Department of Health Economics, Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.
J Occup Rehabil. 2011 Sep;21(3):304-12. doi: 10.1007/s10926-010-9271-3.
Most workers with musculoskeletal disorders on sick leave often consult with regular health care before entering a specific work rehabilitation program. However, it remains unclear to what extent regular healthcare contributes to the timely return to work (RTW). Moreover, several studies have indicated that it might postpone RTW. There is a need to establish the influence of regular healthcare on RTW as outcome; "Does visiting a regular healthcare provider influence the duration of sickness absence and recurrent sick leave due to musculoskeletal disorders?".
A cohort of workers on sick leave for 2-6 weeks due to a-specific musculoskeletal disorders was followed for 12 months. The main outcomes for the present analysis were: duration of sickness absence till 100% return to work and recurrent sick leave after initial RTW. Cox regression analyses were conducted with visiting a general health practitioner, physical therapist, or medical specialist during the sick leave period as independent variables. Each regression model was adjusted for variables known to influence health care utilization like age, sex, diagnostic group, pain intensity, functional disability, general health perception, severity of complaints, job control, and physical load at work.
Patients visiting a medical specialist reported higher pain intensity and more functional limitations and also had a worse health perception at start of the sick leave period compared with those not visiting a specialist. Visiting a medical specialist delayed return to work significantly (HR = 2.10; 95%CI 1.43-3.07). After approximately 8 weeks on sick leave workers visiting a physical therapist returned to work faster than other workers. A recurrent episode of sick leave during the follow up quick was initiated by higher pain intensity and more functional limitations at the moment of fully return to work. Visiting a primary healthcare provider during the sickness absence period did not influence the occurrence of a new sick leave period.
Despite the adjustment for severity of the musculoskeletal disorder, visiting a medical specialist was associated with a delayed full return to work. More attention to the factor 'labor' in the regular healthcare is warranted, especially for those patients experiencing substantial functional limitations due to musculoskeletal disorders.
大多数患有肌肉骨骼疾病并请病假的劳动者在进入特定工作康复计划之前，通常会先去看常规的医疗保健机构。然而，常规医疗保健在多大程度上有助于及时重返工作岗位（RTW）尚不清楚。此外，有几项研究表明，它可能会推迟 RTW。有必要确定常规医疗保健对 RTW 的影响，即“看常规医疗保健提供者是否会影响因肌肉骨骼疾病而导致的病假和再次请病假的持续时间？”。
对因特定肌肉骨骼疾病而请病假 2-6 周的劳动者进行了为期 12 个月的随访。本分析的主要结局是：直至 100%重返工作岗位的病假持续时间和初始 RTW 后的再次请病假。使用 Cox 回归分析，将病假期间就诊的全科医生、物理治疗师或医学专家作为自变量。每个回归模型均根据已知会影响医疗保健利用的变量进行了调整，例如年龄、性别、诊断组、疼痛强度、功能障碍、一般健康感知、投诉严重程度、工作控制和工作物理负荷。
与未就诊的专家相比，就诊医学专家的患者报告的疼痛强度更高，功能障碍更严重，病假开始时的健康感知也更差。就诊医学专家会显著延迟重返工作岗位（HR=2.10；95%CI 1.43-3.07）。在病假大约 8 周后，就诊物理治疗师的劳动者比其他劳动者更快地重返工作岗位。在随访期间再次请病假的原因是在完全重返工作岗位时疼痛强度更高和功能障碍更多。在病假期间就诊的初级保健提供者不会影响新的病假期的发生。
尽管对肌肉骨骼疾病的严重程度进行了调整，但就诊医学专家与完全重返工作岗位的时间延迟有关。需要更加关注常规医疗保健中的“劳动力”因素，尤其是对于那些因肌肉骨骼疾病而经历严重功能障碍的患者。
