Factors predicting return to work in patients with chronic low back pain

Abstract

Objective: The present study aimed to identify the main factors influencing successful return to work (RTW) in patients with chronic low back pain. Materials and Methods: The study included 120 participants aged 25–60 years diagnosed with chronic lumbar pain who completed a three-month rehabilitation program. Physical function was assessed using the Oswestry Disability Index (ODI), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), fear of movement using the Tampa Scale of Kinesiophobia (TSK), and pain catastrophizing using the Pain Catastrophizing Scale (PCS). Interviews were conducted to evaluate work motivation, employer support, and job characteristics. Results: Six months after completion of the program, 68.3% of participants had returned to work. Significant improvement was observed in all measured parameters (p < 0.01). The strongest negative correlations with RTW were found for fear of movement (r = –0.54) and catastrophizing (r = –0.48), while positive correlations were identified for employer support (r = 0.46) and self-rated work ability (r = 0.49). Multiple regression analysis confirmed that low levels of kinesiophobia, high self-efficacy, and organizational support were independent predictors of successful return to work. Conclusion: The findings demonstrate that, beyond physical factors, psychological and social variables play a crucial role in occupational reintegration among patients with chronic low back pain. Low recovery expectations, fear of recurrence, and lack of workplace support represent major barriers, whereas high self-efficacy, workplace adaptation, and collaboration between the patient, employer, and healthcare professionals facilitate successful return to work. Individualized interventions and early identification of high-risk groups may improve long-term outcomes and quality of life.