caa a22 4500 606210962 CHVBK 20210128101035.0 cr unu---uuuuu 210128e20150901xx s 000 0 eng 10.1007/s10926-014-9564-z doi (NATIONALLICENCE)springer-10.1007/s10926-014-9564-z Should General Practitioners Issue a Sick Certificate to Employees Who Consult for Low Back Pain in Primary Care? [Elektronische Daten] [M. Lewis, G. Wynne-Jones, P. Barton, D. Whitehurst, S. Wathall, N. Foster, E. Hay, D. van der Windt] Purpose Back pain is a common problem and has significant societal impact. Sickness certification is commonly issued to patients consulting their general practitioner with low back pain. The aim of this study was to investigate the association of certification for low back pain with clinical outcomes and cost consequences. Methods A prospective cohort study using linked questionnaire and medical record data from 806 low back pain patients in 8 UK general practices: comparison of 116 (14.4%) who received a sickness certificate versus 690 who did not receive certification. The primary clinical measure was the Roland and Morris Disability Questionnaire (RMDQ). Data on back pain consultation and work absenteeism were used to calculate healthcare and societal costs. Results Participants issued a sickness certificate had higher back-related disability at baseline consultation and 6-month follow-up [mean difference 3.1 (95%CI 1.8, 4.4) on the RMDQ], indicating worse health status. After fully adjusting for baseline differences, most changes in clinical outcomes at 6months were not significantly different between study groups. Productivity losses were significantly higher for the certification group, with most absence occurring after the expected end of certification; mean difference in costs due to absenteeism over 6months was £1,956 (95%CI £941, £3040). Conclusions There was no clear evidence of a difference in clinical outcomes between individuals issued a sickness certificate and those not issued a certification for their back pain. With little overall contrast in clinical outcomes, policy makers and care providers may wish to draw on the likely difference in societal costs alongside issues in ethical and moral care in their consideration of patient care for low back pain. The Author(s), 2015 Back pain nationallicence General practice nationallicence Certification nationallicence Clinical effectiveness nationallicence Cost effectiveness nationallicence Lewis M. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut Wynne-Jones G. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut Barton P. Health Economics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Edgbaston, Birmingham, UK aut Whitehurst D. Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, V5A 1S6, Burnaby, BC, Canada aut Wathall S. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut Foster N. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut Hay E. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut van der Windt D. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut Journal of Occupational Rehabilitation Springer US; http://www.springer-ny.com 25/3(2015-09-01), 577-588 1053-0487 25:3<577 2015 25 10926 https://doi.org/10.1007/s10926-014-9564-z text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10926-014-9564-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lewis M. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut NATIONALLICENCE 700 1- Wynne-Jones G. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut NATIONALLICENCE 700 1- Barton P. Health Economics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Edgbaston, Birmingham, UK aut NATIONALLICENCE 700 1- Whitehurst D. Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, V5A 1S6, Burnaby, BC, Canada aut NATIONALLICENCE 700 1- Wathall S. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut NATIONALLICENCE 700 1- Foster N. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut NATIONALLICENCE 700 1- Hay E. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut NATIONALLICENCE 700 1- van der Windt D. Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK aut NATIONALLICENCE 773 0- Journal of Occupational Rehabilitation Springer US; http://www.springer-ny.com 25/3(2015-09-01), 577-588 1053-0487 25:3<577 2015 25 10926