Tschernetzki-Neilson Pamela Joy, Brintnell E Sharon, Haws Calvin, Graham Kathryn
Department of Occupational Therapy, University of Alberta, 2-64 Corbett Hall, Edmonton, AB, Canada, T6G 2E1.
J Occup Rehabil. 2007 Sep;17(3):473-86. doi: 10.1007/s10926-007-9094-z. Epub 2007 Jul 6.
The purposes of this study were to: (1) evaluate the effectiveness of changing a Return to Work (RTW) program's focus to one that was "outcome-focused", and (2) to determine which factors collected in the facility's database were most predictive of RTW.
A total of 13,428 client files were extracted from Millard Health's database which included data on two cohorts of subjects: those in the program before and after the change in focus had been made. This was to determine whether significant improvements in outcomes were achieved. Variables that were hypothesized to be predictive of RTW were selected based on previous published literature. Analyses included ANOVA's, logistic regression analysis and Pearson correlation.
Statistically significant improvements in RTW, total temporary disability claims, client satisfaction, efficiency of services and scores on the Perceived Disability Index (PDI), Short Form-36 (SF-36) and Visual Analogue Scale (VAS) for perceived pain were found. Variables that were predictive of RTW included: more efficient services, completion of a worksite visit, having the worker participate in the visit, availability of modified duties from the employer, fewer absences from the program and better scores on the PDI, SF-36 and VAS. The most predictive variable of RTW was sores on the PDI indicating lower levels of perceived disability.
Changing to an outcome-focused program improved various outcomes in this RTW program. Several factors predict the outcome of RTW and these should be considered in treatment planning.
本研究的目的是：（1）评估将重返工作岗位（RTW）计划的重点转变为“以结果为导向”的计划的有效性，以及（2）确定在该机构数据库中收集的哪些因素最能预测重返工作岗位情况。
从米勒德健康中心的数据库中提取了总共13428份客户档案，其中包括两组受试者的数据：重点转变前后参与该计划的受试者。这是为了确定结果是否有显著改善。根据先前发表的文献选择了假设可预测重返工作岗位情况的变量。分析包括方差分析、逻辑回归分析和皮尔逊相关性分析。
发现重返工作岗位情况、总临时残疾索赔、客户满意度、服务效率以及感知残疾指数（PDI）、简短健康调查问卷（SF-36）和视觉模拟评分法（VAS）的疼痛评分有统计学上的显著改善。可预测重返工作岗位情况的变量包括：服务效率更高、完成工作场所访问、工人参与访问、雇主提供调整后的工作职责、较少缺席该计划以及在PDI、SF-36和VAS上得分更高。最能预测重返工作岗位情况的变量是PDI上的得分较低，表明感知残疾程度较低。
转变为以结果为导向的计划改善了该RTW计划的各项结果。几个因素可预测RTW的结果，在治疗计划中应考虑这些因素。
