病例管理康复干预在促进心肌梗死后重返工作岗位和维持就业方面的有效性：一项随机对照试验的结果。

The Effectiveness of Case-management Rehabilitation Intervention in Facilitating Return to Work and Maintenance of Employment After Myocardial Infarction: Results of a Randomized Controlled Trial.

机构信息

Department of Environmental and Occupational Health, The School of Public Health, Sackler Faculty of Medicine, 58408Tel-Aviv University, Tel-Aviv, Israel.

Marom Cardiology Center, Kefar Sava, Israel.

出版信息

Clin Rehabil. 2022 Jun;36(6):753-766. doi: 10.1177/02692155221076826. Epub 2022 Feb 22.

DOI:10.1177/02692155221076826

PMID:35191331

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9082965/

Abstract

OBJECTIVE

To study the long-term effectiveness of case-management rehabilitation intervention on vocational reintegration of patients after myocardial infarction (MI).

DESIGN

Blinded simple randomization was used to construct an intervention and control groups that were followed up for two years.

SUBJECTS AND SETTING

151 patients, aged 50.3 ± 5.9 years, who experienced uncomplicated MI and were enrolled in a cardiac rehabilitation program were recruited.

INTERVENTIONS

included an early referral to an occupational physician, tailoring an occupational rehabilitation program, based on individual patient needs, coordination with relevant parties, psychosocial intervention, intensive follow-up sessions during a two-year follow-up.

MAIN MEASURES

Return to work within six months of hospitalization and maintenance of employment at one and two years of follow-up.

RESULTS

Return-to-work (RTW) rate in the intervention group was 89% and nearly all maintained employment at one year of follow-up (92%) and two years of follow-up (87%). Moreover, almost all of them returned to and maintained their previous jobs. The corresponding figures were: 98%, 94% and 98%, respectively. The figures for the RTW and employment maintenance for the control group were: 74%, 75%, and 72%, respectively. Only about 75%, in this group kept their previous job. The case-management intervention was associated with increased odds of maintaining employment at follow-up of one year (OR = 5.89, 95% CI 1.42-24.30) and two years (OR = 3.12, 95% CI 1.01-10.03).

CONCLUSIONS

The extended case-management rehabilitation intervention had a substantial positive impact on both the RTW of MI patients and their maintenance of employment at one and two years of follow-up.

TRIAL REGISTRATION

This trial is registered at US National Institutes of Health #NCT04934735.

摘要

目的

研究病例管理康复干预对心肌梗死后患者职业康复的长期效果。

设计

采用盲法简单随机分组，将患者分为干预组和对照组，随访 2 年。

对象和环境

纳入 151 名年龄为 50.3±5.9 岁、经历过非复杂性心肌梗死且参加过心脏康复项目的患者。

干预措施

包括早期转介给职业医生、根据个体患者需求定制职业康复计划、与相关方协调、心理社会干预、在 2 年随访期间进行强化随访。

主要观察指标

住院后 6 个月内重返工作岗位和 1 年及 2 年随访时保持就业。

结果

干预组的重返工作率为 89%，几乎所有患者在 1 年（92%）和 2 年（87%）随访时都保持就业，且几乎所有人都回到并保持了之前的工作。相应的数字分别为：98%、94%和 98%。对照组的重返工作和就业维持率分别为：74%、75%和 72%。只有大约 75%的人在这个组保持了之前的工作。病例管理干预与 1 年（OR=5.89，95%CI 1.42-24.30）和 2 年（OR=3.12，95%CI 1.01-10.03）随访时的就业维持率显著相关。