The fear-avoidance model (FAM) is commonly used in musculoskeletal chronic pain (Vlaeyen 2012). Nevertheless, only few prospective studies have been conducted, especially on return to work (RTW). This study lays the hypothesis that the components of the FAM (catastrophizing, kinesiophobia and depression) can predict RTW 1 year after a vocational rehabilitation for orthopedic trauma patients.
A total of 323 rehab orthopedic trauma inpatients (average time after accident: 9 months) were included. The following predictive factors were analyzed: pain catastrophizing (Pain Catastrophizing Scale, high score≥20 points), kinesiophobia (Tampa Scale of Kinesiophobia≥45 points) and depressive symptoms (Hospital Anxiety and Depression Scale≥8 points). Patients were asked their professional status 1 year after discharge. RTW was defined as return to the same or accommodated job, full time or part time (at least 50%), over the survey period. Simple and multiple logistic regressions were performed to analyze the relation between predictors and RTW.
A total of 194 patients replied at the 1-year follow-up. As they were starting rehabilitation, 35.6% had depressive symptoms, 53.2% had a high score of pain catastrophizing and 58.2% had kinesiophobia. One year after discharge, 51.3% had returned to work. There were less RTW among the patients with depressive symptoms than among the ones without (30% vs 62%; 0.33 [0.15, 0.76], P=0.0001). There were less RTW among the patients with a high score of pain catastrophizing than among the ones with a low score (40% vs 66%; 0.43 [0.20, 0.92], P<0.0001). Patients with higher kinesiophobia were less likely to get back to work, but no statistical association was found after controlling for confounding factors (age, gender, pain intensity, work qualification, French as preferred language, and employment contract). In the multivariate model, pain catastrophizing and depressive symptoms were still associated with RTW (P<0.0001).
This study suggests the usefulness of screening catastrophizing and depressive symptoms in orthopedic trauma patients during vocational rehabilitation. In clinical practice, this may be achieved through the use of the proposed questionnaires clinical thresholds. Further interventional research is needed to investigate whether targeted interventions on psychological factors would then improve the prognostic.