Article
Effectiveness of graded return to work after multimodal rehabilitation in patients with mental disorders. A propensity score analysis
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Authors
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Marco Streibelt
- German Federal Pension Insurance, Berlin, Germany
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Wolfgang Bürger
- fbg – Research and Consulting in Health Care, Karlsruhe, Germany
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Karen Nieuwenhuijsen
- Academic Medical Center, Coronel Institute of Occupational Health, Amsterdam, Netherlands
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Matthias Bethge
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| Published: | April 16, 2019 |
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Outline
Text
Background: Graded Return to Work (GRTW) is a strategy to bring chronically ill persons gradually back to full work load. Several studies showed the effectiveness of GRTW regarding RTW for patients with somatic diseases. Studies in patients with mental health problems showed contrary results.
Aim: Our study aims to determine the effect of GRTW on longer-term RTW in persons with mental disorders.
Method: The data was extracted from the GRTW cohort study in the context of multimodal rehabilitation on behalf of the German Pension Insurance (GPI). Patients with mental disorders in a clinical rehabilitation setting were included. Questionnaires at the start of rehabilitation and 15 months later were provided. Balanced groups (GRTW, noGRTW) were formed by propensity score matching based on 27 covariates. The primary outcomes were the RTW status at follow-up and the number of days on sick leave during follow-up.
Results/findings: From 1,062 data sets (GRTW: 508, noGRTW: 554), 381 pairs were matched (age: 47.8 years; 78% female; 65% affective disorders, 28% neurotic or somatic disorders). At follow-up, 88% of the GRTW group had returned to work compared to only 73% of the controls (RR=1.22, 1.13 to 1.31). The mean sick leave duration during the follow-up period was 7.0 weeks in the GRTW group compared to 13.4 weeks in the control group (p<.001). Additional explorative analyses showed that these effects were only observed in patients with an unsure or negative subjective RTW prognosis.
Discussion and conclusions: GRTW in addition to a multimodal rehabilitation is effective in enhancing successful work participation in people with chronic mental disorders. GRTW after multimodal rehabilitation is particularly suitable for patients with a negative subjective RTW prognosis.
