Musculoskeletal health and work: development and internal-external cross-validation of a model to predict risk of work absence and presenteeism in people seeking primary healthcare

Abstract

Abstract Purpose To develop and validate prediction models for the risk of future work absence and level of presenteeism, in adults seeking primary healthcare with musculoskeletal disorders (MSD). Methods Six studies from the West-Midlands and Northwest regions of England, recruiting adults consulting in primary care with MSD, and including work outcome data up to 12 months following consultation, were included for model development and internal-external cross-validation (IECV). The primary outcome was any work absence within 6 months of their consultation. Ten candidate predictors were included: age; sex; multisite pain; baseline pain score; pain duration; job type; anxiety/depression; presence of comorbidities; absence in the previous 6 months; baseline presenteeism. Results For the 6-month absence model, a total of 2179 participants (215 absences) were available across five studies. Calibration was promising, although varied across individual studies, with a pooled calibration slope of 0.93 (95%CI: 0.41 to 1.46) on IECV. On average, the model discriminated well between those with work absence within 6 months, and those without (IECV-pooled C-statistic 0.76, 95%CI: 0.66 to 0.86). Conclusions The model reasonably predicts risk of work absence within 6 months, on average, in adults consulting with MSD, and showed potential over a range of threshold outcome probabilities. This information could be useful to support shared decision-making and to target occupational health interventions at those individuals with a higher risk of absence in the 6 months following consultation. Further external validation is needed before the model’s use can be recommended or its impact on patients can be fully assessed.