Research Updates

When to take extended sick leave. A complex decision for workers with spine-related pain

Joy Hewitt

This study identified a range of factors that influence when workers with neck and low-back (spine-related) pain take extended sick leave.
Take Home Messages:

The decision by workers with neck or low-back pain to take extended sick leave was not taken lightly and the majority aimed to return to work despite their pain:

  • Individuals with new spine-related pain took sick leave early to obtain diagnosis, guidance and treatment of their pain to enable them to return to work; and
  • Individuals with long-standing spine-related pain tried to avoid, delay or shorten their sick leave to enable them to continue working.

The factors influencing the decision to take sick leave were complex and varied according to:

  • The individual's experience of their pain;
  • Their self-image and work ethic;
  • Organisational work factors; and
  • Economic factors.
Why the study matters:

Extended sick leave absences from work and the associated welfare or insurance benefits pose a significant individual and socio-economic burden in industrialised countries. Musculoskeletal problems such as neck and low-back pain are frequent causes of sick leave absences.

What the study involved:

Researchers from one of Europe's largest medical universities, the Karolinska Institute in Sweden, examined the factors considered by 33 Swedish workers with neck or low-back pain when taking sick leave.

People who had been on full or part-time sick leave for 4 to 15 weeks were included in the study. A total of 20 women and 13 men were interviewed about their education, work, health, the effects of their health problems, and their thoughts of the future.

The onset of spine-related pain was relatively recent in approximately half of the study participants, while the remaining half had long-standing spine-related pain.

Summary of study findings:

While the decision to take extended sick leave was based on the presence of spine-related pain, the decision as to when to take the leave was more complex. The timing of sick leave was influenced by the nature of the pain, the worker's experience of the health care system, work and labour-market related factors and personal factors.

Workers with new spine-related pain generally took sick leave soon after the onset of pain. Their aims were to obtain diagnosis and treatment of their pain before returning to work or finding alternative work. However, some individuals with new spine-related pain delayed taking sick leave in consideration of their workmate's or employer's needs.

Workers with long-standing spine-related pain generally tried to continue working despite their pain. These individuals tended to:

  • Have long periods of sickness attendance ('presenteeism' );
  • Avoid using full-time sick leave; and
  • Return early to work from sick leave.

Factors that influenced their decision to continue working rather than take sick leave included work being a basis for their self-image, interest in their work and workmates, their work ethic, a lack of alternative jobs and an economic need to work.

Original research:

Sickness absence and sickness attendance – What people with neck or back pain think.
Hansson M, Boström C, Harms-Ringdahl K.
Social Science & Medicine; 2006; 62: 2183-2195.

PubMed abstract