Factors associated with generalized anxiety in workers undergoing work rehabilitation for persistent musculoskeletal pain

Abstract

Purpose: To document in workers having a work disability due to a musculoskeletal disorder (MSD), the presence and variation over time of their intolerance of uncertainty and its maintenance factors as defined in Dugas et al.’s generalized anxiety disorder (GAD) model, i.e. worries, negative problem orientation, beliefs about the usefulness of worrying, cognitive avoidance and their consequences on depressive symptoms. Methods: An observational, prospective repeated-measures design was retained. Thirty-nine workers with an MSD having caused a work absence of over three months and who were beginning a work rehabilitation program were recruited and evaluated at four moments (beginning of rehabilitation program, first hours of work exposure, 50% of regular working hours and end of rehabilitation program). Validated self-report questionnaires measuring intolerance of uncertainty and its maintenance factors were administered. Finally, the Worry and Anxiety Questionnaire measured the presence and intensity of GAD symptoms as defined in the DSM-IV-TR. Results: Fifty percent of the workers initially exhibited GAD symptoms. Concerning the variation over time, improvements were noted in all GAD-related factors during the program, particularly with the first hours of work exposure. At the end of rehabilitation, only 21% of the participants still met GAD diagnostic criteria. Conclusion: Workers with an MSD causing a work disability averaging one year in length and enrolled in a work rehabilitation program exhibited a high level of anxiety at the beginning of the work rehabilitation program. Workers perceived a usefulness in worrying and presented some intolerance of uncertainty and some cognitive avoidance strategies. According to Dugas et al.’s GAD model, the intensity of the symptoms associated with GAD development and maintenance factors was, however, not typical of a GAD.

Implication for Rehabilitation

• A reconceptualization of the problem in terms of reducing the work disability rather than reducing pain may constitute a promising avenue to reduce anxiety symptoms.

• Future studies should look at the specific impact of work exposure, not only on pain symptoms but also on worries.

• The high level of anxiety and the reported worries by workers stresses the importance of studying the hypothesis of a workplace phobia in order to improve clinical practice guidelines.

• Anxiety
• disability
• intolerance of uncertainty
• musculoskeletal
• work rehabilitation
• worry

Acknowledgements

This study was made possible through the participation of workers who had had a long-term work absence. The authors also thank all members of the interdisciplinary work rehabilitation teams, without whose cooperation participant recruitment and the actual study itself would have been in jeopardy. Special thanks go to the CAPRIT clinicians, for it was their tireless quest for knowledge during the various knowledge transfer activities that gave rise to the idea behind this study.

Declaration of interest

This study was supported by a joint grant from the Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail and the Quebec Rehabilitation Research Network, a thematic network of the Fonds de la Recherche en Santé du Québec. Marie-France Coutu and Marie-José Durand have salary awards from the Fonds de Recherche en Santé du Québec. The authors have no conflicts of interest to declare.