Early prognostic factors for claim cost and claim duration following a work-related back injury in Saskatchewan, Canada

Early prognostic factors for claim cost and claim duration following a work-related back injury in Saskatchewan, Canada | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Early prognostic factors for claim cost and claim duration following a work-related back injury in Saskatchewan, Canada Paul Bruno, Steven Passmore This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7382852/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Apr, 2026 Read the published version in Journal of Occupational Rehabilitation → Version 1 posted 12 You are reading this latest preprint version Abstract Purpose The objective of the current study was to determine the degree to which individual prognostic factors obtained within the first 3–4 weeks of the initiation of a work-related back injury claim can predict claim cost and claim duration. Methods Prognostic factor data and outcome data regarding claim cost and duration were obtained from back injury claimants via an online questionnaire and the local workers’ compensation board. Regression models were used to determine which of the factors were best able to predict claim cost, claim duration, and chronic work disability. Results Age, disability, and an accommodation and/or early return-to-work program being offered were included in the three final regression models and were therefore deemed to be best able to predict all three outcomes. History of similar back pain, radiating leg pain, job involving heavy work, and recovery expectations were also included in the final regression models for claim cost and claim duration, and were therefore deemed to be able to assist in the prediction of these outcomes. Conclusion The regression models produced in the current study could be used to formulate equations to estimate claim cost and duration, thereby allowing insurers to identify “high-risk claims” early in the claim process and facilitate more targeted interventions in such cases. As well, whether an accommodation and/or early return-to-work program is offered is highlighted as a modifiable risk factor that could be used by insurers, employers, and workers to reduce claim cost and claim duration. disability insurance low back pain public health workers’ compensation Introduction Low back pain (LBP) has a point prevalence of 7.5%, affecting an estimated 577 million people at any given time, and is the leading cause of years lived with disability worldwide [ 1 ]. The indirect costs (e.g., work productivity losses) associated with LBP account for ~ 85% of the total costs with estimated annual indirect costs being $ 28.2 billion in the US and £10.7 billion in the UK [ 2 ]. In Canada, back disorders are associated with estimated annual direct costs of $ 760 million in Ontario [ 3 ] and historically annual indirect costs of $ 8 billion (1994 dollars) nationally [ 4 ]. In Saskatchewan, back injuries have been the second leading cause of Workers’ Compensation Board (WCB) claims, accounting for 15.0–18.1% (depending on the year) of all claims, and a leading cause of claims within nearly every occupation category in each of the past 15 years [ 5 ]. The proportion of back injury claims that progress to chronic work disability account for ~ 75% of the total costs associated with such claims [ 6 – 7 ]. Therefore, identifying individuals at a high risk of developing chronic work disability soon after the initiation of a work-related back injury claim (i.e., within the first 3–4 weeks) would allow for more targeted treatment in such cases, thereby potentially leading to improved outcomes and lower associated costs. Prospective studies [ 8 – 12 ] and systematic reviews [ 13 – 16 ] generally report the following as being negatively associated with claim duration: 1) age; 2) female sex; 3) primary care as the first healthcare provider; 4) job involving heavy work; 5) history of similar LBP; 6) radiating leg pain; 7) self-reported LBP intensity; and 8) self-reported LBP-related disability. These studies also generally report the following as being positively associated with claim duration: 1) an accommodation and/or early return-to-work (RTW) program being offered; and 2) self-reported recovery expectations. In addition, the Keele STarT Back Screening Tool (STarT Back) was developed and validated to sub-group LBP patients in primary care settings (Hill et al., 2008), and stratified management of LBP using the tool is associated with significant improvements in clinical outcomes, health care costs, and LBP-related days off work [ 17 – 18 ]. The objective of the current study was to determine the degree to which individual prognostic factors obtained following claim adjudication (i.e., within the first 3–4 weeks of the initiation of a claim) can predict claim cost and claim duration following a work-related back injury in Saskatchewan, Canada. Methods Study Design A prospective cohort study design was used, with data collection occurring over a 28-month period (January 2022-April 2024). Ethics approval was obtained from the University of Regina Research Ethics Board, and all participants provided informed consent. Data Collection: Phase 1 Over a 16-month intake period (January 2022-April 2023), all individuals who submitted a work-related back injury claim and email address to the Saskatchewan WCB were asked to complete a 15-minute online questionnaire following claim adjudication (i.e., within 3–4 weeks of the initiation of a claim). Recruitment was performed via emails automatically sent by the WCB to prospective participants. One additional reminder email was automatically sent seven days following the initial email. The emails contained: 1) information about the study; 2) the URL for the online questionnaire; and 3) a unique identifier number. Each individual was asked to enter their unique identifier number at the start of the questionnaire. This number was used by the WCB to cross-reference with the individual’s claim number and facilitate the matching of intake data with claim data. The online questionnaire was delivered using the Qualtrics survey platform (Qualtrics, Provo, Utah, USA) and consisted of four sections. Section 1 contained the following questions related to individual prognostic factors that were not included in Sections 2–4: What was the first healthcare provider you saw for your back injury? (Medical Doctor/Chiropractor/Physiotherapist/Massge Therapist/Other) Does your job typically involve heavy work (e.g., manual labour that includes heavy lifting)? (Yes/No) Has your employer offered you light duty full-time or part-time work, a flexible schedule, special equipment, or other job modifications if needed to allow you to work? (Yes/No) Have you had an episode of back pain in the past similar to your current back pain? (Yes/No) Do you have radiating pain in your leg(s) associated with your back pain? (Yes/No) How certain are you that you will be working in six months? (0–10 scale) Section 2 related to the Quadruple Numerical Rating Scale (QNRS), which was used to assess LBP intensity [ 19 ] and consisted of four questions that were each scored using a 0–10 scale. The responses were assessed by: 1) calculating the average scores provided for the first, second, and fourth questions; and 2) multiplying the result by 10. Participants were then classified as having “low” pain intensity (< 50) or “high” pain intensity (≥ 50) [ 19 ]. Section 3 related to the STarT Back [ 17 – 18 , 20 ] and consisted of nine questions. The responses were assessed by: 1) scoring questions 1–8 as positive if the response was “Yes”; and 2) scoring question 9 as positive if the response was “Very Much” or “Extremely”. Participants were then classified as “high risk” (≥ 4 positive responses for questions 3, 6, 7, 8, and 9), “medium risk” (not “high risk” and ≥ 4 positive responses for all questions), or “low risk” (not “high risk” and < 4 positive responses for all questions) [ 17 – 18 , 20 ]. Section 4 related to the Roland-Morris Disability Questionnaire (RMDQ), which was used to assess LBP-related disability [ 21 ] and consisted of 24 questions regarding their status on the day. Response options for each question were “Yes” or “No”. The responses were assessed by: 1) scoring each question as positive if the response was “Yes”; and 2) calculating the total number of positive responses (0–24) [ 21 ]. Data Collection: Phase 2 One year following the end of the Phase 1 intake period (April 2024), the Saskatchewan WCB was supplied with the unique identifier numbers provided by the participants. The following additional prognostic factor data were provided by the WCB for each of these individuals: 1) age (years); 2) sex (male/female); 3) occupation (National Occupation Classification Code); and 4) area(s) of injury (National Work Injuries Statistics Program Code). Using the National Occupation Classification Codes, participants were classified into one of the following ten occupational categories: 1) management; 2) administrative/clerical; 3) technicians; 4) health; 5) education/social services; 6) security; 7) retail; 8) trades/mechanical; 9) primary industry (e.g., farming, mining); or 10) processing/manufacturing. Using the National Work Injuries Statistics Program Codes, participants were classified into one of the following two area of injury categories: 1) axial spine injury (e.g., cervical, thoracic, lumbar); or 2) axial spine injury plus an injury to ≥ 1 additional body region. In addition to these prognostic factor data, the WCB also provided the claim cost (Canadian dollars) and claim duration (weeks) for each participant. Using the claim duration data, participants were classified as either having chronic work disability (claim duration ≥ 3 months) or not having chronic work disability (claim duration < 3 months) [ 22 ]. Prognostic Factors and Outcome Variables Collectively, Phase 1 and Phase 2 provided data for each participant on the following thirteen prognostic factors: 1) age; 2) sex; 3) occupation; 4) area of injury; 5) first healthcare provider; 6) job involving heavy work; 7) an accommodation and/or early RTW program being offered; 8) history of similar LBP; 9) radiating leg pain; 10) self-reported recovery expectations; 11) self-reported LBP intensity (QNRS); 12) self-reported LBP-related disability (RMDQ); and 13) STarT Back. Phase 2 also provided data for each of participant on the following outcome variables: 1) claim cost; 2) claim duration; and 3) chronic work disability status. Statistical Analyses For claim cost and claim duration , a multiple (linear) regression analysis was performed to determine which of the prognostic factors were best able to predict the outcome. For each analysis, a model using all of the prognostic factors was formulated (Model 1). Forward variable selection using p-values (Model 2) and the AIC (Model 3) were then implemented to determine whether another model provided better data fit compared to Model 1. Prognostic factors common to Models 2 and 3 were deemed to be best able to predict the outcome. For chronic work disability status, a logistic regression analysis was performed to determine which of the prognostic factors were best able to predict group status (i.e., whether or not an individual developed chronic work disability). The data set was split into a training set comprised of 60% of the observations and a testing set comprised of 40% of the observations. Forward and backward selection using the AIC (Model 1), BIC (Model 2), and p-values (Model 3) were implemented to formulate models comprised of prognostic factors that improved the explanatory power of the regression model. Prognostic factors common to all three models were deemed to be best able to predict group status and therefore used to create a fitted regression model. The prediction accuracy of the fitted model was assessed using the testing set of observations. All statistical analyses were performed using RStudio software (RStudio, PBC, Boston, MA, USA). An a priori α of 0.05 was used to indicate statistical significance for all of the analyses. Results Participants Based on the planned analyses and number of predictors (prognostic factors) that would be used, a sample size estimate using G*Power software indicated that a minimum of 200 participants would be required to provide adequate statistical power. To improve statistical power and account for potential missing data, the study had a recruitment target of 400 participants. Over the 16-month intake period, 368 individuals who submitted a work-related back injury claim in Saskatchewan completed the online questionnaire. There were 2247 claimant recipients over this time period (16.4% response rate). Table 1 provides the participant demographics. The 20.0% of participants who were classified as having chronic work disability accounted for 76.5% of the total costs. Table 1 Participant demographics. Age (years; mean ± SD) 40.96 ± 12.16 Sex (n) 178 male, 190 female Occupation (n) 9 management 21 administrative/clerical 5 technicians 90 health 32 education/social services 4 security 64 retail/sales 109 trades 18 primary industry (e.g., farming, mining) 15 processing/manufacturing Areas of injury (n) 264 axial spine injury 104 axial spine injury + injury to another region First healthcare provider (n) 263 medical doctor 80 chiropractor 16 physical therapist 4 massage therapist 5 other Job involving heavy work (n) 282 yes, 86 no Accommodation and/or early return to work program offered (n) 230 yes, 136 no History of similar back pain (n) 131 yes, 236 no Radiating leg pain (n) 143 yes, 223 no Certainty about working in 6 months (0–10 scale; mean ± SD) 8.90 ± 1.98 QNRS classification (n) 230 high pain intensity, 136 low pain intensity STarT Back classification (n) 118 high risk, 129 medium risk, 121 low risk RMDQ score (0–24 scale; mean ± SD) 11.37 ± 7.21 Claim cost (Canadian dollars; mean ± SD, median) $ 12,607.50 ± $ 25,194.73, $ 2,199.16 Claim duration (weeks; mean ± SD, median) 8.33 ± 15.07, 1.65 Long-term disability status (n) 73 yes, 295 no Note: QNRS: Quadruple Numerical Rating Scale, RMDQ: Roland-Morris Disability Questionnaire. Claim Cost The model using all the prognostic factors (Model 1) identified three statistically significant factors: 1) age; 2) self-reported LBP-related disability; and 3) an accommodation and/or early RTW program being offered. Forward selection using p-values (Model 2) identified seven statistically significant factors, which included the three factors identified in Model 1 along with: 1) history of similar LBP; 2) radiating leg pain; 3) job involving heavy work; and 4) self-reported recovery expectations. Forward selection using the AIC (Model 3) identified eight statistically significant factors, which included the three factors identified in Model 1 along with: 1) history of similar LBP; 2) radiating leg pain; 3) job involving heavy work; 4) occupation; and 5) self-reported LBP intensity. The following six prognostic factors were common to Models 2 and 3 and therefore deemed to be best able to predict claim cost: 1) age; 2) self-reported LBP-related disability; 3) an accommodation and/or early RTW program being offered; 4) history of similar LBP; 5) radiating leg pain; and 6) job involving heavy work. Table 2 provides the details regarding the final regression model using these six factors. Table 2 Final linear regression model for the prediction of claim cost. Variable Coefficient SE t p Intercept -10433.90 5534.40 -1.885 0.060 Age 246.60 101.90 2.419 0.016 Disability 1217.30 172.90 7.041 < 0.001 Accommodation -8928.30 2492.60 -3.582 < 0.001 Back pain history -4215.90 2594.60 -1.625 0.105 Radiating leg pain 3481.90 2546.90 1.367 0.172 Heavy work 6400.00 2859.00 2.239 0.026 Claim Duration The model using all the prognostic factors (Model 1) identified four statistically significant factors: 1) age; 2) self-reported LBP-related disability; 2) an accommodation and/or early RTW program being offered; and 4) self-reported recovery expectations. Forward selection using p-values (Model 2) identified eight statistically significant factors, which included the four factors identified in Model 1 along with: 1) history of similar LBP; 2) radiating leg pain; 3) job involving heavy work; and 4) area of injury. Forward selection using the AIC (Model 3) identified seven statistically significant factors, which included the four factors identified in Model 1 along with: 1) history of similar LBP; 2) radiating leg pain; and 3) self-reported LBP intensity. The following six prognostic factors were common to Models 2 and 3 and therefore deemed to be best able to predict claim duration: 1) age; 2) self-reported LBP-related disability; 3) an accommodation and/or early RTW program being offered; 4) history of similar LBP; 5) radiating leg pain; and 6) self-reported recovery expectations. Table 3 provides the details regarding the final regression model using these six factors. Table 3 Final linear regression model for the prediction of claim duration. Variable Coefficient SE t p Intercept 4.108 4.478 0.917 0.360 Age 0.135 0.059 2.272 0.024 Disability 0.768 0.102 7.512 < 0.001 Accommodation -4.353 1.463 -2.976 0.003 Back pain history -2.773 1.059 -1.825 0.069 Radiating leg pain 2.382 1.493 1.595 0.112 Recovery expectations -0.808 0.363 -2.229 0.026 Chronic Work Disability Status The following three prognostic factors were common to Models 1–3 and therefore deemed to be best able to predict whether or not an individual developed chronic work disability: 1) age; 2) self-reported LBP-related disability; and 3) an accommodation and/or early RTW program being offered. Table 4 provides details regarding the fitted regression model using these three factors. Using the testing set of observations, the prediction accuracy of the fitted model was 80.7% (i.e., the model correctly classified 80.7% of the participants as either developing or not developing chronic work disability). Table 4 Final fitted regression model for the prediction of chronic work disability status. Variable Coefficient SE z p Intercept -2.434 1.457 -1.671 0.095 Age 0.034 0.028 1.226 0.220 Disability -0.082 0.052 -1.596 0.110 Accommodation 0.490 0.784 0.625 0.532 Summary of Results The following three prognostic factors were included in the final regression models for claim cost, claim duration, and chronic work disability status, and therefore are deemed to be best able to predict all three outcomes: 1) age; 2) self-reported LBP-related disability; and 3) an accommodation and/or early RTW program being offered. The following two prognostic factors were also included in the final regression models for claim cost and claim duration, and therefore have potential to assist in the prediction of these two outcomes: 1) history of similar LBP; and 2) radiating leg pain. The following two prognostic factors were also included in one of the final regression models for claim cost and claim duration, and therefore also have potential to assist in the prediction of these outcomes: 1) job involving heavy work (included in the final model for claim cost); and 2) self-reported recovery expectations (included in the final model for claim duration). Discussion The current study analyzed the ability of thirteen prognostic factors obtained following claim adjudication (i.e., within the first 3–4 weeks of the initiation of a claim) to predict claim cost and duration following a work-related back injury in Saskatchewan, Canada. Increasing age and higher self-reported LBP-related disability were associated with a higher cost, longer claim duration, and an increased risk of chronic work disability; conversely, an accommodation and/or early RTW program being offered was associated with a lower cost, shorter claim duration, and a decreased risk of chronic work disability (Tables 2 – 4 ). These findings are consistent with previous studies reporting that increasing age and higher self-reported LBP-related disability are associated with negative RTW outcomes, and an accommodation and/or early RTW program being offered is associated with positive RTW outcomes [ 11 – 16 ]. Radiating leg pain was associated with a higher cost and longer claim duration (Tables 2 – 3 ), which is consistent with previous studies reporting that this factor is associated with negative RTW outcomes [ 8 – 9 , 12 , 15 , 16 ]. A history of similar LBP was associated with a lower cost and shorter claim duration (Tables 2 – 3 ), which is inconsistent with previous studies reporting that this factor is either associated with negative RTW outcomes [ 8 , 10 ] or not associated with RTW outcomes [ 9 , 15 ]. Recurrence of LBP following a previous episode is common [ 23 ], and it has been proposed that an individual’s personal capacity to tolerate recurrent/varying pain determines their response to a current pain episode [ 22 ]. Therefore, an individual who develops work-related LBP that is similar to one or more previous episodes of LBP from which they have recovered may have developed coping strategies (e.g., reduced catastrophizing and/or fear-avoidance behaviours) that facilitate improved RTW outcomes for that individual. Further studies are warranted to elaborate on this factor as a potential predictor for claim cost and duration following a work-related back injury. A job involving heavy work was associated with a higher claim cost (Table 2 ), which is consistent with previous studies reporting that this factor is associated with negative RTW outcomes [ 11 , 13 – 16 ]. Higher self-reported recovery expectations were associated with a shorter claim duration (Table 3 ), which is consistent with previous studies reporting that this factor is associated with positive RTW outcomes [ 8 , 11 , 13 , 16 ]. While some studies have reported that female sex, primary care as the first healthcare provider, and higher self-reported pain intensity are associated with negative RTW outcomes, other studies have reported that these factors are not associated with RTW outcomes [ 11 – 16 ]. In the current study, sex, first healthcare provider, and self-reported LBP intensity were not included in the any of the final regression models and therefore are not deemed to be strong predictors of claim cost, claim duration, or chronic work disability. Similarly, the STarT Back risk category was not included in any of the final models. While previous studies suggest that stratified management of LBP using this tool is associated with improved RTW outcomes [ 17 – 18 ], the findings of the current study challenge its use as an early predictor of claim cost or claim duration. Further studies are warranted to further investigate its usefulness in this regard. The distributions of the claim cost and duration data in the current study were positively skewed, with the mean values for both outcomes being markedly higher than the corresponding median values (Table 1 ) and the relatively small proportion of claims with durations ≥ 3 months accounted for a majority of the total costs. These findings mirror those of previous reports [ 6 – 7 ]. Early identification of individuals at a high risk of developing high cost and/or long duration claims would be beneficial for insurers and claimants. The final regression models produced in the current study (Tables 1 – 2 ) could be used to formulate equations to predict claim cost and duration using data collected from claimants early in the claim process. This would allow for the identification of claims that are estimated to have costs and/or durations above a particular threshold deemed to be an indication of a “high-risk claim” and therefore facilitate more targeted interventions in such cases. Of the seven prognostic factors included in the final models for claim cost and duration (Tables 2 – 3 ), six are either non-modifiable (age, job involving heavy work), based on self-reports (LBP-related disability, recovery expectations), or clinical features (history of similar LBP, radiating leg pain). However, whether an accommodation and/or early RTW program is offered is an opportunity by which insurers could work with employers and workers to potentially reduce the cost and/or duration of a claim. For example, the findings of the current study estimate that, on average, offering an accommodation and/or early RTW program would decrease the claim cost by ~ $ 9000 (Table 2 ) and decrease the claim duration by ~ 1 month (Table 3 ) when the effects of each of the other prognostic factors are held constant. A limitation of the current study is that the response rate for the online questionnaire was 16.3% (368/2247 claimants over a 16-month period). It is unknown whether the results of the study are generalizable to the overall population of individuals who submitted a work-related back injury claim in Saskatchewan during this time or to populations in other jurisdictions. The online questionnaire was necessary since the Saskatchewan WCB does not routinely collect data related to most of the prognostic factors included in the current study. If a process could be initiated to collect data on all the factors identified in the final regression models from individuals who submit a work-related back injury claim (e.g., as part of the claim adjudication process), a future study could be initiated using all claim data over a particular period of time that would: 1) address the response rate issue described above as data from all claimants could be used; and 2) provide a larger data set that could be used to assess the accuracy of the final models from the current study and permit modifications, if necessary, to improve their accuracy. With the exception of the RMDQ, the prognostic factors identified in the regression models all involve answering a single question. Therefore, it is estimated that collecting data related to all the factors would not be overly time-intensive from the claimants’ perspective. Conclusion The objective of the current study was to determine the degree to which individual prognostic factors obtained following claim adjudication (i.e., within the first 3–4 weeks of the initiation of a claim) predict claim cost and claim duration following a work-related back injury in Saskatchewan, Canada. The results indicate that the following seven prognostic factors are best able to predict claim cost and duration: 1) age; 2) self-reported LBP-related disability; 3) an accommodation and/or early RTW program being offered; 4) history of similar LBP; 5) radiating leg pain; 6) job involving heavy work; and 7) self-reported recovery expectations. Of these seven factors, whether an accommodation and/or early return to work program is offered is highlighted as an opportunity by which insurers could work with employers and workers to potentially reduce the cost and/or duration of a claim. Finally, if a process could be initiated to collect data on all of the factors from individuals who submit a work-related back injury claim, a future study could be initiated using all claim data over a particular period of time to assess the accuracy of the final regression models for claim cost and claim duration from the current study and permit modifications, if necessary, to improve their accuracy. Declarations Funding: This work was supported by funding provided by the Saskatchewan Workers’ Compensation Board, the Chiropractors’ Association of Saskatchewan, and the Canadian Chiropractic Research Foundation. Competing Interests: The authors have no relevant financial or non-financial interests to disclose. Author Contributions: Both authors contributed to the study conception and design. Data collection and analysis were performed by Paul Bruno. The first draft of the manuscript was written by Paul Bruno, and both authors read and approved the final manuscript. Ethical Approval: Ethics approval for the study was obtained from the University of Regina Research Ethics Board. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed Consent: Informed consent was obtained from all individuals who participated in the study. Data Availability: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon request. Acknowledgements: We would like to thank Dr. Sean Tucker for facilitating communication with individuals at the Saskatchewan Workers’ Compensation Board during the development phase of the study. 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Hartvigsen J, Hancock M, Kongsted A, Louw Q, Ferreira M, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets R, Underwood M, Lancet Low Back Series Working Group. What is low back pain and why we need to pay attention. Lancet. 2018. https://doi.org/10.1016/S0140-6736(18)30480-X . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 12 Apr, 2026 Read the published version in Journal of Occupational Rehabilitation → Version 1 posted Editorial decision: Revision requested 01 Oct, 2025 Reviews received at journal 30 Sep, 2025 Reviews received at journal 23 Sep, 2025 Reviews received at journal 22 Sep, 2025 Reviewers agreed at journal 08 Sep, 2025 Reviewers agreed at journal 07 Sep, 2025 Reviewers agreed at journal 07 Sep, 2025 Reviewers agreed at journal 22 Aug, 2025 Reviewers invited by journal 18 Aug, 2025 Editor assigned by journal 16 Aug, 2025 Submission checks completed at journal 16 Aug, 2025 First submitted to journal 15 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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The indirect costs (e.g., work productivity losses) associated with LBP account for ~\u0026thinsp;85% of the total costs with estimated annual indirect costs being \u003cspan\u003e$\u003c/span\u003e28.2\u0026nbsp;billion in the US and \u0026pound;10.7\u0026nbsp;billion in the UK [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In Canada, back disorders are associated with estimated annual direct costs of \u003cspan\u003e$\u003c/span\u003e760\u0026nbsp;million in Ontario [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and historically annual indirect costs of \u003cspan\u003e$\u003c/span\u003e8\u0026nbsp;billion (1994 dollars) nationally [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Saskatchewan, back injuries have been the second leading cause of Workers\u0026rsquo; Compensation Board (WCB) claims, accounting for 15.0\u0026ndash;18.1% (depending on the year) of all claims, and a leading cause of claims within nearly every occupation category in each of the past 15 years [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The proportion of back injury claims that progress to chronic work disability account for ~\u0026thinsp;75% of the total costs associated with such claims [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, identifying individuals at a high risk of developing chronic work disability soon after the initiation of a work-related back injury claim (i.e., within the first 3\u0026ndash;4 weeks) would allow for more targeted treatment in such cases, thereby potentially leading to improved outcomes and lower associated costs.\u003c/p\u003e\u003cp\u003eProspective studies [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and systematic reviews [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] generally report the following as being negatively associated with claim duration: 1) age; 2) female sex; 3) primary care as the first healthcare provider; 4) job involving heavy work; 5) history of similar LBP; 6) radiating leg pain; 7) self-reported LBP intensity; and 8) self-reported LBP-related disability. These studies also generally report the following as being positively associated with claim duration: 1) an accommodation and/or early return-to-work (RTW) program being offered; and 2) self-reported recovery expectations. In addition, the Keele STarT Back Screening Tool (STarT Back) was developed and validated to sub-group LBP patients in primary care settings (Hill et al., 2008), and stratified management of LBP using the tool is associated with significant improvements in clinical outcomes, health care costs, and LBP-related days off work [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe objective of the current study was to determine the degree to which individual prognostic factors obtained following claim adjudication (i.e., within the first 3\u0026ndash;4 weeks of the initiation of a claim) can predict claim cost and claim duration following a work-related back injury in Saskatchewan, Canada.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eA prospective cohort study design was used, with data collection occurring over a 28-month period (January 2022-April 2024). Ethics approval was obtained from the University of Regina Research Ethics Board, and all participants provided informed consent.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection: Phase 1\u003c/h3\u003e\n\u003cp\u003eOver a 16-month intake period (January 2022-April 2023), all individuals who submitted a work-related back injury claim and email address to the Saskatchewan WCB were asked to complete a 15-minute online questionnaire following claim adjudication (i.e., within 3\u0026ndash;4 weeks of the initiation of a claim). Recruitment was performed via emails automatically sent by the WCB to prospective participants. One additional reminder email was automatically sent seven days following the initial email. The emails contained: 1) information about the study; 2) the URL for the online questionnaire; and 3) a unique identifier number. Each individual was asked to enter their unique identifier number at the start of the questionnaire. This number was used by the WCB to cross-reference with the individual\u0026rsquo;s claim number and facilitate the matching of intake data with claim data.\u003c/p\u003e\u003cp\u003eThe online questionnaire was delivered using the Qualtrics survey platform (Qualtrics, Provo, Utah, USA) and consisted of four sections. \u003cem\u003eSection 1\u003c/em\u003e contained the following questions related to individual prognostic factors that were not included in Sections 2\u0026ndash;4:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat was the first healthcare provider you saw for your back injury? (Medical Doctor/Chiropractor/Physiotherapist/Massge Therapist/Other)\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDoes your job typically involve heavy work (e.g., manual labour that includes heavy lifting)? (Yes/No)\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHas your employer offered you light duty full-time or part-time work, a flexible schedule, special equipment, or other job modifications if needed to allow you to work? (Yes/No)\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHave you had an episode of back pain in the past similar to your current back pain? (Yes/No)\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDo you have radiating pain in your leg(s) associated with your back pain? (Yes/No)\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow certain are you that you will be working in six months? (0\u0026ndash;10 scale)\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eSection 2\u003c/em\u003e related to the Quadruple Numerical Rating Scale (QNRS), which was used to assess LBP intensity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and consisted of four questions that were each scored using a 0\u0026ndash;10 scale. The responses were assessed by: 1) calculating the average scores provided for the first, second, and fourth questions; and 2) multiplying the result by 10. Participants were then classified as having \u0026ldquo;low\u0026rdquo; pain intensity (\u0026lt;\u0026thinsp;50) or \u0026ldquo;high\u0026rdquo; pain intensity (\u0026ge;\u0026thinsp;50) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eSection 3\u003c/em\u003e related to the STarT Back [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and consisted of nine questions. The responses were assessed by: 1) scoring questions 1\u0026ndash;8 as positive if the response was \u0026ldquo;Yes\u0026rdquo;; and 2) scoring question 9 as positive if the response was \u0026ldquo;Very Much\u0026rdquo; or \u0026ldquo;Extremely\u0026rdquo;. Participants were then classified as \u0026ldquo;high risk\u0026rdquo; (\u0026ge;\u0026thinsp;4 positive responses for questions 3, 6, 7, 8, and 9), \u0026ldquo;medium risk\u0026rdquo; (not \u0026ldquo;high risk\u0026rdquo; and \u0026ge;\u0026thinsp;4 positive responses for all questions), or \u0026ldquo;low risk\u0026rdquo; (not \u0026ldquo;high risk\u0026rdquo; and \u0026lt;\u0026thinsp;4 positive responses for all questions) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eSection 4\u003c/em\u003e related to the Roland-Morris Disability Questionnaire (RMDQ), which was used to assess LBP-related disability [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and consisted of 24 questions regarding their status on the day. Response options for each question were \u0026ldquo;Yes\u0026rdquo; or \u0026ldquo;No\u0026rdquo;. The responses were assessed by: 1) scoring each question as positive if the response was \u0026ldquo;Yes\u0026rdquo;; and 2) calculating the total number of positive responses (0\u0026ndash;24) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eData Collection: Phase 2\u003c/h3\u003e\n\u003cp\u003eOne year following the end of the Phase 1 intake period (April 2024), the Saskatchewan WCB was supplied with the unique identifier numbers provided by the participants. The following additional prognostic factor data were provided by the WCB for each of these individuals: 1) age (years); 2) sex (male/female); 3) occupation (National Occupation Classification Code); and 4) area(s) of injury (National Work Injuries Statistics Program Code). Using the National Occupation Classification Codes, participants were classified into one of the following ten occupational categories: 1) management; 2) administrative/clerical; 3) technicians; 4) health; 5) education/social services; 6) security; 7) retail; 8) trades/mechanical; 9) primary industry (e.g., farming, mining); or 10) processing/manufacturing. Using the National Work Injuries Statistics Program Codes, participants were classified into one of the following two area of injury categories: 1) axial spine injury (e.g., cervical, thoracic, lumbar); or 2) axial spine injury plus an injury to \u0026ge;\u0026thinsp;1 additional body region.\u003c/p\u003e\u003cp\u003eIn addition to these prognostic factor data, the WCB also provided the claim cost (Canadian dollars) and claim duration (weeks) for each participant. Using the claim duration data, participants were classified as either having chronic work disability (claim duration\u0026thinsp;\u0026ge;\u0026thinsp;3 months) or not having chronic work disability (claim duration\u0026thinsp;\u0026lt;\u0026thinsp;3 months) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003ePrognostic Factors and Outcome Variables\u003c/h3\u003e\n\u003cp\u003eCollectively, Phase 1 and Phase 2 provided data for each participant on the following thirteen prognostic factors: 1) age; 2) sex; 3) occupation; 4) area of injury; 5) first healthcare provider; 6) job involving heavy work; 7) an accommodation and/or early RTW program being offered; 8) history of similar LBP; 9) radiating leg pain; 10) self-reported recovery expectations; 11) self-reported LBP intensity (QNRS); 12) self-reported LBP-related disability (RMDQ); and 13) STarT Back. Phase 2 also provided data for each of participant on the following outcome variables: 1) claim cost; 2) claim duration; and 3) chronic work disability status.\u003c/p\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003eFor \u003cem\u003eclaim cost\u003c/em\u003e and \u003cem\u003eclaim duration\u003c/em\u003e, a multiple (linear) regression analysis was performed to determine which of the prognostic factors were best able to predict the outcome. For each analysis, a model using all of the prognostic factors was formulated (Model 1). Forward variable selection using p-values (Model 2) and the AIC (Model 3) were then implemented to determine whether another model provided better data fit compared to Model 1. Prognostic factors common to Models 2 and 3 were deemed to be best able to predict the outcome.\u003c/p\u003e\u003cp\u003eFor chronic work disability status, a logistic regression analysis was performed to determine which of the prognostic factors were best able to predict group status (i.e., whether or not an individual developed chronic work disability). The data set was split into a training set comprised of 60% of the observations and a testing set comprised of 40% of the observations. Forward and backward selection using the AIC (Model 1), BIC (Model 2), and p-values (Model 3) were implemented to formulate models comprised of prognostic factors that improved the explanatory power of the regression model. Prognostic factors common to all three models were deemed to be best able to predict group status and therefore used to create a fitted regression model. The prediction accuracy of the fitted model was assessed using the testing set of observations.\u003c/p\u003e\u003cp\u003eAll statistical analyses were performed using RStudio software (RStudio, PBC, Boston, MA, USA). An a priori α of 0.05 was used to indicate statistical significance for all of the analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eBased on the planned analyses and number of predictors (prognostic factors) that would be used, a sample size estimate using G*Power software indicated that a minimum of 200 participants would be required to provide adequate statistical power. To improve statistical power and account for potential missing data, the study had a recruitment target of 400 participants. Over the 16-month intake period, 368 individuals who submitted a work-related back injury claim in Saskatchewan completed the online questionnaire. There were 2247 claimant recipients over this time period (16.4% response rate). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides the participant demographics. The 20.0% of participants who were classified as having chronic work disability accounted for 76.5% of the total costs.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant demographics.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years; mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.96\u0026thinsp;\u0026plusmn;\u0026thinsp;12.16\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e178 male, 190 female\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 management\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 administrative/clerical\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 technicians\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 health\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 education/social services\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 security\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 retail/sales\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e109 trades\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 primary industry (e.g., farming, mining)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 processing/manufacturing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAreas of injury (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e264 axial spine injury\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e104 axial spine injury\u0026thinsp;+\u0026thinsp;injury to another region\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst healthcare provider (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e263 medical doctor\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 chiropractor\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 physical therapist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 massage therapist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 other\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob involving heavy work (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e282 yes, 86 no\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccommodation and/or early return to work program offered (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e230 yes, 136 no\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of similar back pain (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131 yes, 236 no\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiating leg pain (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e143 yes, 223 no\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCertainty about working in 6 months (0\u0026ndash;10 scale; mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQNRS classification (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e230 high pain intensity, 136 low pain intensity\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSTarT Back classification (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e118 high risk, 129 medium risk, 121 low risk\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRMDQ score (0\u0026ndash;24 scale; mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.37\u0026thinsp;\u0026plusmn;\u0026thinsp;7.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClaim cost (Canadian dollars; mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, median)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e12,607.50 \u0026plusmn; \u003cspan\u003e$\u003c/span\u003e25,194.73, \u003cspan\u003e$\u003c/span\u003e2,199.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClaim duration (weeks; mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, median)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.33\u0026thinsp;\u0026plusmn;\u0026thinsp;15.07, 1.65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLong-term disability status (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 yes, 295 no\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cem\u003eNote: QNRS: Quadruple Numerical Rating Scale, RMDQ: Roland-Morris Disability Questionnaire.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eClaim Cost\u003c/h3\u003e\n\u003cp\u003eThe model using all the prognostic factors (Model 1) identified three statistically significant factors: 1) age; 2) self-reported LBP-related disability; and 3) an accommodation and/or early RTW program being offered. Forward selection using p-values (Model 2) identified seven statistically significant factors, which included the three factors identified in Model 1 along with: 1) history of similar LBP; 2) radiating leg pain; 3) job involving heavy work; and 4) self-reported recovery expectations. Forward selection using the AIC (Model 3) identified eight statistically significant factors, which included the three factors identified in Model 1 along with: 1) history of similar LBP; 2) radiating leg pain; 3) job involving heavy work; 4) occupation; and 5) self-reported LBP intensity.\u003c/p\u003e\u003cp\u003eThe following \u003cem\u003esix prognostic factors\u003c/em\u003e were common to Models 2 and 3 and therefore deemed to be best able to predict claim cost: 1) age; 2) self-reported LBP-related disability; 3) an accommodation and/or early RTW program being offered; 4) history of similar LBP; 5) radiating leg pain; and 6) job involving heavy work. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides the details regarding the final regression model using these six factors.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFinal linear regression model for the prediction of claim cost.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-10433.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5534.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.885\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.060\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e246.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.419\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1217.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e172.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccommodation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-8928.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2492.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-3.582\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBack pain history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-4215.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2594.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.625\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.105\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiating leg pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3481.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2546.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.172\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeavy work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6400.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2859.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eClaim Duration\u003c/h2\u003e\u003cp\u003eThe model using all the prognostic factors (Model 1) identified four statistically significant factors: 1) age; 2) self-reported LBP-related disability; 2) an accommodation and/or early RTW program being offered; and 4) self-reported recovery expectations. Forward selection using p-values (Model 2) identified eight statistically significant factors, which included the four factors identified in Model 1 along with: 1) history of similar LBP; 2) radiating leg pain; 3) job involving heavy work; and 4) area of injury. Forward selection using the AIC (Model 3) identified seven statistically significant factors, which included the four factors identified in Model 1 along with: 1) history of similar LBP; 2) radiating leg pain; and 3) self-reported LBP intensity.\u003c/p\u003e\u003cp\u003eThe following \u003cem\u003esix prognostic factors\u003c/em\u003e were common to Models 2 and 3 and therefore deemed to be best able to predict claim duration: 1) age; 2) self-reported LBP-related disability; 3) an accommodation and/or early RTW program being offered; 4) history of similar LBP; 5) radiating leg pain; and 6) self-reported recovery expectations. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides the details regarding the final regression model using these six factors.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFinal linear regression model for the prediction of claim duration.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.478\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.917\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.360\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.272\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.768\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.512\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccommodation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-4.353\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.976\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBack pain history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-2.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.825\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiating leg pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.493\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.595\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.112\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecovery expectations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.808\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eChronic Work Disability Status\u003c/h2\u003e\u003cp\u003eThe following \u003cem\u003ethree prognostic factors\u003c/em\u003e were common to Models 1\u0026ndash;3 and therefore deemed to be best able to predict whether or not an individual developed chronic work disability: 1) age; 2) self-reported LBP-related disability; and 3) an accommodation and/or early RTW program being offered. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e provides details regarding the fitted regression model using these three factors. Using the testing set of observations, the prediction accuracy of the fitted model was 80.7% (i.e., the model correctly classified 80.7% of the participants as either developing or not developing chronic work disability).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFinal fitted regression model for the prediction of chronic work disability status.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ez\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-2.434\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.457\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.095\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.220\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.596\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccommodation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.490\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.784\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.625\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.532\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSummary of Results\u003c/h2\u003e\u003cp\u003eThe following \u003cem\u003ethree prognostic factors\u003c/em\u003e were included in the final regression models for claim cost, claim duration, and chronic work disability status, and therefore are deemed to be best able to predict all three outcomes: 1) age; 2) self-reported LBP-related disability; and 3) an accommodation and/or early RTW program being offered. The following \u003cem\u003etwo prognostic factors\u003c/em\u003e were also included in the final regression models for claim cost and claim duration, and therefore have potential to assist in the prediction of these two outcomes: 1) history of similar LBP; and 2) radiating leg pain. The following \u003cem\u003etwo prognostic factors\u003c/em\u003e were also included in one of the final regression models for claim cost and claim duration, and therefore also have potential to assist in the prediction of these outcomes: 1) job involving heavy work (included in the final model for claim cost); and 2) self-reported recovery expectations (included in the final model for claim duration).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study analyzed the ability of thirteen prognostic factors obtained following claim adjudication (i.e., within the first 3\u0026ndash;4 weeks of the initiation of a claim) to predict claim cost and duration following a work-related back injury in Saskatchewan, Canada. Increasing age and higher self-reported LBP-related disability were associated with a higher cost, longer claim duration, and an increased risk of chronic work disability; conversely, an accommodation and/or early RTW program being offered was associated with a lower cost, shorter claim duration, and a decreased risk of chronic work disability (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). These findings are consistent with previous studies reporting that increasing age and higher self-reported LBP-related disability are associated with negative RTW outcomes, and an accommodation and/or early RTW program being offered is associated with positive RTW outcomes [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRadiating leg pain was associated with a higher cost and longer claim duration (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), which is consistent with previous studies reporting that this factor is associated with negative RTW outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A history of similar LBP was associated with a lower cost and shorter claim duration (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), which is inconsistent with previous studies reporting that this factor is either associated with negative RTW outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] or not associated with RTW outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Recurrence of LBP following a previous episode is common [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and it has been proposed that an individual\u0026rsquo;s personal capacity to tolerate recurrent/varying pain determines their response to a current pain episode [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, an individual who develops work-related LBP that is similar to one or more previous episodes of LBP from which they have recovered may have developed coping strategies (e.g., reduced catastrophizing and/or fear-avoidance behaviours) that facilitate improved RTW outcomes for that individual. Further studies are warranted to elaborate on this factor as a potential predictor for claim cost and duration following a work-related back injury.\u003c/p\u003e\u003cp\u003eA job involving heavy work was associated with a higher claim cost (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), which is consistent with previous studies reporting that this factor is associated with negative RTW outcomes [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Higher self-reported recovery expectations were associated with a shorter claim duration (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), which is consistent with previous studies reporting that this factor is associated with positive RTW outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile some studies have reported that female sex, primary care as the first healthcare provider, and higher self-reported pain intensity are associated with negative RTW outcomes, other studies have reported that these factors are not associated with RTW outcomes [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In the current study, sex, first healthcare provider, and self-reported LBP intensity were not included in the any of the final regression models and therefore are not deemed to be strong predictors of claim cost, claim duration, or chronic work disability. Similarly, the STarT Back risk category was not included in any of the final models. While previous studies suggest that stratified management of LBP using this tool is associated with improved RTW outcomes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], the findings of the current study challenge its use as an early predictor of claim cost or claim duration. Further studies are warranted to further investigate its usefulness in this regard.\u003c/p\u003e\u003cp\u003eThe distributions of the claim cost and duration data in the current study were positively skewed, with the mean values for both outcomes being markedly higher than the corresponding median values (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and the relatively small proportion of claims with durations\u0026thinsp;\u0026ge;\u0026thinsp;3 months accounted for a majority of the total costs. These findings mirror those of previous reports [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Early identification of individuals at a high risk of developing high cost and/or long duration claims would be beneficial for insurers and claimants. The final regression models produced in the current study (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) could be used to formulate equations to predict claim cost and duration using data collected from claimants early in the claim process. This would allow for the identification of claims that are estimated to have costs and/or durations above a particular threshold deemed to be an indication of a \u0026ldquo;high-risk claim\u0026rdquo; and therefore facilitate more targeted interventions in such cases.\u003c/p\u003e\u003cp\u003eOf the seven prognostic factors included in the final models for claim cost and duration (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), six are either non-modifiable (age, job involving heavy work), based on self-reports (LBP-related disability, recovery expectations), or clinical features (history of similar LBP, radiating leg pain). However, whether an accommodation and/or early RTW program is offered is an opportunity by which insurers could work with employers and workers to potentially reduce the cost and/or duration of a claim. For example, the findings of the current study estimate that, on average, offering an accommodation and/or early RTW program would decrease the claim cost by ~\u003cspan\u003e$\u003c/span\u003e9000 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and decrease the claim duration by ~\u0026thinsp;1 month (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) when the effects of each of the other prognostic factors are held constant.\u003c/p\u003e\u003cp\u003eA limitation of the current study is that the response rate for the online questionnaire was 16.3% (368/2247 claimants over a 16-month period). It is unknown whether the results of the study are generalizable to the overall population of individuals who submitted a work-related back injury claim in Saskatchewan during this time or to populations in other jurisdictions. The online questionnaire was necessary since the Saskatchewan WCB does not routinely collect data related to most of the prognostic factors included in the current study. If a process could be initiated to collect data on all the factors identified in the final regression models from individuals who submit a work-related back injury claim (e.g., as part of the claim adjudication process), a future study could be initiated using all claim data over a particular period of time that would: 1) address the response rate issue described above as data from all claimants could be used; and 2) provide a larger data set that could be used to assess the accuracy of the final models from the current study and permit modifications, if necessary, to improve their accuracy. With the exception of the RMDQ, the prognostic factors identified in the regression models all involve answering a single question. Therefore, it is estimated that collecting data related to all the factors would not be overly time-intensive from the claimants\u0026rsquo; perspective.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe objective of the current study was to determine the degree to which individual prognostic factors obtained following claim adjudication (i.e., within the first 3\u0026ndash;4 weeks of the initiation of a claim) predict claim cost and claim duration following a work-related back injury in Saskatchewan, Canada. The results indicate that the following seven prognostic factors are best able to predict claim cost and duration: 1) age; 2) self-reported LBP-related disability; 3) an accommodation and/or early RTW program being offered; 4) history of similar LBP; 5) radiating leg pain; 6) job involving heavy work; and 7) self-reported recovery expectations. Of these seven factors, whether an accommodation and/or early return to work program is offered is highlighted as an opportunity by which insurers could work with employers and workers to potentially reduce the cost and/or duration of a claim. Finally, if a process could be initiated to collect data on all of the factors from individuals who submit a work-related back injury claim, a future study could be initiated using all claim data over a particular period of time to assess the accuracy of the final regression models for claim cost and claim duration from the current study and permit modifications, if necessary, to improve their accuracy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This work was supported by funding provided by the Saskatchewan Workers\u0026rsquo; Compensation Board, the Chiropractors\u0026rsquo; Association of Saskatchewan, and the Canadian Chiropractic Research Foundation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Both authors contributed to the study conception and design. Data collection and analysis were performed by Paul Bruno. The first draft of the manuscript was written by Paul Bruno, and both authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e Ethics approval for the study was obtained from the University of Regina Research Ethics Board. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u003c/strong\u003e Informed consent was obtained from all individuals who participated in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e The datasets generated during and/or analyzed during the current study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We would like to thank Dr. Sean Tucker for facilitating communication with individuals at the Saskatchewan Workers\u0026rsquo; Compensation Board during the development phase of the study. We would also like to thank the following individuals at the Saskatchewan Workers\u0026rsquo; Compensation Board for their assistance over the course of the study: Tim Chapman, Annette Goski, Katherine Prior, Jolyn Rhodes, Jonathan Sherman, Jonathan Stobbs, and Yvonne Weisgerber. Finally, we would like to thank Zakhraf Asghar for his assistance in collating the data, as well as Dr. James McVittie for his assistance with the statistical analyses.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWu A, March L, Zheng X, Huang J, Wang X, Zhao J, Blyth F, Smith E, Buchbinder R, Hoy D. Global low back pain prevalence and years lived with disability from 1990\u0026ndash;2017: estimates of the Global Burden of Disease Study 2017. 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Lancet. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(18)30480-X\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(18)30480-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-occupational-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joor","sideBox":"Learn more about [Journal of Occupational Rehabilitation](https://www.springer.com/journal/10926)","snPcode":"10926","submissionUrl":"https://submission.nature.com/new-submission/10926/3","title":"Journal of Occupational Rehabilitation","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"disability insurance, low back pain, public health, workers’ compensation ","lastPublishedDoi":"10.21203/rs.3.rs-7382852/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7382852/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe objective of the current study was to determine the degree to which individual prognostic factors obtained within the first 3\u0026ndash;4 weeks of the initiation of a work-related back injury claim can predict claim cost and claim duration.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePrognostic factor data and outcome data regarding claim cost and duration were obtained from back injury claimants via an online questionnaire and the local workers\u0026rsquo; compensation board. Regression models were used to determine which of the factors were best able to predict claim cost, claim duration, and chronic work disability.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAge, disability, and an accommodation and/or early return-to-work program being offered were included in the three final regression models and were therefore deemed to be best able to predict all three outcomes. History of similar back pain, radiating leg pain, job involving heavy work, and recovery expectations were also included in the final regression models for claim cost and claim duration, and were therefore deemed to be able to assist in the prediction of these outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe regression models produced in the current study could be used to formulate equations to estimate claim cost and duration, thereby allowing insurers to identify \u0026ldquo;high-risk claims\u0026rdquo; early in the claim process and facilitate more targeted interventions in such cases. As well, whether an accommodation and/or early return-to-work program is offered is highlighted as a modifiable risk factor that could be used by insurers, employers, and workers to reduce claim cost and claim duration.\u003c/p\u003e","manuscriptTitle":"Early prognostic factors for claim cost and claim duration following a work-related back injury in Saskatchewan, Canada","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-26 14:02:32","doi":"10.21203/rs.3.rs-7382852/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-01T14:07:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T22:54:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-23T05:15:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-22T15:26:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296056445818686604276699765227151391288","date":"2025-09-08T20:28:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333300414121521898273583409779662035769","date":"2025-09-07T22:42:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92833321815502121815876087116757399805","date":"2025-09-07T21:16:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6165584761113041881167986871938758913","date":"2025-08-22T05:31:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-18T15:53:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-16T05:01:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-16T04:59:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Occupational Rehabilitation","date":"2025-08-15T16:16:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-occupational-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joor","sideBox":"Learn more about [Journal of Occupational Rehabilitation](https://www.springer.com/journal/10926)","snPcode":"10926","submissionUrl":"https://submission.nature.com/new-submission/10926/3","title":"Journal of Occupational Rehabilitation","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4060b04f-6643-412c-b416-b8b1bc57d75b","owner":[],"postedDate":"August 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T16:04:33+00:00","versionOfRecord":{"articleIdentity":"rs-7382852","link":"https://doi.org/10.1007/s10926-026-10386-8","journal":{"identity":"journal-of-occupational-rehabilitation","isVorOnly":false,"title":"Journal of Occupational Rehabilitation"},"publishedOn":"2026-04-12 15:58:29","publishedOnDateReadable":"April 12th, 2026"},"versionCreatedAt":"2025-08-26 14:02:32","video":"","vorDoi":"10.1007/s10926-026-10386-8","vorDoiUrl":"https://doi.org/10.1007/s10926-026-10386-8","workflowStages":[]},"version":"v1","identity":"rs-7382852","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7382852","identity":"rs-7382852","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}