Chronic pain (CP) is detrimental to physical and psychological function frequently resulting in work-absence which in turn is associated with reduced wellbeing. Patients with negative cognitive representations of pain are less likely to engage in re-employment oriented activities.
OBJECTIVE:
To explore patients’ beliefs and attitudes towards return to work (RTW) and understand how these may impact on RTW readiness.
METHODS:
Patients attending a 3-week high intensity pain management rehabilitation programme (PMP) at the Royal National Orthopaedic Hospital were recruited to participate in semi-structured focus group discussions. The sample consisted of 17 patients (M:F 8:9, age range 18–65+ years). Data was digitally recorded and transcribed verbatim to permit a thematic analysis.
RESULTS:
Four superordinate themes emerged from the data: (1) living with CP, (2) the fine balance between CP and RTW, (3) work is a beautiful thing... when you have it and (4) the luck of the draw. The first two imparted patients’ coping strategies towards maintaining employment or RTW. The second two reflected participants’ cognitions on factors that facilitate or obstruct RTW.
CONCLUSIONS:
The need for vocational support in chronic pain rehabilitation programmes was identified. Several recommendations are presented for vocational rehabilitation intervention targets.
AdamsJ. H., & WilliamsA. C. (2003). What affects return-to-work for graduates of a pain management program with chronic upper limb pain?Journal of Occupational Rehabilitation, 13(2), 91–106.
2.
AndersenG. J. (2002). Coping with long-term unemployment: Economic security, labour market integration and well-being. Results from a Danish panel study, 1994-1999. International Journal of Social Welfare, 11(3), 178–90.
3.
BraunV., & ClarkeV. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.
4.
British Society of Rehabilitation Medicine. (2000). Vocational Rehabilitation: TheWay Forward (2nd Edition): Working Party Report.
5.
BrouwerS., FrancheR. L., Hogg-JohnsonS., LeeH., KrauseN., & ShawW. S. (2011). Return-to-work self-efficacy: Development and validation of a scale in claimants with musculoskeletal disorders. Journal of Occupational Rehabilitation, 21, 244–258.
CoutuM. F., BarilR., DurandM. J., CôtéD., RouleauA., & CadieuxG. (2010). Transforming the meaning of pain: An important step for the return to work. Work: A Journal of Prevention, Assessment and Rehabilitation, 35(2), 209–219.
8.
DionneC. E., BourbonnaisR., FrémontP., RossignolM., StockS. R., & LarocqueI. (2005). A clinical return-to-work rule for patients with back pain. Canadian Medical Association Journal, 172(12), 1559–1567.
9.
DurandM. J., LoiselP. (2001). Therapeutic return to work: Rehabilitation in the workplace. Work, 17(1), 57–63.
10.
FritzJ. M., GeorgeS. Z., & DelittoA. (2001). The role of fear avoidance beliefs in acute low back pain: Relationships with current and future disability and work status. Pain, 94, 7–15.
11.
GrossiG., SoaresJ. J. F., ÄngesleväJ., & PerskiA. (1999). Psychosocial correlates of long-term sick leave among patients with musculoskeletal pain. Pain, 80, 607–19.
12.
HamerH., GandhiR., WongS., & MahomedN. N. (2013). Predicting return to work following treatment of chronic pain disorder. Occupational Medicine, 63, 253–259.
13.
HellstromC. (2001). Temporal dimensions of the self-concept: Entrapped and possible selves in chronic pain. Psychological Health, 16, 111–24.
14.
HoogendoornW. E., BongersP. M., de VetH. C. W., HoutmanI. L. D, AriensG. A. M., van MechelenW., & BouterL. M. (2001). Psychosocial work characteristics and psychological strain in relation to low-back pain. Scandinavian Journal of Work, Environment & Health, 27(4), 258–267.
15.
KelleyH. H. (1967). Attribution Theory in Social Psychology. In LevineD. (Ed.), Nebraska Symposium on Motivation (Vol 15, pp. 192–240). Lincoln: University of Nebraska Press.
KrauseN., DasingerL. K., DeeganL. J., RudolphL., & BrandR. J. (2001). Psychosocial job factors and return-to-work after compensated low back injury: A disability phase-specific analysis. American Journal of Industrial Medicine, 40(4), 374–39.
18.
LabriolaM., LundT., ChristensenK. B., AlbertsenK., BultmannU., JensenJ. N., & VilladsenE. (2007). Does self-efficacy predict return-to-work after sickness absence? A prospective study among workers with sickness absence for three weeks or more. Work, 29, 233–8.
19.
LovellC., & SwiftL. (2011). Chronic pain and employment: The role of multi-disciplinary pain management programmes. European Journal of Employment and Disadvantage, 1, 37–49.
20.
LumleyM. A., CohenJ. L., BorszczG. S., CanoA., RadcliffeA. M., PorterL. S., & KeefeF. J. (2011). Pain and emotion: A biopsychosocial review of recent research. Journal of Clinical Psychology, 67(9), 942–68.
21.
LydellM., BaigiA., MarklundB., & ManssonJ. (2005). Predictive factors for work capacity in patients with musculoskeletal disorders. Journal of Rehabilitation Medicine, 37(5), 281–285.
22.
ManiadakisN., & GrayA. (2000). The economic burden of back pain in the UK. Pain, 84(1), 95–103.
23.
MarholdC., LintonS. T., & MelvinL. (2002). Identification of obstacles for chronic pain patients to return to work: Evaluation of a questionnaire. Journal of Occupational Rehabilitation, 12(2), 65–75.
24.
McCrackenL. M., VowlesK. E., & EcclestonC. (2004). Acceptance of chronic pain: Component analysis and revised assessment method. Pain, 107(1-2), 159–166.
25.
MetalskyG. I., AbramsonL. Y. (1981). Attributional styles: Toward a framework for conceptualization and assessment. In KendallP. C. & HollonS. D. (Eds.), Assessment strategies for cognitive-behoral interventions. New York, NY: Academic Press.
26.
MuijzerA., GeertzenJ. H., de BoerW., GroothoffJ. H., & BrouwerS. (2012). Identifying factors relevant in the assessment of return-to-work efforts in employees on long-term sickness absence due to chronic low back pain: A focus group study. BMC Public Health, 12, 77–81.
Pain in Europe. A 2003 Report. Research project by NFO World group. Funded by an educational grant from Mundipharma International Limited. Cambridge, England. October 2003.
29.
PatelS., GreasleyK., & WatsonP. J. (2007). Barriers to rehabilitation and return to work for unemployed chronic pain patients: A qualitative study. European Journal of Pain, 11, 831–840.
30.
PostM., KrolB., & GroothoffJ. W. (2006). Self-rated health as a predictor of return to work among employees on long-term sickness absence. Disability and Rehabilitation, 28, 289–297.
31.
SampereM., GimenoD., SerraC., PlanaM., LópezJ. C., MartínezJ. M., ... BenavidesF. G. (2012). Return to work expectations of workers on long-term non-work-related sick leave. Journal of Occupational Rehabilitation, 22, 15–26.
32.
SchultzI. Z., CrookJ., MelocheG. R., BerkowitzJ., MilnerR., ZuberbierO. A., & MelocheW. (2004). Psychosocial factors predictive of occupational low back disability: Towards development of a return-to-work model. Pain, 107(1), 77–85.
33.
ShawW. S., & HuangY. H. (2005). Concerns and expectations about returning to work with low back pain: Identifying themes from focus groups and semi-structured interviews. Disability and Rehabilitation, 27(21), 1269–1281.
34.
ShawW., HongQ. N., PranskyG., & LoiselP. (2008). A literature review describing the role of return-to-work coordinators in trial programs and interventions designed to prevent workplace disability. Journal of Occupational Rehabilitation, 18, 2–15.
35.
SvenssonT., MüssenerU., & AlexandersonK. (2006). Pride, empowerment, and return to work: On the significance of promoting positive social emotions among sickness absentees. Work, 27(1), 57–65.
36.
van der GiezenA. M., BouterL. M., & NijhuisF. J. (2000). Prediction of return-to-work of low back pain patients sicklisted for months. Pain, 87(3), 285–294.
37.
VowlesK. E., & GrossR. T. (2003). Work-related beliefs about injury and physical capability for work in individuals with chronic pain. Pain, 101, 291–298.
38.
WaddellG., & WatsonP. J. (2004). Rehabilitation. In WaddellG. (Ed.), The back pain revolution (2nd ed., pp. 371–399). Edinburgh: Churchill Livingstone.
39.
WeinerB. (1972), Theories of motivation: From mechanism to cognition. Chicago, IL: Markham Publishing Company.
40.
WeinerB. (2000). Intrapersonal and interpersonal theories of motivation from an attributional perspective. Educational Psychology Review, 12(1), 1–14.
