The power of positive thinking: More evidence on patient expectations and return to work

Recent research from the Institute for Work & Health reinforces evidence that patients who are optimistic about recovery following an injury will actually recover and return to work faster than patients who are less optimistic— a finding that should be recognized in case management decisions.

Published: August 11, 2011

It has long been understood that patients’ expectations of recovery influence their outcomes. When comparing people with similar degrees of functional impairment, workers with optimistic expectations recover more quickly than those with less optimistic expectations.

Institute for Work & Health (IWH) Scientist Dr. Jason Busse has recently completed a study that reinforces this evidence and is reported in a paper accepted for publication by the Journal of Orthopaedic Trauma. As he explains, Our goal was to develop a predictive instrument that allows identification of individuals more or less likely to do well after surgery.

A team of investigators led by Busse developed the Somatic Pre-occupation and Coping (SPOC) questionnaire to survey patients with broken shin bones—clinically known as tibial shaft fractures—about their experiences with symptoms, coping abilities and recovery beliefs. Tibial fractures were selected because they are the most common type of long bone fracture and they tend to disproportionately affect young people in the workforce.

Six weeks after surgery, researchers administered the 27-item SPOC questionnaire to 359 patients. Items fell into four categories: physical symptoms, coping, energy and optimism. (Interestingly, the questions were not injury-specific.) Then, one year post-surgery—when it was revealed that 64 per cent of patients had returned to work and one third (36 per cent) had not—researchers linked the questionnaire scores to the patients’ outcomes.

Four categories in
SPOC Questionnaire
Examples of items in each category
Physical symptoms Experienced pain in the last week
Experienced problems with sleep in the past week
Coping Lost sleep over worry in the past week
Thinking of yourself as worthless person in the past week
Energy Difficulty concentrating
Feeling low in energy or slowed down in the past week
Optimism My treatment will be effective in curing my injury
There is a lot that I can do to control my injury-related symptoms

Scores predict recovery

The researchers found that the six-week SPOC scores were a more powerful predictor of recovery and return to work than age, gender, fracture type, smoking status or the presence of multiple injuries.

According to Busse, two questions are central: Can we modify patients’ beliefs? And will such changes result in improved outcomes? If we can do these two things, then we have something very exciting, he says. This study provides strong evidence that there’s more to people’s experience of recovery from injury than simply tissue repair.

Application to other populations holds promise. I would like to examine disability due to sciatica, says Busse. Sciatica refers to pain and numbness in the leg due to injury to, or compression of, the sciatic nerve, which starts in the spine and runs down the back of each leg. Disc herniation is one of its causes.

Busse notes that the rate of disc herniation as a cause of Workplace Safety and Insurance Board lost-time claims more than doubled from 1999 to 2008. As well, elective surgery to address disc herniation causing sciatica only benefits some patients.

Back surgeons may be able to use SPOC scores to identify patients who are unlikely to experience successful recoveries, Busse explains, adding that the SPOC is easy to use.