• Jonathan Petersen, Lilli Kirkeskov, Bjarke Brandt Hansen, Luise Moelenberg Begtrup, Esben Meulengracht Flachs, Mikael Boesen, Philip Hansen, Henning Bliddal, and Ann Isabel Kryger.
• Department of Occupational and Environmental Medicine, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark.
• BMJ Open. 2019 May 22; 9 (5): e026917.

ObjectivesTo investigate if self-reported high physical demand at work, objective physical workload using a job exposure matrix (JEM) and fear-avoidance beliefs are associated with reported sick leave in the previous year in persons with low back pain (LBP). Second, to investigate if the effects of fear-avoidance and self-reported high physical demand at work on sick leave are modified by the objective physical workloads.SettingsParticipants were recruited from general practice and by advertisement in a local newspaper.Participants305participants with a current period of 2-4 weeks LBP and self-reported difficulty in maintaining physically demanding jobs due to LBP were interviewed, clinically examined and had an MRI at baseline.Main Outcome MeasuresIndependent variables were high fear-avoidance, self-reported high physical demand at work and objective measures of physical workloads (JEM). Outcome was self-reported sick leave due to LBP in the previous year. Logistic regression and tests for interaction were used to identify risk factors and modifiers for the association with self-reported sick leave.ResultsSelf-reported physically demanding work and high fear-avoidance were significantly associated with prior sick leave due to LBP in the previous year with OR 1.75 95% CI (1.10 to 2.75) and 2.75 95% CI (1.61to 4.84), respectively. No objective physical workloads had significant associations. There was no modifying effect of objective physical workloads on the association between self-reported physical demand at work/high fear-avoidance and sick leave.ConclusionsOccupational interventions to reduce sick leave due to LBP may have to focus more on those with high self-reported physical demands and high fear-avoidance, and less on individuals with the objectively highest physical workload.Trial Registration NumberNCT02015572; Post-results.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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