Spotlight on article published in

Occupational & Environmental Medicine

IBI Spotlights call attention to important health and productivity findings from peer-reviewed work by external researchers. Unless otherwise stated, the authors are not affiliated with IBI, nor was the research executed on IBI’s behalf. IBI members are encouraged to obtain the original articles from the copyright holder.

What is the Issue?

Back pain is a common ailment that is responsible for a large proportion of lost work time. However, existing studies vary widely in their estimates of how many employees will miss work, the durations of absence, and rates of return-to-work (RTW). It is not well known whether differences in the study populations or their methodologies are responsible for the variation in findings.

What are the findings/solutions?

The setting in which a study occurred explained the largest amount of variation in findings. This could indicate that differences in study populations are an underlying factor. Differences in study design – particularly in the definitions of absence and return to work and the period for which these outcomes were observed – also account for some of the variation in findings.

Journal Citation

Wynne-Jones, G., Cowen, J., & Jordan, J. L. et al (2014), Absence From Work and Return to Work in People With Back Pain: A Systematic Review and Meta-Analysis. Occupational & Environmental Medicine, 71(6), 448-456.


To investigate the extent to which differences in study settings and study design are responsible for variation in estimates of work absence and return to work.


A systematic review and meta-analysis of 45 peer-reviewed articles that measured work absence subjectively or objectively and included return to work (RTW) measures among employees with back pain. 34 studies are included in the meta-analysis of work absence or return to work rates; 18 studies are included in a descriptive summary of the duration of work absence.


The median duration of work absence was 14 to 24 days in studies conducted in healthcare settings, compared to 7 to 61 days for studies of administrative data and 5 to 28 days for workplace settings. The pooled occurrence of employees with any work absence was 15% but was lower in healthcare settings (7.9%) and in studies using insurance data (11.8%) than in population-based studies (20.8%) and studies conducted in workplace settings (35%). The pooled proportions of employees returning to work from leave for back pain were:

  • 68% at 1 month follow-up
  • 86% at 1-6 months follow-up
  • 93% at 6 month or longer follow-up.


A large proportion of workers with back pain take some leave from work, but estimates vary based on the study setting and the ways in which absence is defined. A sizable proportion of leave takers remain off the job at one-month follow-up, which indicates that RTW interventions at this point could cost-effectively prevent long term work absence. Future research would benefit from addressing methodological issues in defining and measuring absence and return to work and investigating the efficient timing of RTW interventions.

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