Prognostic factors associated with return to work following multidisciplinary vocational rehabilitation

Attføringssenteret i Rauland, Rauland, Norway.
Journal of Rehabilitation Medicine (Impact Factor: 1.68). 08/2008; 40(7):548-54. DOI: 10.2340/16501977-0202
Source: PubMed


The number of people in Western countries on long-term sick-leave and disability pension due to musculoskeletal complaints and psychological health problems is increasing. The main objective of this study was to examine whether fear-avoidance beliefs, illness perceptions, subjective health complaints, and coping are prognostic factors for return to work after multidisciplinary vocational rehabilitation, and to assess the relative importance and inter-relationship of these factors.
A prospective cohort study with a 1-year follow-up period was performed. A total of 135 individuals on long-term sick-leave (87 women, mean age 45 years) participated in a 4-week inpatient multidisciplinary vocational rehabilitation programme. The participants had been out of work for an average of 10.5 months.
Fear-avoidance beliefs about work was the most important risk factor for not returning to work, both at 3 months (odds ratio (OR) 3.8; confidence interval (CI) 1.30-11.32) and 1 year (OR 9.5; CI 2.40-37.53) after the intervention. Forty-eight percent of the variance in fear-avoidance beliefs was explained by subjective health complaints, illness perceptions and education. Coping explained only 1% of the variance.
These findings indicate that interventions for these patients should target fear of returning to work and illness perceptions about subjective health complaints.

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Available from: Irene Oyeflaten, Oct 06, 2015
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    • "They exhibit high comorbidity of psychiatric and somatic diagnoses, but often with no or few objective medical explanations (i.e. subjective health complaints (SHCs)) (Huijs et al., 2012; Oyeflaten, Hysing, & Eriksen, 2008; Salmi et al., 2009). Multidisciplinary interventions have been reported to be more efficacious and cost-effective in increasing RTW compared with single modality interventions across diagnoses (Gabbay et al., 2011; Hillage et al., 2008; Holm et al., 2010; Norlund, Ropponen, & Alexanderson, 2009). "
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    ABSTRACT: Objective: The aim of the present study was to compare responders and nonresponders in terms of work ability (WA) to a multidisciplinary vocational rehabilitation program (MVRP) in Norway. Methods: The WA of 74 participants was tested at baseline and in the final week of a 4–6-week intervention. The participants whose WA increased were defined as WA-responders, whereas participants with no increases or with decreases in their WA after the intervention were defined as WA-nonresponders. Measures of functional health, psychological functioning, and demographics were also collected. Results: Overall, the results of this study indicate that the WA improved and the proportion of participants with poor WA decreased by 26% after the intervention. However, the main outcome of this study was that not all of the participants reported improved WA after the intervention. WA of 43% of the participants did not improve and they were defined as WA-nonresponders, whereas the WA of the other 57% participants improved and they were defined as WA-responders. At baseline, the two groups did not differ significantly in terms of their basic characteristics, whereas there were significant differences between the two groups in terms of pain intensity and sense of mastery variables. Logistic regression analysis identified pain intensity and sense of mastery as significant predictors of WA-response. Conclusion: Multidisciplinary vocational rehabilitation seems effective for some but not all participants. Unfavorable WA responses were more prevalent in participants who reported high pain intensity and low sense of mastery at baseline. It is still a challenge to understand what distinguishes responders from nonresponders to MVRPs; thus, further research is required.
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    • "In Norway, tertiary institutional care occupational rehabilitation programs have been active for more than 27 years. Although some evaluations have been performed [19,20] none have used a randomized research design. Thus, the effects on work participation and health outcomes of institutional occupational rehabilitation programs are largely unknown. "
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    ABSTRACT: BackgroundLong-term sick leave has considerably negative impact on the individual and society. Hence, the need to identify effective occupational rehabilitation programs is pressing. In Norway, group based occupational rehabilitation programs merging patients with different diagnoses have existed for many years, but no rigorous evaluation has been performed. The described randomized controlled trial aims primarily to compare two structured multicomponent inpatient rehabilitation programs, differing in length and content, with a comparative cognitive intervention. Secondarily the two inpatient programs will be compared with each other, and with a usual care reference group.Methods/designThe study is designed as a randomized controlled trial with parallel groups. The Social Security Office performs monthly extractions of sick listed individuals aged 18–60 years, on sick leave 2–12 months, with sick leave status 50% - 100% due to musculoskeletal, mental or unspecific disorders. Sick-listed persons are randomized twice: 1) to receive one of two invitations to participate in the study or not receive an invitation, where the latter “untouched” control group will be monitored for future sick leave in the National Social Security Register, and 2) after inclusion, to a Long or Short inpatient multicomponent rehabilitation program (depending on which invitation was sent) or an outpatient cognitive behavioral therapy group comparative program. The Long program consists of 3 ½ weeks with full rehabilitation days. The Short program consists of 4 + 4 full days, separated by two weeks, in which a workplace visit will be performed if desirable. Three areas of rehabilitation are targeted: mental training, physical training and work-related problem solving. The primary outcome is number of sick leave days. Secondary outcomes include time until full sustainable return to work, health related quality of life, health related behavior, functional status, somatic and mental health, and perceptions of work. In addition, health economic evaluation will be performed, and the implementation of the interventions, expectations and experiences of users and service providers will be investigated with different qualitative methods.Trial NCT01926574.
    BMC Public Health 04/2014; 14(1):368. DOI:10.1186/1471-2458-14-368 · 2.26 Impact Factor
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    • "Van Rhenen et al. [14] found that employees with an active coping style had a lower frequency and shorter duration of later sick leave compared to those with a more passive coping style. Among rehabilitation clients , coping as a predictor for RTW differed between three and 12 months follow-up [12] [13], and among disability pensioners, coping did not predict RTW [13]. Possible explanations of the discrepancy between studies may be the small and skewed study samples or that the contribution of the separate subscales may differ between the study populations. "
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    ABSTRACT: The aim of this study was to explore how functional ability, coping and health were related to work and benefit status three years after participating in a four-week inpatient interdisciplinary occupational rehabilitation program. The cohort consisted of 338 individuals (75% females, mean age 51 years (SD=8.6)) who three years earlier had participated in a comprehensive inpatient interdisciplinary occupational rehabilitation program, due to long-term sick leave. The participants answered standardised questionnaires about subjective health complaints, functional ability, coping, and current work and benefit status. The relationships between these variables were analysed using logistic regression analyses. At the time of the survey, 59% of the participants worked at least 50% of a full working day. Twenty-five percent received at least 50% disability pension and 16% received other benefits. Poor functional ability (OR 4.8; CI 3.0-7.6), poor general health (OR 3.8; CI 2.3-6.1), high level of subjective health complaints (OR 3.3; CI 2.1-5.2), low coping (OR 2.8; CI 1.7-4.4), poor physical fitness (OR 2.8; CI 1.7-4.6) and poor sleep quality (OR 2.4; CI 1.5-3.7) were associated with receiving allowances. In a fully adjusted model, only poor functional ability and low coping were associated with receiving allowances three years after occupational rehabilitation. Functional ability and coping were the variables most strongly associated with not having returned to work. More attention should therefore be paid to enhance these factors in occupational rehabilitation programs. Part-time work may be a feasible way to integrate individuals with reduced workability in working life, if the alternative is complete absence from work.
    Scandinavian Journal of Public Health 04/2014; 42(5). DOI:10.1177/1403494814528291 · 1.83 Impact Factor
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