Maladaptive illness behaviour (Health factor for workers with an MSD)

Interpretation of the “Maladaptive illness behaviour” factor

A maladaptive illness behaviour negatively influences RTW or sickness absence duration.

Definition of the “Maladaptive illness behaviour” factor

Short definition: Maladaptive illness behaviours are defined as observable and potentially measurable actions and conduct which express and communicate the individual’s own perception of disturbed health (Waddell, Bircher, Finlayson et Main, 1984).

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Maladaptive illness behaviours negatively influence RTW in workers with an MSD (Gaines Jr et Hegmann, 1999; Schultz, Crook, Berkowitz, Milner et Meloche, 2005; Schultz et al., 2002). These behaviors encompass monitoring and interpreting bodily sensations, utilizing healthcare resources, discussing illness or symptoms with providers, and adhering to prescribed medical regimens (Rau et Williams, 2020). They can therefore be divided in self-care and healthcare-utilization behaviours and their variation is often attributed to psychological and sociocultural factors.

Illness behaviour involves how individuals present themselves and communicate with healthcare providers.  In the context of MSDs, maladaptive illness behaviours manifest often in ways of communicating pain, which are interpreted as out of proportion to the underlying physical disease and relates more to associated psychological disturbances. However, what might be considered maladaptive in one illness context could serve an adaptive purpose in another. Therefore, providers are urged to take disease characteristics into account when suspecting maladaptive illness behaviors (Rau et Williams, 2020).

Gaines Jr, W. G. et Hegmann, K. T. (1999). Effectiveness of Waddell’s nonorganic signs in predicting a delayed return to regular work in patients experiencing acute occupational low back pain. Spine, 24(4), 396-400.

Rau, H. et Williams, P. (2020). Illness behavior. Dans Encyclopedia of behavioral medicine (p. 1126-1127): Springer.

Schultz, I. Z., Crook, J., Berkowitz, J., Milner, R. et Meloche, G. R. (2005). Predicting Return to Work After Low Back Injury Using the Psychosocial Risk for Occupational Disability Instrument: A Validation Study. Journal of Occupational Rehabilitation, 15(3), 365-376. doi: 10.1007/s10926-005-5943-9

Schultz, I. Z., Crook, J. M., Berkowitz, J., Meloche, G. R., Milner, R., Zuberbier, O. A. et Meloche, W. (2002). Biopsychosocial multivariate predictive model of occupational low back disability. Spine, 27(23), 2720-2725.

Waddell, G., Bircher, M., Finlayson, D. et Main, C. J. (1984). Symptoms and signs: physical disease or illness behaviour? Br Med J (Clin Res Ed), 289(6447), 739-741.

Tools for measuring the “Maladaptive illness behaviour” factor