To return or not return? Predictive factors for return to work in persons with musculoskeletal disorders – prospective studies over a 10-year period

Sammanfattning: Background: Musculoskeletal disorders (MSD) are a major reason for sick leave and results in individual suffering as well as economical consequences for both the individual and society. It is important to study variables from a multidimensional perspective to predict sustainable return to work (RTW). The overall aim was to identify multidimensional predictors and psychosocial characteristics for RTW in persons with musculoskeletal disorders (MSD), over a 10-year period. Study I: Aim: To identify predictive factors for RTW in patients with MSD. Design: Prospective. Method: Persons aged 18-65 years (n=377), were divided into two groups due to sickness certification one year after rehabilitation. The groups were compared with each other regarding predictive factors for RTW using logistic regression analysis. Result: Predictive factors for RTW were gender, age, education, number of sick-listed days before rehabilitation, physical capacity, self-rated pain, self-rated functional capacity and self-rated Quality of Life (QoL). Implication: Identifying predictors for RTW is an essential task for designing a suitable individual rehabilitation. Study II: Aim: To identify multidimensional predictive factors for sustainable RTW in a long-term follow-up study of persons with MSD. Design: Prospective. Method: Persons aged 18-65 years (n=183) were divided into “working full-time” and “sick-listed” groups five and ten years after a rehabilitation program. The groups were compared with each other regarding predictive factors for RTW using stepwise logistic regression. Result: Long-term predictive factors were number of sick-listed days before rehabilitation, age, self-rated pain, life events, gender, physical capacity, self-rated functional capacity, educational level, and light physical labour. Implication: Sustained RTW can be facilitated by early planning of the sick leave period using instruments that take these predictors into account. Study III: Aim: To describe thoughts and feelings of future working life related to RTW in persons who are sick-listed due to MSD and to compare these descriptions with the person’s actual working situation to create predictors for RTW. Design: Prospective and explorative. Method: Persons aged 18-65 years (n=320) answered an open-ended question about thoughts and feelings of their future working life before participating in a rehabilitation program. The answers were analysed using qualitative content analysis. The emerging categories were compared with the persons working situation one, five and ten years after the rehabilitation program using Pearson’s chi-squared test. Result: Three categories; “motivation and optimism”, “limitations to overcome” and “hindrance and hesitation”, and nine subcategories, were defined. Persons in the subcategories driving force, new possibilities and demand another job had changed job. Those in the reduced work-time subcategory were working part-time after a five-year period. Implication: Persons with a motivation for RTW and those expressing some kind of hindrance should have different types of support. Study IV: Aim: To compare psychosocial factors between healthy and sick-listed persons, both groups with MSD ten years ago. Design: Prospective. Method: Ten years after a rehabilitation program persons aged 18-65 years (n=183) were divided into a healthy group and a sick-listed group. The groups were compared with each other in regards to psychosocial factors using logistic regression analysis and Pearson’s chi-squared test. Result: The healthy group had a higher QoL, more control over the working situation, better sense of coherence (SOC) and more life events. Implication: Using the knowledge about the characteristics of the healthy group, adequate rehabilitation can be given. General conclusion and implications: The focus of this thesis has been on healthy factors for RTW in line with the salutogenic theory. When predicting RTW for persons with MSD we must have a multidimensional perspective and physical, psychosocial and occupational factors must be considered. The instruments in this thesis can be used to predict RTW. Taking all dimensions and all predictive factors into account, sick leave can be reduced by directing the person to the correct amount rehabilitation, not more and not less. Keywords: Certified sick leave, functional capacity, job strain, motivation, musculoskeletal disorders, pain, physical capacity, qualitative content analysis, quality of life, return to work, sense of coherence, working life ISBN 978-91-628-8061-3 Abstract To return or not return? Predictive factors for return to work in persons with musculoskeletal disorders - prospective factors over a 10-year period Marie Lydell, Sahlgrenska School of Public Health and Community Medicine, Department of Primary Health Care, University of Gothenburg. Background: Musculoskeletal disorders (MSD) are a major reason for sick leave and results in individual suffering as well as economical consequences for both the individual and society. It is important to study variables from a multidimensional perspective to predict sustainable return to work (RTW). The overall aim was to identify multidimensional predictors and psychosocial characteristics for RTW in persons with musculoskeletal disorders (MSD), over a 10-year period. Study I: Aim: To identify predictive factors for RTW in patients with MSD. Design: Prospective. Method: Persons aged 18-65 years (n=377), were divided into two groups due to sickness certification one year after rehabilitation. The groups were compared with each other regarding predictive factors for RTW using logistic regression analysis. Result: Predictive factors for RTW were gender, age, education, number of sick-listed days before rehabilitation, physical capacity, self-rated pain, self-rated functional capacity and self-rated Quality of Life (QoL). Implication: Identifying predictors for RTW is an essential task for designing a suitable individual rehabilitation. Study II: Aim: To identify multidimensional predictive factors for sustainable RTW in a long-term follow-up study of persons with MSD. Design: Prospective. Method: Persons aged 18-65 years (n=183) were divided into “working full-time” and “sick-listed” groups five and ten years after a rehabilitation program. The groups were compared with each other regarding predictive factors for RTW using stepwise logistic regression. Result: Long-term predictive factors were number of sick-listed days before rehabilitation, age, self-rated pain, life events, gender, physical capacity, self-rated functional capacity, educational level, and light physical labour. Implication: Sustained RTW can be facilitated by early planning of the sick leave period using instruments that take these predictors into account. Study III: Aim: To describe thoughts and feelings of future working life related to RTW in persons who are sick-listed due to MSD and to compare these descriptions with the person’s actual working situation to create predictors for RTW. Design: Prospective and explorative. Method: Persons aged 18-65 years (n=320) answered an open-ended question about thoughts and feelings of their future working life before participating in a rehabilitation program. The answers were analysed using qualitative content analysis. The emerging categories were compared with the persons working situation one, five and ten years after the rehabilitation program using Pearson’s chi-squared test. Result: Three categories; “motivation and optimism”, “limitations to overcome” and “hindrance and hesitation”, and nine subcategories, were defined. Persons in the subcategories driving force, new possibilities and demand another job had changed job. Those in the reduced work-time subcategory were working part-time after a five-year period. Implication: Persons with a motivation for RTW and those expressing some kind of hindrance should have different types of support. Study IV: Aim: To compare psychosocial factors between healthy and sick-listed persons, both groups with MSD ten years ago. Design: Prospective. Method: Ten years after a rehabilitation program persons aged 18-65 years (n=183) were divided into a healthy group and a sick-listed group. The groups were compared with each other in regards to psychosocial factors using logistic regression analysis and Pearson’s chi-squared test. Result: The healthy group had a higher QoL, more control over the working situation, better sense of coherence (SOC) and more life events. Implication: Using the knowledge about the characteristics of the healthy group, adequate rehabilitation can be given. General conclusion and implications: The focus of this thesis has been on healthy factors for RTW in line with the salutogenic theory. When predicting RTW for persons with MSD we must have a multidimensional perspective and physical, psychosocial and occupational factors must be considered. The instruments in this thesis can be used to predict RTW. Taking all dimensions and all predictive factors into account, sick leave can be reduced by directing the person to the correct amount rehabilitation, not more and not less. Keywords: Certified sick leave, functional capacity, job strain, motivation, musculoskeletal disorders, pain, physical capacity, qualitative content analysis, quality of life, return to work, sense of coherence, working life ISBN 978-91-628-8061-3