Added to this is the evidence of the heterogeneity in the measurement of the outcome of back pain within this review. Studies differed in their assessment (patient rated, biomechanical testing, compensation MDV3100 status, different time scales for assessment) which makes comparisons all the more complex; future reviews should consider this issue. Comparison with other reviews This review has concentrated on the effects of employment social support, whereas most other reviews have considered this as part of
a wider search of employment psychosocial factors. This has led other reviews to include only a small number of studies on which to base their conclusions, for example, Steenstra et al. (2005) based theirs on four studies, Hoogendoorn et al. (2000) on six studies and Hartvigsen et al. (2004) on nine studies. The greater number of studies included in this review (thirty-two)
has enabled a more specified focus on employment support type and outcome (risk and prognosis), which we believe has overcome some of the issues of heterogeneity and inconsistency described by previous reviews. Strengths and limitations While this review has a comprehensive systematic search strategy, it did not include studies in languages other than English and so may have missed important findings; however, we did include studies from a range of countries worldwide. In addition, no review is completely immune from publication Selleckchem PP2 bias, and it may be the case that there are other findings (grey literature) we have not accessed. Strengths of the study are: the use of a systematic critical synthesis of the evidence which has enabled a closer inspection of the term employment social support and a better assessment of the types of support combined with an examination of individual study bias on the associations. Further selleck chemicals research This review has highlighted a need for consensus on what is meant by the term ‘employment social support’. As mentioned previously, there are Vasopressin Receptor a number of differing conceptualisations and future
research needs to report on those concepts to facilitate easier comparisons for future reviews but also, more importantly, to understand what factors of employment social support associate with outcomes. Secondly, and related to the first point, there is a need for research to consider the role of theoretical models within their research. Many studies (over 50 % in this review) employed the Karasek Job Content Questionnaire, or a derivative, as their measure of employment social support. However, studies did not perform the appropriate analysis techniques to ascertain whether employment social support is a moderator component as prescribed by the Karasek model. Conclusion This review has shown that employment-related support has little to no effect on risk of occurrence but a more notable effect on prognosis for those with back pain.