Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
Disabil Rehabil. 2011;33(6):453-66. doi: 10.3109/09638288.2010.493596. Epub 2010 Jun 7.
Under the national framework law in Sweden, all eligible people should have equal chances of receiving vocational rehabilitation. We aimed to review the evidence on (1) whether access to vocational rehabilitation is equitable in practice and (2) whether the outcomes vary for different groups in the population.
Systematic review of studies in Sweden that reported diagnostic or socio-demographic characteristics of people offered or taking up rehabilitation programmes and outcomes of such programmes for different diagnostic and socio-demographic groups. Searches of 11 relevant electronic databases, 15 organisational websites, citation searching and contact with experts in the field, for the period 1990-2009.
A total of 11 studies were included in the final review, six of which addressed review question (1) and seven addressed review question (2). All the six observational studies of access reported biased selection into vocational rehabilitation: greater likelihood for men, younger people, those with longer-term sick leave, those with lower income, employed rather than unemployed people and those with musculoskeletal and mental disorders or alcohol abuse. Having had a rehabilitation investigation also increased the likelihood of receiving vocational rehabilitation. Differential outcome of rehabilitation was reported in seven studies: outcomes were better for men, younger people, employed individuals, those with shorter sick leave and those with higher income. Selection into vocational rehabilitation was perceived as important for successful outcomes, but success also depended on the state of the local labour market.
There is evidence of socio-demographic differences in access to and outcomes of vocational rehabilitation in Sweden, even though the national framework law is meant to apply to everyone. Few studies have deliberately measured differential access or outcomes, and there is a need for this kind of equity analysis of population-wide policies. Studies evaluating the effects of vocational rehabilitation must consider selection into the programmes for adequate interpretation of impact results.
根据瑞典国家框架法，所有符合条件的人都应享有平等获得职业康复的机会。我们旨在审查以下两个问题的证据：（1）在实践中，职业康复的机会是否公平；（2）不同人群的结果是否存在差异。
系统综述了瑞典的研究，这些研究报告了提供或接受康复计划的人群的诊断或社会人口统计学特征，以及不同诊断和社会人口统计学群体的康复计划结果。1990 年至 2009 年期间，在 11 个相关电子数据库、15 个组织网站、引文搜索和与该领域专家联系进行了搜索。
最终综述共纳入 11 项研究，其中 6 项研究针对问题 1，7 项研究针对问题 2。所有 6 项关于获得职业康复的观察性研究均报告称，职业康复存在选择性偏差：男性、年轻人、长期请病假者、收入较低者、就业者而非失业者、患有肌肉骨骼和精神障碍或酗酒者，接受职业康复的可能性更大。接受康复调查也增加了接受职业康复的可能性。有 7 项研究报告了康复结果的差异：男性、年轻人、就业者、病假较短者和收入较高者的结果更好。选择职业康复被认为对成功的结果很重要，但成功也取决于当地劳动力市场的状况。
即使国家框架法旨在适用于所有人，但瑞典在获得职业康复的机会和结果方面仍存在社会人口学差异的证据。很少有研究有意衡量差异的获得或结果，因此需要对这种人口层面政策的公平性进行分析。评估职业康复效果的研究必须考虑到方案的选择，以便对影响结果进行充分的解释。
