Individual Factors and GP Approach as Predictors for the Outcome of Rehabilitation Among Long-Term Sick Listed Cases

Abstract

There appears to be a lack of evidence concerning the effect of rehabilitation programmes for the long-term sick. More focus in this area would supplement an approach that has been directed toward process evaluation of rehabilitation programmes. It was the purpose of this study to shed light on individual factors and health care and social welfare-related factors, which play a role for the outcome of rehabilitation programmes. In connection with a participatory, action-oriented outpatient rehabilitation program, a questionnaire survey was performed among the programmes participants ("clients"). Questionnaires were completed before the rehabilitation programme's start, at the end of the 8-week programme, and at the 9-months follow-up. Among 389 clients, 271 (69.7%) participated in the study at baseline as well at the 9-months follow-up. The majority of 212 participants were on sick leave--6.6% for more than 1 year. The remainder had been transferred to receiving social benefits after having exceeded the time limit for being sick-listed. A plan of action for active rehabilitation, which was made at the end of the 8-week rehabilitation programme, was only poorly fulfilled after 9 months, 48% were still on sick leave or social benefits at this time. Individual background variables, as well as psychological well-being, mental health, pain level, and pain coping, seemed to have little effect on the outcome of rehabilitation, whilst clients' own evaluations of competence and ability of the involved health care professionals were found important for a positive outcome of the programme. Especially stable relations to a single General Practitioner (GP), who took good care of the patient in the form of giving good information about health and social possibilities, and an empathic attitude toward these hard-pressed clients, were important factors. The odds ratio for a nonbeneficial outcome of the rehabilitation programme, among those who had changed GP and reported poor case treatment by the GP, was 3.9 (95% CI; 1.3-11.9). Additional findings were an association between a desire to go on early retirement pension, higher age, and self-estimated poorer health at baseline, and actual status as pensioner 9 months after the programme. Predictors of a beneficial outcome from the 8-week rehabilitation programme included good and comprehensive care-taking in particular by the clients' GP. The presence of a high level of symptoms and complaints of pain and stress had no effect on the outcome of rehabilitation in this cohort.