Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
Int J Behav Med. 2011 Jun;18(2):160-71. doi: 10.1007/s12529-010-9099-4.
Prolonged fatigue can cause physical, mental and occupational disability. Fatigue often persists because of a combination of biopsychosocial factors.
To evaluate the process and outcomes of three existing outpatient vocational rehabilitation interventions (VRI) in patients with prolonged fatigue complaints. The VRIs differ with regard to the content and treatment duration, enrolment procedure and financing.
A pre-post design was used with repeated measurements before treatment, after treatment and 3 months after treatment. Primary outcomes (fatigue and work participation) and secondary outcomes (physical and social functioning, mental health and physiological indicators (heart rate variability)) were assessed over time using linear mixed models analysis. A process evaluation (i.e. patient reach, content completeness and patient satisfaction) was conducted as well.
One hundred patients participated. Post-treatment, fatigue decreased (p < .001) and work participation (p < .010), physical functioning (p < .001) and mental health (p < .001) improved considerably in all three VRIs. Social functioning improved in one VRI (p = .022), but did not in the other two (p = .442, p = .196, respectively). Physiologically, heart rate variability improved in two VRIs (p = .044, p = .038, respectively). VRIs were administered according to the programme protocol. Almost all patients met their personal goals and the majority was satisfied with the outcomes of diminished constraints at work.
Three VRIs showed significant and clinically relevant outcomes over time regarding decreased fatigue and improved functioning and work participation in fatigued patients. The VRIs administered patient-tailored biopsychosocial interventions as planned and patients were satisfied with the interventions.
长期疲劳会导致身体、精神和职业障碍。疲劳往往会持续存在，因为它是生物心理社会因素共同作用的结果。
评估三种现有的门诊职业康复干预（VRI）在慢性疲劳患者中的治疗过程和结局。这些 VRI 在内容和治疗时间、入组程序和资金来源方面存在差异。
采用治疗前、治疗后和治疗后 3 个月的重复测量设计，使用线性混合模型分析评估主要结局（疲劳和工作参与）和次要结局（身体和社会功能、心理健康和生理指标（心率变异性））。同时还进行了过程评估（即患者接触、内容完整性和患者满意度）。
共有 100 名患者参与了研究。治疗后，三种 VRI 均显著降低了患者的疲劳感（p<0.001）和工作参与度（p<0.010），显著改善了患者的身体功能（p<0.001）和心理健康（p<0.001）。其中一种 VRI 显著改善了患者的社会功能（p=0.022），而另外两种 VRI 则无显著改善（p=0.442，p=0.196）。两种 VRI 还显著改善了患者的心率变异性（p=0.044，p=0.038）。VRI 是根据方案协议进行管理的。几乎所有患者都实现了个人目标，且大多数患者对工作受限的减少感到满意。
三种 VRI 随着时间的推移，在慢性疲劳患者中均显示出显著的、具有临床意义的结果，表现为疲劳感降低、功能和工作参与度提高。VRI 提供了个体化的生物心理社会干预，符合预期，患者对干预结果也较为满意。
