Getting back to work after a low back injury can be a challenge for some patients. Work-related injuries can lead to fear of re-injury. Workers may think they cannot perform their job again without pain. This is called fear avoidance behavior (FAB).

In fact, studies show that a worker's beliefs about his or her ability to get back to work is the strongest predictor of who will still be off work a month after the first episode of low back pain (LBP). Patients can be tested for FAB using a special survey called the fear-avoidance belief questionnaire (FABQ).

Based on these findings, scientists think that patients at risk for chronic LBP may be able to avoid a chronic work-related disability. The idea is to identify people at risk of not being able to return to work. Then the next task is to find ways to treat these folks and prevent chronic disability.

In this study, patients with high levels of FAB were divided into two groups. Both groups received physiotherapy two to three times each week. The PT program included treatment of pain and improvement of flexibility, strength, and coordination. The treatment was given to everyone in both groups by the same therapist. The patients were treated by the therapist until they could go back to work.

The first (education) group received education and counseling. They were given ways to manage their pain. They were also taught the value of physical activity and exercise. The second (comparison) group received an educational pamphlet that was also given to the first group. This brochure described common exercises used for back pain. Ways to improve posture and work strategies called ergonomics were also given to all patients in both groups.

The comparison group was not given advice on activity, exercise, or pain management strategies. If they asked any questions about these topics, the therapist gave a brief answer. The education group had ongoing discussions with the therapist about their pain and activity level. They read (and discussed with the therapist) a special booklet on back pain that wasn't given to the comparison group.

How well these two groups did in their recovery was judged based on the number of days before they could return to work (RTW). RTW meant they could resume their former job tasks and duties. The authors report a big difference between the two groups. The education group RTW within 45 days of their injury. But after 45 days, one-third of the comparison group was still off work.

Analysis of the FABQ scores and number of days it took workers to RTW showed a significant link between these two factors. Therapists treating patients with work-related LBP can use the FABQ to identify FABs. High scores can identify patients at risk for delay in returning to work due to FAB. Adding education and counseling to the regular treatment/rehab program may help prevent these delays.

Joseph J. Godges, PT, DPT, OCS, et al. Effects of Education on Return-to-Work Status for People with Fear-Avoidance Beliefs and Acute Low Back Pain. In Physiotherapy. February 2008. Vol. 88. No. 2. Pp. 231-239.