Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK.
Academic Unit of Injury, Recovery and Inflammation Science, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK.
Occup Med (Lond). 2024 Feb 19;74(1):53-62. doi: 10.1093/occmed/kqad041.
Significant numbers of individuals struggle to return to work following acute coronavirus disease 2019 (COVID-19). The UK Military developed an integrated medical and occupational pathway (Defence COVID-19 Recovery Service, DCRS) to ensure safe return to work for those with initially severe disease or persistent COVID-19 sequalae. Medical deployment status (MDS) is used to determine ability to perform job role without restriction ('fully deployable', FD) or with limitations ('medically downgraded', MDG).
To identify which variables differ between those who are FD and MDG 6 months after acute COVID-19. Within the downgraded cohort, a secondary aim is to understand which early factors are associated with persistent downgrading at 12 and 18 months.
Individuals undergoing DCRS had comprehensive clinical assessment. Following this, their electronic medical records were reviewed and MDS extracted at 6, 12 and 18 months. Fifty-seven predictors taken from DCRS were analysed. Associations were sought between initial and prolonged MDG.
Three hundred and twenty-five participants were screened, with 222 included in the initial analysis. Those who were initially downgraded were more likely to have post-acute shortness of breath (SoB), fatigue and exercise intolerance (objective and subjective), cognitive impairment and report mental health symptoms. The presence of fatigue and SoB, cognitive impairment and mental health symptoms was associated with MDG at 12 months, and the latter two, at 18 months. There were also modest associations between cardiopulmonary function and sustained downgrading.
Understanding the factors that are associated with initial and sustained inability to return to work allows individualized, targeted interventions to be utilized.
大量个体在急性冠状病毒病 2019（COVID-19）康复后难以重返工作岗位。英国军方制定了一个综合医疗和职业途径（国防 COVID-19 康复服务，DCRS），以确保那些最初患有严重疾病或持续 COVID-19 后遗症的人安全返回工作岗位。医疗部署状态（MDS）用于确定在没有限制的情况下执行工作角色的能力（“完全可部署”，FD）或有局限性（“医疗降级”，MDG）。
确定在急性 COVID-19 后 6 个月，FD 和 MDG 之间有哪些变量不同。在降级队列中，次要目标是了解哪些早期因素与 12 个月和 18 个月时持续降级相关。
接受 DCRS 的个体接受全面的临床评估。在此之后，回顾他们的电子病历并在 6、12 和 18 个月提取 MDS。分析了 57 个来自 DCRS 的预测因子。研究了初始和长期 MDG 之间的关联。
筛选了 325 名参与者，其中 222 名纳入了初始分析。最初降级的个体更有可能出现急性后呼吸急促（SoB）、疲劳和运动不耐受（客观和主观）、认知障碍和报告心理健康症状。疲劳和 SoB、认知障碍和心理健康症状的存在与 12 个月时的 MDG 相关，后两者与 18 个月时的 MDG 相关。心肺功能与持续降级之间也存在适度的关联。
了解与初始和持续无法返回工作岗位相关的因素可以利用个体化、针对性的干预措施。
