotson, K. M., Caboor, D., Roy, P. V., & Clarys, J. P. (1997) · Occupational Medicine · doi:10.1093/occmed/47.1.25 · Cited by 41
Self-citationUrquhart, D. M., Kelsall, H. L., Hoe, V. C. W., Cicuttini, F., Forbes, A. B., & Sim, M. R. (2013) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e31827ff0c0 · Cited by 40
George, S. Z., Childs, J. D., Teyhen, D. S., Wu, S. S., Wright, A. C., Dugan, J. L., & Robinson, M. E. (2007) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-8-92 · Cited by 40
Pain‐related fear at the start of a new low back pain episode
Sieben, J. M., Portegijs, P. J. M., Vlaeyen, J. W. S., & Knottnerus, J. A. (2005) · European Journal of Pain · doi:10.1016/j.ejpain.2004.12.007 · Cited by 40
The Experience of Low Back Pain in Iranian Women: A Focus Group Study
Tavafian, S. S., Gregory, D., & Montazeri, A. (2008) · Health Care For Women International · doi:10.1080/07399330701876356 · Cited by 39
George, S. Z., Bialosky, J. E., & Fritz, J. M. (2004) · Physical Therapy · doi:10.1093/ptj/84.6.538 · Cited by 38
Odéen, M., Ihlebæk, C., Indahl, A., Wormgoor, M. E. A., Lie, S. A., & Eriksen, H. R. (2013) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-013-9451-z · Cited by 37
“An educational pamphlet on advice and reasons to stay active showed promising results [42], and a non-randomized study of the precursor to the atWork intervention also had a significant effect on sick leave [23], as did an integrated care approach [43].”
BackgroundO’Sullivan, K., O’Sullivan, P., O'Sullivan, L. W., & Dankaerts, W. (2013) · Physiotherapy Practice and Research · doi:10.3233/ppr-2012-0012 · Cited by 35
Bowey, J., Davis, S., Purcell‐Jones, G., & Watson, P. (2010) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e3181ffc00b · Cited by 34
Beales, D. J., Fried, K., Nicholas, M. K., Blyth, F., Finniss, D. G., & Moseley, G. L. (2016) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2016.08.011 · Cited by 37
Chaory, K., Rannou, F., Fermanian, J., et al. (2004) · Annales de Réadaptation et de Médecine Physique · doi:10.1016/j.annrmp.2003.10.007 · Cited by 32
Development of a Pain and Discomfort Module for Use with the WHOQOL-100
Mason, V. L., Skevington, S. M., & Osborn, M. (2004) · Quality of Life Research · doi:10.1023/b:qure.0000031344.53009.eb · Cited by 32
Traduction française et adaptation culturelle du « back book »
Coudeyre, E., Givron, P., Grémeaux, V., Lavit, P., Hérisson, C., Combe, B. G., Burton, K. A., & Poiraudeau, S. (2003) · Annales de Réadaptation et de Médecine Physique · doi:10.1016/j.annrmp.2003.02.001 · Cited by 31
Self-citationNegative beliefs about low back pain are associated with persistent high intensity low back pain
Ng, S. K., Cicuttini, F., Wang, Y., Wluka, A. E., Fitzgibbon, B. M., & Urquhart, D. M. (2016) · Psychology Health & Medicine · doi:10.1080/13548506.2016.1220602 · Cited by 30
“The questionnaire has been reported to have good internal consistency (Cronbach = .7) and test–retest reliability (ICC = .87; Symonds et al., 1995).”
Background
Metadata
- Authors
- Symonds, T. L., Burton, A. K., Tillotson, K. M., & Main, C. J.
- Affiliations
- University of Huddersfield (GB)
- Salford Royal NHS Foundation Trust (GB)
- Corresponding author
- Symonds, Tara L.
- Tillotson, K. Malcolm
- Venue
- Spine
- Published
- 1995-12
- Volume
- 20
- Issue
- 24
- Pages
- 2738-2745
- ISSN
- 0362-2436 (ISSN-L)
- OpenAlex
- W2080043403
- Cited by
- 193
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2022: 1 · 2021: 4 · 2020: 1 · 2019: 4 · 2018: 2 · 2017: 5 · 2016: 6 · 2015: 6 · 2014: 6 · 2013: 8 · 2012: 8
- FWCI
- 3.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Spine (publishedVersion)
- PubMed (publishedVersion)
- University of Huddersfield Repository (University of Huddersfield) (submittedVersion)
- Huddersfield Research Portal (University of Huddersfield) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- low back pain, absenteeism, psychosocial interventions, health education leaflets, avoidance behavior, pain beliefs, locus of control, work loss, industrial workers, chronic pain
- MeSH terms
- Absenteeism, Adult, Fear, Health Surveys, Humans, Pamphlets, Surveys and Questionnaires, Social Support, Time Factors, Work, Low Back Pain, Workplace
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