Bardal Ingvild, Aars Nils Abel Prestegård, Sanatkar Samineh, Stevelink Sharon Am, Brandseth Oda Lekve, Brinchmann Beate, Mykletun Arnstein
Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway.
Department of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway.
BMC Public Health. 2025 Mar 30;25(1):1202. doi: 10.1186/s12889-025-22368-1.
Musculoskeletal disorders (MSD) are among the leading causes of sickness absence (SA) and disability. Graded sickness absence (GSA) as an alternative to full time sickness absence (FSA) has been implemented in the Nordic countries to promote return to work (RTW) and prevent disability, similar to the Fit Note in the UK. However, the evidence of the effects of GSA on RTW is limited. FSA is plausibly associated with more health problems than GSA. The aim is to investigate if the hypothesized benefits of GSA over FSA on RTW is confounded by health in a cohort of sick listed patients referred to secondary care due to MSD.
Data was obtained from the Norwegian Neck and Back Register and the Norwegian Labour and Welfare Administration. Poisson regression was used to estimate the association of GSA versus FSA on RTW at 12 months after assessment, with and without adjustment for measures of symptom severity.
A total of 3371 patients were on GSA (n = 1671, 49.6%) or FSA (n = 1700, 50.4%) at baseline. Patients on FSA reported more severe symptoms than those on GSA on all measures, and detailed analysis of GSA indicated more severe symptoms with higher SA levels. Patients on GSA had higher rates of RTW at 12 months follow up than patients on FSA (unadjusted RR = 1.29, 95% CI 1.22-1.37), and the association remained in the fully adjusted model (RR = 1.19, 95% CI 1.12-1.26). We found an association between levels of GSA and RTW rates, with more work being associated with higher RR for RTW.
Among sick listed patients referred to secondary care due to MSD, GSA is associated with higher rates of RTW than FSA. Some of the beneficial association between GSA and RTW is confounded by higher symptom levels in FSA than GSA patients, but most of the benefit remains after adjusting for symptom severity. Mechanisms for the benefit of GSA remains unknown.
肌肉骨骼疾病（MSD）是导致病假缺勤（SA）和残疾的主要原因之一。北欧国家已实施分级病假缺勤（GSA）作为全日制病假缺勤（FSA）的替代方案，以促进重返工作岗位（RTW）并预防残疾，这与英国的“健康证明”类似。然而，GSA对RTW影响的证据有限。FSA可能比GSA与更多的健康问题相关。目的是调查在因MSD转诊至二级护理的病假登记患者队列中，GSA相对于FSA在RTW方面的假设益处是否会因健康状况而混淆。
数据来自挪威颈部和背部登记处以及挪威劳动和福利管理局。采用泊松回归来估计在评估后12个月时GSA与FSA对RTW的关联，同时调整和不调整症状严重程度的测量指标。
共有3371名患者在基线时处于GSA（n = 1671，49.6%）或FSA（n = 1700，50.4%）状态。在所有测量指标上，FSA患者报告的症状比GSA患者更严重，对GSA的详细分析表明，SA水平越高，症状越严重。在12个月的随访中，GSA患者的RTW率高于FSA患者（未调整的RR = 1.29，95%CI 1.22 - 1.37），并且该关联在完全调整模型中仍然存在（RR = 1.19，95%CI 1.12 - 1.26）。我们发现GSA水平与RTW率之间存在关联，工作量越大，RTW的RR越高。
在因MSD转诊至二级护理的病假登记患者中，GSA与比FSA更高的RTW率相关。GSA与RTW之间的一些有益关联因FSA患者的症状水平高于GSA患者而被混淆，但在调整症状严重程度后，大部分益处仍然存在。GSA有益的机制尚不清楚。
