Insurance Work and Health Group, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Ann Surg. 2019 May;269(5):972-978. doi: 10.1097/SLA.0000000000002666.
To characterize patterns of engagement in work during the 4-year period after major traumatic injury, and to identify factors associated with those patterns.
Employment is an important marker of functional recovery from injury. There are few population-based studies of long-term employment outcomes, and limited data on the patterns of return to work (RTW) after injury.
A population-based, prospective cohort study using the Victorian State Trauma Registry. A total of 1086 working age individuals, in paid employment or full-time education before injury, were followed-up through telephone interview at 6, 12, 24, 36, and 48 months post-injury. Responses to RTW questions were used to define 4 discrete patterns: early and sustained; delayed; failed; no RTW. Predictors of RTW patterns were assessed using multivariate multinomial logistic regression.
Slightly more than half of respondents (51.6%) recorded early sustained RTW. A further 15.5% had delayed and 13.3% failed RTW. One in 5 (19.7%) did not RTW. Compared with early sustained RTW, predictors of delayed and no RTW included being in a manual occupation and injury in a motor vehicle accident. Older age and receiving compensation predicted both failed and no RTW patterns. Preinjury disability was an additional predictor of failed RTW. Presence of comorbidity was an additional predictor of no RTW.
A range of personal, occupational, injury, health, and compensation system factors influence RTW patterns after serious injury. Early identification of people at risk for delayed, failed, or no RTW is needed so that targeted interventions can be delivered.
描述重大创伤后 4 年内工作参与模式，并确定与这些模式相关的因素。
就业是从伤害中恢复功能的重要标志。关于长期就业结果的人群研究较少，关于受伤后重返工作岗位 (RTW) 的模式的数据有限。
一项基于人群的前瞻性队列研究，使用维多利亚州创伤登记处。在受伤前处于就业或全日制教育状态的 1086 名工作年龄个体通过电话访谈进行了为期 6、12、24、36 和 48 个月的随访。通过 RTW 问题的回答来定义 4 种不同的模式：早期和持续；延迟；失败；无 RTW。使用多变量多项逻辑回归评估 RTW 模式的预测因素。
略多于一半的受访者（51.6%）记录了早期持续的 RTW。另有 15.5%的人延迟 RTW，13.3%的人 RTW 失败。五分之一（19.7%）的人没有 RTW。与早期持续 RTW 相比，延迟和无 RTW 的预测因素包括从事体力劳动职业和机动车事故受伤。年龄较大和获得赔偿预测了失败和无 RTW 模式。受伤前的残疾是 RTW 失败的另一个预测因素。合并症的存在是无 RTW 的另一个预测因素。
个人、职业、伤害、健康和赔偿制度等一系列因素影响严重伤害后 RTW 模式。需要早期识别有延迟、失败或无 RTW 风险的人，以便提供有针对性的干预措施。
