Thesis: "Women on sick leave for long-term musculoskeletal pain: Factors associated with work ability, well-being and return to work", Mamunur Rashid

Belief in itself is the strongest factor researchers have found to predict a change in behavior and return to work.

Predict in this context does not mean causal.

 

You have to wonder if these people ever really listen to the stuff they say.

So the woman with debilitating back pain and a loving husband whose salary is enough to support them both might choose not to work. And the woman with debilitating back pain but without that support might drag herself off to work.

There's no need to add the idea of 'fear of work' to an hypothesis about support and work participation. Let's just withdraw all family, friends and societal support - starvation and not being able to pay for rent and power are excellent motivators to return to work.

 

Surely it also depends what type of work they do. If someone knows that their regular job involves activity that exacerbates their pain, then they will realistically be less likely to think they will be able to return to work.
And how do they measure the severity of the pain.

Someone with severe long term pain is also likely to be realistic and say they are unlikely to be able to return to work.

I've only read the abstract, but it seems to want to interpret everything people do as driven by their positive or negative thoughts, rather than realistic recognition of what they can do. It's so judgemental.

 

There was a survey of 600 Swedish women on sick leave for musculoskeletal pain which produced 208 usable responses at baseline (there was a followup survey with just 141 respondents). There were 8 survey tools with a large number of questions covering things like pain intensity, ratings of social support, self efficacy, sense of coherence, coping strategies (divert attention, ignore), job strain and support at work, anxiety and depression, work ability and well-being. There were also background questions:

Amazingly, given the aim of identifying what factors influence return to work, there were no questions asking how many hours of unpaid work women were doing, about how many children the woman was caring for or the ages of the children, or whether the women had responsibility for caring for elderly parents. I think the issue about children is a particular gap because giving birth is a major cause of persistent lower back pain, and having multiple pregnancies increases that risk.

It was found that self-ratings of ability to do work (Work Ability Index) predicted return to work (RTW) after a year. And the Work Ability Index was related to pain intensity, job strain and beliefs about the likelihood of return to the same work in the next 6 months. Which is all very predictable.

This thesis is thoroughly infected with BPS.

There was very little discussion about how the type of work was influencing decisions to return to work. Musculoskeletal pain while being employed in elderly care, childcare, cleaning or being a nurse sounds particularly difficult.

I haven't spent a lot of time looking at this study, so it's possible I'm not being completely fair. But my conclusion is that that there is the vague circular thinking coloured by prejudices that we see in every paper with a BPS view of the world. It doesn't produce anything useful - it is victim-blaming and leads only to recommendations for programs to fix the way people think. If this PhD student had instead asked the women that were surveyed what they thought had caused their pain, what was stopping them returning to work and what would help them return to some kind of work, the study might have come up with some useful ideas to improve things.

There are so many good questions that could be answered around this topic - Why do women in Sweden seem to have higher rates of musculoskeletal pain than men? What can be done during pregnancy and the birth process to minimise back damage and bone density loss? What is it about some types of work (including unpaid work in the home) that results in injury and what can be done to reduce that injury? Are women suffering greater injuries in work and in accidents because the built environment (the cars; commercial vacuum cleaners and so on) isn't well designed for the typical female body? How can treatment of musculoskeletal pain be improved? Do we have to acknowledge that years of some types of work do wear a human body out and so society should not expect that a person will keep doing that kind of work until they are suffering significant pain?

But instead we now have another person with the authority of a doctorate going out into the world seemingly convinced that if only women (and presumably men too) could be made to think differently and develop a bit of moral fibre, they would be back at work in no time at all, smiling through the pain.

And one quick bit of pedantry to finish on:

Pregnancy - a disease or disorder?

 

Listening to female patients will only lead to them doing the tango after sunset, and the end of civilisation.