Interrelationships Among Workload, Illness Severity, and Function on Return to Work following Acute Respiratory Distress Syndrome

Abstract

Research Objectives Delayed return to work (RTW) is common in persons with acute respiratory distress syndrome (ARDS). This research aims to examine relationships among pre-ARDS job demands, illness severity, and post-ARDS functions with RTW 6 and 12 months after ARDS hospitalization. Design Prospective cohort study with 12-month follow-up. Setting 43 participating U.S. ARDSNet hospitals. Participants Previously employed adults with ARDS. Interventions Not applicable. Main Outcome Measures Pre-ARDS work demands were defined by the U.S. Occupational Information Network. Post-ARDS cognitive, psychological, interpersonal, and physical function were measured with the Mini-Mental State Examination, SF-36 mental health, social functioning, and physical functioning sub-scales, respectively. Results RTW rates among 329 enrolled previously employed adults with ARDS were 52% at 6-months and 55% at 12-months. Illness severity had a large effect [standardized coefficients range: -0.51 to -0.54, p < 0.001] on RTW at 6 months while function at 6-months (psychological [0.42, p < 0.001], interpersonal [0.40, p < 0.001], and physical [0.43, p < 0.001]) had a medium effect. Working at 6 months had a large effect [0.79 to 0.72, P < 0.001] on RTW at 12 months. Illness severity [-0.32 to -0.33, P=0.001] and post-ARDS function (psychological [6 months: 0.44, p < 0.001; 12 months: 0.33, p=0.002], interpersonal [0.44, p < 0.001; 0.22, p=0.03], and physical abilities [0.47, p < 0.001; 0.33, p=0.007]) had medium effect on RTW at 12 months. Conclusions RTW at 12 months was associated with illness severity, post-ARDS function, and working at 6 months. Among these factors, working at 6 months and function may be modifiable mediators of 12-month post-ARDS RTW. Improving RTW rates may include facilitating early RTW, providing job accommodations, and developing interventions across the healthcare spectrum to improve patients’ physical, psychological, and interpersonal function. Author(s) Disclosures On behalf of all authors, the corresponding author states that there are no conflicts of interest. Delayed return to work (RTW) is common in persons with acute respiratory distress syndrome (ARDS). This research aims to examine relationships among pre-ARDS job demands, illness severity, and post-ARDS functions with RTW 6 and 12 months after ARDS hospitalization. Prospective cohort study with 12-month follow-up. 43 participating U.S. ARDSNet hospitals. Previously employed adults with ARDS. Not applicable. Pre-ARDS work demands were defined by the U.S. Occupational Information Network. Post-ARDS cognitive, psychological, interpersonal, and physical function were measured with the Mini-Mental State Examination, SF-36 mental health, social functioning, and physical functioning sub-scales, respectively. RTW rates among 329 enrolled previously employed adults with ARDS were 52% at 6-months and 55% at 12-months. Illness severity had a large effect [standardized coefficients range: -0.51 to -0.54, p < 0.001] on RTW at 6 months while function at 6-months (psychological [0.42, p < 0.001], interpersonal [0.40, p < 0.001], and physical [0.43, p < 0.001]) had a medium effect. Working at 6 months had a large effect [0.79 to 0.72, P < 0.001] on RTW at 12 months. Illness severity [-0.32 to -0.33, P=0.001] and post-ARDS function (psychological [6 months: 0.44, p < 0.001; 12 months: 0.33, p=0.002], interpersonal [0.44, p < 0.001; 0.22, p=0.03], and physical abilities [0.47, p < 0.001; 0.33, p=0.007]) had medium effect on RTW at 12 months. RTW at 12 months was associated with illness severity, post-ARDS function, and working at 6 months. Among these factors, working at 6 months and function may be modifiable mediators of 12-month post-ARDS RTW. Improving RTW rates may include facilitating early RTW, providing job accommodations, and developing interventions across the healthcare spectrum to improve patients’ physical, psychological, and interpersonal function.