General practitioner sickness absence certification for low back pain is not directly associated with beliefs about back pain Paul J. Watson a, * , Julia Bowey a,b , Gari Purcell-Jones b , Tom Gales c a Department of Health Sciences, University of Leicester, Gwendolen Road, Leicester LE5 4PW, UK b Department of Anaesthesia and Pain Management, St. Helier Hospital, Jersey, UK c States of Jersey Department of Employment and Social Security, St. Helier, Jersey, UK Received 16 March 2007; received in revised form 23 May 2007; accepted 14 June 2007 Available online 30 July 2007 Abstract Recent research has demonstrated a relationship between healthcare practitioner beliefs about low back pain and recommenda- tions about activity, work restrictions and work absence. None of the research to date has looked at the relationship between prac- titioner beliefs and actual behaviour. This study investigated the internal consistency of the pain attitudes and beliefs scale (PABS) and if general practitioner (GP) beliefs about back pain were more predictive of sickness certification for non-specific low back pain (NSLBP) than a general predisposition to sick certify patients with other non-specific conditions (common mental illness and non- specific upper respiratory disorders). Ninty-four eligible general practitioners were invited to participate in the study and data from 83 (88.3%) were included in the full analysis. Evaluation of the internal consistency of the PABS found the biomedical subscale was good (a = 0.781) but the psychosocial subscale was poor (a = 0.396) after item elimination both subscales improved; biomedical a = 0.790, psychosocial a = 0.602. GP sickness certification behaviour for 1 year was gathered from the Department of Employment and Social Security database. Multiple regression analysis demonstrated that neither the biomedical nor the psychosocial subscale of the PABS predicted the number of sickness certificates issued even after controlling for the time employed as a GP, number of hours worked per week and the number of NSLBP patients seen. Certification for other conditions was predictive of NSLBP certificates issued. These results demonstrate that sickness absences certification for NSLBP is predicted by sickness certification behaviour in general and not by scores on the PABS. Ó 2007 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved. Keywords: Low back pain; Sickness certification; Work; Primary care 1. Introduction The management of non-specific low back pain (NSLBP) remains a major consumer of health care resources in developed countries. However the costs of healthcare are dwarfed by the costs associated with work absence, wage replacement and other social ben- efits associated with inability to work (Maniadakis and Gray, 2000). The evidence for the psychosocial nature of predictors of work absence from this condition is considerable (Main et al., 2005) and recent attention has focused on the influence of fear avoidance beliefs (Vlaeyen and Linton, 2006). The fear avoidance model of non-specific low back pain disability suggests that people who perceive that back pain is harmful and that physical activity (including work) is to be avoided 1090-3801/$32 Ó 2007 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ejpain.2007.06.002 * Corresponding author. Tel.: +44 116 2584613; fax: +44 116 2588317. E-mail address: pjw25@le.ac.uk (P.J. Watson). www.EuropeanJournalPain.com Available online at www.sciencedirect.com European Journal of Pain 12 (2008) 314–320