CoChat
Sign Up
Cited by 123Musculoskeletal pain and rehabilitationWorkplace Health and Well-beingMedical Practices and Rehabilitation

Staying at work with chronic nonspecific musculoskeletal pain: a qualitative study of workers' experiences

Open access
de Vries, Haitze J, Brouwer, Sandra, Groothoff, Johan W, Geertzen, Jan HB, Reneman, Michiel F·2011·BMC Musculoskeletal Disorders
DOI 10.1186/1471-2474-12-126PMC PMC3121659
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Many people with chronic nonspecific musculoskeletal pain (CMP) have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study was to explore why people with CMP stay at work despite pain (motivators) and how they manage to maintain working (success factors). METHODS: A semi-structured interview was conducted among 21 subjects who stay at work despite CMP. Participants were included through purposeful sampling. Interviews were audio-recorded, transcribed verbatim, and imported into computer software Atlas.ti. Data was analyzed by means of thematic analysis. The interviews consisted of open questions such as: "Why are you working with pain?" or "How do you manage working while having pain?" RESULTS: A total of 16 motivators and 52 success factors emerged in the interviews. Motivators were categorized into four themes: work as value, work as therapy, work as income generator, and work as responsibility. Success factors were categorized into five themes: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs. CONCLUSIONS: Personal characteristics, well-developed self-management skills, and motivation to work may be considered to be important success factors and prerequisites for staying at work, resulting in behaviors promoting staying at work such as: raising adjustment latitude, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. Motivators and success factors for staying at work may be used for interventions in rehabilitation and occupational medicine, to prevent absenteeism, or to promote a sustainable return to work. This qualitative study has evoked new hypotheses about staying at work; quantitative studies on staying at work are needed to obtain further evidence.

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative study explored why workers with chronic nonspecific musculoskeletal pain (CMP) stay at work despite pain and how they manage to do so. It identified 16 motivators and 52 success factors, organized into four motivator themes and five success-factor themes.

Key findings

  • Among 21 workers with CMP (9 male, 12 female), interviews yielded 16 motivators grouped as work as value, work as therapy, work as income generator, and work as responsibility.
  • Interviews also yielded 52 success factors grouped as personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs.
  • Participants had mean current pain intensity 4.5 (SD 1.9) and average pain 5.3 (SD 1.7) on an 11-point NRS; mean Pain Disability Index was 20.3 (SD 8.2), and mean occupational PDI was 3.7 (SD 1.5).
  • Most participants had pain for more than 5 years (18/21, 86%) and no work absence due to CMP in the previous year (17/21, 81%).

Methods

  • Individual semi-structured interviews lasting 45–90 minutes were conducted with 21 participants with CMP, recruited by purposeful sampling from the “Working with Pain” study; inclusion required CMP >6 months, age 20–60, employment ≥20 hours/week for 12 months prior, and CMP-related absence ≤5% of potential working hours.
  • Interviews were audio-recorded, transcribed verbatim, imported into Atlas.ti, and analyzed using thematic analysis guided by the questions “why” and “how”; coding was done independently by the first and second authors, with consultation and peer debriefing.
  • Data collection continued until saturation, which was reached after 21 participants; pain intensity was measured with an 11-point numeric rating scale and disability with the Pain Disability Index.

Limitations

  • Stated by the authors: no participants aged 20–30 were included, and most had pain for more than 5 years, so conclusions may be less generalizable to younger people or those with a shorter pain history.
  • Stated by the authors: the Dutch social security system is relatively generous, so generalization to countries with less generous systems is uncertain; participants were selected because they stayed at work despite CMP, and their mean occupational PDI was 3.7, so results cannot simply be generalized to return-to-work populations, and comparison with workers who did not stay at work would have strengthened the results.
  • Evident from the text: recruitment through newspaper and patient-association announcements may have selected a self-motivated sample, and the qualitative cross-sectional design cannot establish causal relationships.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1471-2474-12-126

Cites

61 of 61 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 58 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The second research question resulted in five themes of success factors: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs.

    “The second research question,”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Workers who stay at work despite chronic nonspecific musculoskeletal pain are a successful group.
  • Findingown data

    Diminished capacity for spare time activities such as sports, gardening, or social events was a negative consequence of staying at work despite pain.

    “Diminished capacity for spare time activities such as sports, gardening, or social events was one.”
    Quote in the paperNot a substantial claim
  • Findingown data

    A few participants said their threshold of pain diminished as the pain lasted longer.

    “A few participants said their threshold of pain diminished as the pain lasted longer.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants who stay at work with pain placed a high value on working.

    “Participants who stay at work with pain placed a high value on working.”
    Quote in the paperSubstantial claim
  • Findingown data

    For most participants a secure income appeared to be a strong motivator to stay at work with CMP.

    “For most participants a secure income appeared to be a strong motivator to stay at work with CMP.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 40
  • Classified as probably not a substantial claim. 39

  • May combine two claims.

    Findingown data

    Participants stated that staying at work (SAW) had both positive and negative consequences.

    “Participants stated that SAW had both positive and negative consequences.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Many participants experienced their work as being a place for healing and recovering, and indicated that work increased their mental and physical well-being.

    “Many participants experienced their work as being a place for healing and recovering. They indicated that work increased their mental and physical well-being.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Remaining active was experienced as promoting coping style for SAW by most of the participants, preventing deconditioning.

    “Remaining active was experienced as promoting coping style for SAW by most of the participants, preventing deconditioning.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Within the group of participants the answers turned out to be divergent.

    “Within the group of participants the answers turned out to be divergent.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Other participants avoided provocative movements, carefully taking notice of the pain and understanding the heightening pain level as a signal to stop overworking themselves.

    “Other participants avoided provocative movements, carefully taking notice of the pain and understanding the heightening pain level as a signal to stop overworking themselves.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    A negative effect on one's private life and decreased quality of work was a negative consequence of staying at work despite pain.

    “A negative effect on one's private life and decreased quality of work was another.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Modifications at work enabled workers with CMP to stay at work, and these modifications were made at different levels: by changing jobs, by retraining to fulfill alternative tasks, and by organizing their work in terms of flexible working hours, more flexible work, adjusted work, short-time working, ergonomic adjustments, or having a more suitable work content.

    “It appeared that modifications at work enabled workers with CMP to stay at work, and that these modifications were made at different levels: by changing jobs, by retraining to fulfill alternative tasks, and by organizing their work in terms of flexible working hours, more flexible work, adjusted work, short-time working, ergonomic adjustments, or having a more suitable work content.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Most participants had strong feelings of responsibility and kept on working despite pain.

    “Most participants had strong feelings of responsibility and kept on working despite pain.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Some participants were disappointed in healthcare, while others stated that healthcare services helped them to stay at work.

    “Although some participants indicated that they were disappointed in healthcare, others stated that healthcare services helped them to stay at work.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Being communicative, assertive, or self-confident helped participants to ask for support, to set their limits, to balance load and capacity, to communicate their needs to the employer, and to initiate work modifications.

    “Being communicative, assertive, or self-confident helped participants to ask for support, to set their limits, to balance load and capacity, to communicate their needs to the employer, and to initiate work modifications.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Being at work generated social contacts; it may prevent feelings of loneliness.

    “Being at work generated social contacts; it may prevent feelings of loneliness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Support from others was often mentioned as a success factor for SAW, for instance, with the spouse or children taking over housework, the extended family helping with the babysitting, and the manager or the employer allowing flexible working hours.

    “Support from others was often mentioned as a success factor for SAW, for instance, with the spouse or children taking over housework, the extended family helping with the babysitting, and the manager or the employer allowing flexible working hours.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Most motivators for SAW were labeled as positive and were seen as stimulants for participants to stay at work.

    “Most motivators for SAW were labeled as positive (Figure 1), and were seen as stimulants for participants to stay at work.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants reported a variety of styles in coping with pain: some promoting and others hindering SAW.

    “Participants reported a variety of styles in coping with pain: some promoting and others hindering SAW.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In their work, participants found recognition and approval, self-realization, and self-respect.

    “In their work, participants found recognition and approval, self-realization, and self-respect.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    Most participants were able to answer the question about what other workers with CMP on sick leave could learn from them, revealing their personal success factors.

    “Most participants were able to answer this question, revealing their personal success factor in the process:”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Workers who stay at work despite chronic nonspecific musculoskeletal pain are a successful group.

  • May combine two claims.

    Findingown data

    Most participants evaluated their threshold of pain as above average, which enabled them to act despite pain.

    “Most participants evaluated their threshold of pain as above average, which enabled them to act despite pain.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Reassuring advice by physicians to keep exercising despite pain, manual therapy or physiotherapy, and rehabilitation therapy made it easier for participants to stay at work.

    “Reassuring advice by physicians to keep exercising despite pain, manual therapy or physiotherapy, and rehabilitation therapy all made it easier for participants to stay at work.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    A total of 16 motivators and 52 success factors emerged in the interviews.

    “A total of 16 motivators and 52 success factors emerged in the interviews.”
    • Also stated in: § Results · plain
      “A total of four themes of motivators (work as value, work as therapy, work as income generator and work as responsibility) and five themes of success factors (personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs) were recorded in the interviews.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The score on the occupational parameter of the PDI was on average 3.7 (scale 0-10), indicating an almost moderate level of occupational disability.

    “Apparently, their pain did not lead to strong disability; the score on the occupational parameter of the PDI was on average 3.7 (scale 0-10), indicating an almost moderate level of occupational disability.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants had taken upon themselves the responsibility to change and had taken chances at the appropriate moment.

    “Participants had taken upon themselves the responsibility to change and had taken chances at the appropriate moment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Most participants appeared to self-manage their challenges, take responsibility for themselves, and scored high on self-efficacy, although this did not always mean that they had been acting entirely on their own.

    “Most participants appeared to self-manage their challenges, take responsibility for themselves, and scored high on self-efficacy, although this did not always mean that they had been acting entirely on their own.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The results indicate that a variety of factors are relevant for SAW, which is in accordance with the disability prevention management model of Loisel and colleagues.

    “Our results indicate that a variety of factors are relevant for SAW, which is in accordance with the disability prevention management model of Loisel and colleagues [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Loisel P, Durand MJ, Berthelette D, Vezina N, Baril R, Gagnon D, Lariviere C, Tremblay C: Disability prevention - New paradigm for the management of occupational back pain. Disease Management & Health Outcomes. 2001, 9: 351-360. 10.2165/00115677-200109070-00001. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The behaviors promoting SAW were increasing adjustment latitude, improving coping strategies, organizing work modifications, making use of healthcare services, and asking for support.

    “Those behaviors promoting SAW were: increasing adjustment latitude, improving coping strategies, organizing work modifications, making use of healthcare services, and asking for support.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Workers who stay at work despite chronic nonspecific musculoskeletal pain are a successful group.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The influence of CMP on the degree of employee absenteeism and disability allowances is high.

    “The influence of CMP on the degree of employee absenteeism and disability allowances is high [1-3].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] Andersson GBJ: Epidemiological features of chronic low-back pain. Lancet. 1999, 354: 581-585. 10.1016/S0140-6736(99)01312-4. source

      Not checked in the free run.

    • cites [2] Bloch FS, Prins R: Social security, work incapacity, and reintegration. Who returns to work and why. A six country study on work incapacity & reintegration. Edited by: Bloch FS, Prins R. 2000, New Brunswick: Transaction Publishers, 5: 9-25.

      Not checked in the free run.

    • cites [3] Picavet HS, Schouten JS: Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003, 102: 167-178. 10.1016/s0304-3959(02)00372-x. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    A purposeful sampling strategy was used to ensure that the sample consisted of a rich mixture of different perspectives according to gender, age, social background, and occupation.

    “A purposeful sampling strategy was used to ensure that the sample consisted of a rich mixture of different perspectives according to gender, age, social background, and occupation [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Malterud K: Qualitative research: standards, challenges, and guidelines. Lancet. 2001, 358: 483-488. 10.1016/S0140-6736(01)05627-6. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other authors agree that further exploration into this underreported and unknown group is needed.

    “Other authors agree that further exploration into this underreported and unknown group is needed [11,12].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11] Engstrom LG, Janson S: Predictors of work presence--sickness absence in a salutogenic perspective. Work. 2009, 33: 287-295. source

      Not checked in the free run.

    • cites [12] Turk DC, Okifuji A: Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 2002, 70: 678-690. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Most people with chronic disorders such as rheumatoid arthritis, diabetes mellitus, or COPD and asthma also stay at work.

    “This is not unique for CMP, for in cases of chronic disorders such as rheumatoid arthritis, diabetes mellitus, or COPD and asthma, most people also stay at work [7,8].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Backman CL: Employment and work disability in rheumatoid arthritis. Curr Opin Rheumatol. 2004, 16: 148-152. 10.1097/00002281-200403000-00014. source

      Not checked in the free run.

    • cites [8] Varekamp I, Verbeek JH, van Dijk FJ: How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective. Int Arch Occup Environ Health. 2006, 80: 87-97. 10.1007/s00420-006-0112-9. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Validity and utility of the 11-point NRS is sufficient and it is responsive to changes in individuals.

    “Validity and utility of the 11-point NRS is sufficient and it is responsive to changes in individuals [20-22].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [20] Jensen MP, Karoly P, Braver S: The Measurement of Clinical Pain Intensity - a Comparison of 6 Methods. Pain. 1986, 27: 117-126. 10.1016/0304-3959(86)90228-9. source

      Not checked in the free run.

    • cites [21] Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM: Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001, 94: 149-158. 10.1016/S0304-3959(01)00349-9. source

      Not checked in the free run.

    • cites [22] Childs JD, Piva SR, Fritz JM: Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976). 2005, 30: 1331-1334. 10.1097/01.brs.0000164099.92112.29. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Topics of relevance were developed at an expert meeting attended by occupational, rehabilitation, and insurance physicians; a healthcare psychologist; an expert on labor; and a patient representative.

    “Topics of relevance were developed at an expert meeting attended by occupational, rehabilitation, and insurance physicians; a healthcare psychologist; an expert on labor; and a patient representative.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The interview topics were tested in a trial by way of seven interviews, after which the interview guide was altered slightly, and some new topics were added.

    “These topics were tested in a trial by way of seven interviews, after which the interview guide was altered slightly, and some new topics were added (Additional file 1: Questions 4, 17, 18, 20, and 29).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The background of the second author was complementary to the knowledge of the first author, giving the opportunity to analyze the data from different perspectives.

    “The background of the second author, who had a great deal of experience in work and health research, was complementary to the knowledge of the first author. This gave us the opportunity to analyze the data from different perspectives.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Feeling the desire to stay at work may be an important success factor and a prerequisite for SAW despite pain.

    “Feeling the desire to stay at work may be recognized as being an important success factor and a prerequisite for SAW despite pain.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Agreement was reached on the naming and defining of the preliminary emerged codes.

    “Agreement was reached on the naming and defining of the preliminary emerged codes.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The sample was considered saturated when no new themes emerged from the gathered data.

    “The sample was considered saturated when no new themes emerged from the gathered data [34].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Kuper A, Reeves S, Levinson W: An introduction to reading and appraising qualitative research. BMJ. 2008, 337: a288-10.1136/bmj.a288. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    An experienced psychologist was consulted about the coding.

    “An experienced psychologist was consulted about the coding.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Participants in the study felt the need to stay at work, which seemed to encourage them to find ways to be able to stay at work.

    “In general, participants in our study felt the need to stay at work, which seemed to encourage them to find ways to be able to stay at work.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Peer debriefing, audit trail, and verbatim quotes were used to ensure that participants' personal perceptions were analyzed, and not the personal beliefs of the investigators.

    “Peer debriefing, audit trail, and verbatim quotes were used to ensure that participants' personal perceptions were analyzed, and not the personal beliefs of the investigators [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Giacomini MK, Cook DJ: Users' guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 2000, 284: 357-362. 10.1001/jama.284.3.357. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Feedback on objectivity was given by an experienced psychologist during three pilot interviews, conducted independently from the study sample, to avoid the risk of the first author acting as a therapist.

    “To avoid this risk, feedback on objectivity was given by an experienced psychologist during three pilot interviews, conducted independently from the study sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    At first, the transcribed interviews were read and open-coded by the first and second author, independently.

    “At first, the transcribed interviews were read and open-coded by the first and second author, independently.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Anonymity, confidentiality, and the right to withdraw from the study at all times were guaranteed.

    “Anonymity, confidentiality, and the right to withdraw from the study at all times were guaranteed.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    No explicit theoretical framework was used in the construction of the interview so as to enable participants to speak for themselves without theoretical constraints imposed by the interviewer and also to set no limitations on the interviewer's mindset.

    “For that reason, no explicit theoretical framework was used in the construction of the interview so as to enable participants to speak for themselves without theoretical constraints imposed by the interviewer and also to set no limitations on the interviewer's mindset.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Linton and Buer have suggested enlisting the help of workers who managed to successfully cope with CMP to teach their absentee colleagues.

    “Linton and Buer have suggested enlisting the help of workers who managed to successfully cope with CMP to”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Linton SJ, Buer N: Working despite pain: Factors associated with work attendance versus dysfunction. Int J Behav Med. 1995, 2: 252-262. 10.1207/s15327558ijbm0203_4. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Reliability and validity of the PDI are supported by the literature.

    “Reliability and validity of the PDI are supported by the literature [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Tait RC, Chibnall JT, Krause S: The Pain Disability Index: psychometric properties. Pain. 1990, 40: 171-182. 10.1016/0304-3959(90)90068-O. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The analyses were completed by the interviewer in close collaboration with the second author (SB).

    “The analyses were completed by the interviewer in close collaboration with the second author (SB).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    In a further attempt to minimize the risk of observer bias, the interviews were also analyzed by the second author.

    “In a further attempt to minimize the risk of observer bias, the interviews were also analyzed by the second author.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Workers who were not able to stay at work may have other motives in life that overpower the motivation to stay working.

    “Contrary to what was investigated in our study, workers who were not able to stay at work may have other motives in life, overpowering the motivation to stay working [27,29].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [27] Berglind H, Gerner U: Motivation and return to work among the long-term sicklisted: an action theory perspective. Disabil Rehabil. 2002, 24: 719-726. 10.1080/09638280210124301. source

      Not checked in the free run.

    • cites [29] Nicholson N: Absence Behaviour and Attendance Motivation: a Conceptual Synthesis. JMS. 1977, 14: 231-252.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All participants signed an informed consent form.

    “All participants signed an informed consent form.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The transcribed text was verified and corrected by the interviewer.

    “The transcribed text was verified and corrected by the interviewer.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The interview guide guaranteed that no information was overlooked, whereas the semi-structured format also made allowances for spontaneous interaction.

    “The interview guide guaranteed that no information was overlooked, whereas the semi-structured format also made allowances for spontaneous interaction.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The first author's 12 years of experience in a rehabilitation clinic made communication with the participants easier.

    “The first author, who did the interviews, has worked in a rehabilitation clinic for 12 years, and so was familiar with the phenomenon of chronic pain management. This experience made communication with the participants easier.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Many success factors identified in the study can be put into practice by the workers themselves, yet sometimes people need help in finding alternative behaviors in order to stay working.

    “It is obvious, however, that many success factors identified in our study can be put into practice by the workers themselves; yet sometimes people need help in finding alternative behaviors in order to stay working.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Data were analyzed continuously until the point of saturation was reached.

    “Data were analyzed continuously until the point of saturation was reached.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    People without the appropriate motivation or personal characteristics for promoting coping are bound to have more difficulties finding or developing strategies promoting RTW or SAW.

    “People without the appropriate motivation or personal characteristics for promoting coping are bound to have more difficulties finding or developing strategies promoting RTW or SAW.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was judged and approved by the Medical Ethical Committee of the University Medical Center of Groningen.

    “The study was judged and approved by the Medical Ethical Committee of the University Medical Center of Groningen.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Strategies and competency leading to SAW can be trained or taught.

    “Strategies and competency leading to SAW can be trained or taught.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The study offers an overview of many motivators and success factors for SAW as experienced by participants with CMP.

    “The strength of our study is that it offers an overview of many motivators and success factors for SAW as experienced by participants with CMP.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    These behaviors are modifiable and can be influenced by the workers themselves.

    “These behaviors are modifiable and can be influenced by the workers themselves.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    Since workers aged over 45 years more frequently call in sick, the sample still seems to be representative.

    “Since workers aged over 45 years more frequently call in sick, our sample still seems to be representative [3,58].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] Picavet HS, Schouten JS: Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003, 102: 167-178. 10.1016/s0304-3959(02)00372-x. source

      Not checked in the free run.

    • cites [58] Broersen JP, de Zwart BC, van Dijk FJ, Meijman TF, van Veldhoven M: Health complaints and working conditions experienced in relation to work and age. Occup Environ Med. 1996, 53: 51-57. 10.1136/oem.53.1.51. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    It is difficult to fit all self-experienced determinants for SAW retrieved in the study into one of the existing models, although models which stress the multi-causality of work participation seem to be the most suitable.

    “It is difficult to fit all self-experienced determinants for SAW retrieved in our study into one of these models, although models which stress the multi-causality of work participation seem to be the most suitable.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The themes of motivation Work as income and Work as responsibility have also been described in the Illness Flexibility Model by Johansson and Lundberg.

    “The themes of motivation”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Johansson G, Lundberg I: Adjustment latitude and attendance requirements as determinants of sickness absence or attendance. Empirical tests of the illness flexibility model. Soc Sci Med. 2004, 58: 1857-1868. 10.1016/S0277-9536(03)00407-6. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Attention was paid to credibility, transferability, dependability and confirmability.

    “Attention was paid to credibility, transferability, dependability and confirmability [33,57].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] Giacomini MK, Cook DJ: Users' guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 2000, 284: 357-362. 10.1001/jama.284.3.357. source

      Not checked in the free run.

    • cites [57] Mays N, Pope C: Qualitative research in health care. Assessing quality in qualitative research. BMJ. 2000, 320: 50-52. 10.1136/bmj.320.7226.50. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductreasoning

    A comparison with workers who were not able to stay at work would have lent more weight to the results.

    “A comparison with workers who were not able to stay at work would have lent more weight to the results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Sick leave has been linked to motivation, stress and coping, the balance between work demands and capacity, adaptation, or a combination of these.

    “Sick leave has been linked to motivation [26,27,29,42,50,51], to stress and coping [25,52], to the balance between work demands and capacity [28,31], to adaptation [30], or to a combination of these [32].”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [26] Aronsson G, Gustafsson K: Sickness presenteeism: prevalence, attendance-pressure factors, and an outline of a model for research. J Occup Environ Med. 2005, 47: 958-966. 10.1097/01.jom.0000177219.75677.17. source

      Not checked in the free run.

    • cites [27] Berglind H, Gerner U: Motivation and return to work among the long-term sicklisted: an action theory perspective. Disabil Rehabil. 2002, 24: 719-726. 10.1080/09638280210124301. source

      Not checked in the free run.

    • cites [29] Nicholson N: Absence Behaviour and Attendance Motivation: a Conceptual Synthesis. JMS. 1977, 14: 231-252.

      Not checked in the free run.

    • cites [42] Johansson G, Lundberg I: Adjustment latitude and attendance requirements as determinants of sickness absence or attendance. Empirical tests of the illness flexibility model. Soc Sci Med. 2004, 58: 1857-1868. 10.1016/S0277-9536(03)00407-6. source

      Not checked in the free run.

    • cites [50] Rhodes S, Steers R: A systematic approach to diagnosing employee absenteeism. Employee Relations. 1993, 3: 17-22. source

      Not checked in the free run.

    • cites [51] Thulesius HO, Grahn BE: Reincentivizing--a new theory of work and work absence. BMC Health Serv Res. 2007, 7: 100-10.1186/1472-6963-7-100. source

      Not checked in the free run.

    • cites [25] Antonovsky A: Health, Stress, and Coping: new perspectives on mental and physical health. 1979, San Francisco: Jossey-Bass

      Not checked in the free run.

    • cites [52] French JR, Caplan RD: Organizational stress and individual strain. The failure of success. Edited by: Marrow AJ. 1972, New York: Amacon, 31-66.

      Not checked in the free run.

    • cites [28] Karasek RA: Job Demands, Job Decision Latitude, and Mental Strain - Implications for Job Redesign. Adm Sci Q. 1979, 24: 285-308. 10.2307/2392498. source

      Not checked in the free run.

    • cites [31] van Dijk FJH, Dormolen M, Kompier MAJ, Meijman TF: Re-evaluation of the model work demands-capacity (in Dutch). Tijdschrift voor Sociale Gezondheidszorg. 1990, 68: 3-10.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Successful workers only had a few suggestions and often were not fully aware of their own coping strategies.

    “It appeared, however, that these successful workers only had a few suggestions and often were not fully aware of their own coping strategies [37].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Linton SJ, Buer N: Working despite pain: Factors associated with work attendance versus dysfunction. Int J Behav Med. 1995, 2: 252-262. 10.1207/s15327558ijbm0203_4. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Whether generalization of these results to countries with less generous social security systems is possible is uncertain because the relative weight of financial incentives may be stronger.

    “Whether generalization of these results to countries with less generous social security systems is possible is uncertain: the relative weight of financial incentives may be stronger.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The Dutch social security system is relatively generous.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent studies indicate that in addition to workers' personal factors, environmental factors such as job characteristics, work modifications, involved stakeholders, and the compensation system are of upmost importance for SAW and RTW.

    “Recent studies indicate that in addition to workers' personal factors (workers' characteristics, health, and medical care), environmental factors such as job characteristics, work modifications, involved stakeholders, and the compensation system are of upmost importance for SAW and RTW [54-56].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [54] Anema JR, Schellart AJ, Cassidy JD, Loisel P, Veerman TJ, van der Beek AJ: Can cross country differences in return-to-work after chronic occupational back pain be explained? An exploratory analysis on disability policies in a six country cohort study. J Occup Rehabil. 2009, 19: 419-426. 10.1007/s10926-009-9202-3. source

      Not checked in the free run.

    • cites [55] Loisel P, Buchbinder R, Hazard R, Keller R, Scheel I, van Tulder M, Webster B: Prevention of work disability due to musculoskeletal disorders: the challenge of implementing evidence. J Occup Rehabil. 2005, 15: 507-524. 10.1007/s10926-005-8031-2. source

      Not checked in the free run.

    • cites [56] Carroll C, Rick J, Pilgrim H, Cameron J, Hillage J: Workplace involvement improves return to work rates among employees with back pain on long-term sick leave: a systematic review of the effectiveness and cost-effectiveness of interventions. Disabil Rehabil. 2010, 32: 607-621. 10.3109/09638280903186301. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many workers in a work rehabilitation trajectory were ready to accept the idea that the pain might never disappear and were willing to learn how to deal with this reality.

    “Many workers were ready to accept the idea that the pain might never disappear and they were willing to learn how to deal with this reality [49].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Coutu MF, Baril R, Durand MJ, Cote D, Rouleau A, Cadieux G: Transforming the meaning of pain: an important step for the return to work. Work. 2010, 35: 209-219. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    In present-day pain management programs, pain acceptance is increasingly achieved by paying less attention to the pain by focusing on themes that are really important in life.

    “In present-day pain management programs, pain acceptance is increasingly achieved by paying less attention to the pain by focusing on themes that are really important in life [47,48].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [47] Hayes SC, Strosahl KD, Kelly GW: Acceptance and Comitment Therapy: An Experimental Approach to behavior change. 1999, New York: The Guilford Press

      Not checked in the free run.

    • cites [48] Vowles KE, McCracken LM: Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. J Consult Clin Psychol. 2008, 76: 397-407. source

      Not checked in the free run.

69 of 69

  • The paper relies on this without support.

    Knowledge about workers who stay at work despite chronic pain is limited.

    “Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation.”
    “Understanding workers who stay at work despite pain is limited.”

  • The paper relies on this without support.

    A qualitative study of SAW in working men and women with CMP is not yet available.

    “However, a qualitative study of SAW in working men and women with CMP is not yet available.”

  • The paper relies on this without support.

    Each explanatory model of sick leave and work attendance has shortcomings.

    “Each model seems to have shortcomings.”

  • The paper relies on this without support.

    The Dutch social security system is relatively generous.

    “In the Netherlands the system of social security is a relatively generous one.”

  • The paper relies on this without support.

    Workers who stay at work despite chronic nonspecific musculoskeletal pain are a successful group.

    “Because of the aim of our study, which was to learn from a successful group of workers, we selected workers who worked despite CMP.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Employment is associated with both economical and psychological well-being for patients with chronic pain.

    “Employment is associated with both economical and psychological well-being for patients with chronic pain.28–32”

    From Does work have to be so painful? A review of the literature examining the effects of fibromyalgia on the working experience from the patient perspective (2020) · cites this paper as [28]

    The Results (Motivators for staying at work; page not provided) describe income as a reason to keep working and report that participants felt work improved their mental well-being. The claim extends those experiences among workers with chronic nonspecific musculoskeletal pain to patients with chronic pain generally; the Discussion (Strengths and limitations; page not provided) cautions against generalizing the study's results to other work-status populations. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Average pain score is below the minimum implied by its categories

    Major

    Even if every participant scored at the bottom of their reported category, the mean would be 5.62, not 5.3. The reported mean is therefore incompatible with the category counts.

    Reported 5.3 · recomputed 5.619048

  • Journalist percentage does not round from the reported count

    Minor

    One of 21 participants is 4.76%, which rounds to 5%, not the reported 4%.

    Reported 4 · recomputed 4.761905

2 of 2

Cites

Flagged first, then by citations

1 of the 62 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Bloch FS, Prins R: Social security, work incapacity, and reintegration. Who returns to work and why. A six country study on work incapacity & reintegration. Edited by: Bloch FS, Prins R. 2000, New Brunswick: Transaction Publishers, 5: 9-25.
  2. Central Statistics office: Sickness absence stabilizing last years. 2010, Dutch: Centraal Bureau voor Statistiek. Ziekteverzuim laatste jaren stabiel. CBS-publications
  3. Engers AJ, Koke A, Torenbeek M: Nederlandse Dataset Pijnrevalidatie. 2007, Hoensbroek: Stichting Revalidatie Limburg
  4. Antonovsky A: Health, Stress, and Coping: new perspectives on mental and physical health. 1979, San Francisco: Jossey-Bass

Cited by

Sorted by citations

Related

Authors
de Vries, H. J., Brouwer, S., Groothoff, J. W., Geertzen, J. H., & Reneman, M. F.
Affiliations
University Medical Center Groningen (NL)
ORCID
Venue
BMC Musculoskeletal Disorders
Publisher
Springer Science and Business Media LLC
Published
2011-06-03
Volume
12
Issue
1
Pages
126-126
ISSN
1471-2474 (ISSN-L)
DOI
10.1186/1471-2474-12-126
PMC
PMC3121659
OpenAlex
W2022479636
Semantic Scholar
c353fa2ec1746815f4f9b6f47a4be3ebb5bcf16a
Cited by
123
References
62
Citations by year
2026: 2 · 2025: 5 · 2024: 3 · 2023: 8 · 2022: 4 · 2021: 12 · 2020: 14 · 2019: 9 · 2018: 7 · 2017: 7 · 2016: 10 · 2015: 13 · 2014: 8 · 2013: 9 · 2012: 9
FWCI
6.32
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Musculoskeletal Disorders (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
Funders
Instituut Gak
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords
work participation, return to work, employee motivation, pain coping, self-management, pain beliefs, health care utilization, work modification, absenteeism prevention, occupational medicine
MeSH terms
Absenteeism, Adaptation, Psychological, Adult, Chronic Disease, Employment, Female, Humans, Income, Interviews as Topic, Job Satisfaction, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Motivation, Musculoskeletal Diseases, Netherlands, Pain, Social Desirability, Social Responsibility, Health Behavior, Occupational Health, Pain Threshold, Qualitative Research, Young Adult, Pain Management

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review