Background Little is known about the prognostic factors for work-related outcomes of sciatica caused by disc herniation.
Objectives To identify prognostic factors for return to work (RTW) during a 2-year follow-up among sciatica patients referred to secondary care.
Methods The setting was a multicenter prospective cohort study including 466 patients. Study participation did not involve any specific type of intervention. In patients with severe symptoms, surgery was performed at the discretion of each center.
Administrative data from the National Sickness Benefit Register were accessed for 227 patients. Two patient samples were used. Sample (A) comprised patients who at the time of inclusion in the cohort reported being on partial sick leave or complete sick leave, or were undergoing rehabilitation because of back pain/sciatica. Sample (B) comprised patients who, according to the sickness benefit register, at the time of inclusion received sickness benefits or rehabilitation allowances because of back pain/sciatica. In sample (A), the outcome was self-reported return to full-time work at the 2-year follow-up. In sample (B), the outcome was time to first sustained RTW, defined as the first period of >60 days without receiving benefits from the register. Analyses were performed by multivariate logistic regression and Cox proportional hazard modeling.
Results One-fourth of the patients were still out of work at the 2-year follow-up. In sample A (n=237), younger age, better general health, lower baseline sciatica bothersomeness, less fear avoidance–work, and a negative straight-leg-raising test result were significantly associated with a higher probability of RTW at the 2-year follow-up. Surgery was not significantly associated with the outcome. In sample B (n=125), a previous history of sciatica, duration of the current sciatica episode >3 months, and greater sciatica bothersomeness, fear avoidance–work, and back pain were significantly associated with a longer time to sustained RTW. Surgery was negatively associated with time to sustained RTW both in univariate (hazard ratio,HR 0.60; 95% confidence interval (CI) 0.39, 0.93; p=0.02) and in multivariate analysis (HR 0.49; 95% CI 0.31, 0.79; p=0.003).
Conclusions The baseline factors associated with RTW identified in multivariate analysis were age, general health, previous history of sciatica, duration of the current episode, baseline sciatica bothersomeness, fear avoidance–work, back pain, and the straight-leg-raising test result. Surgical treatment was associated with slower RTW.
Disclosure of Interest None Declared
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