Predicting return to work among sickness-certified patients in general practice: Properties of two assessment tools

Abstract

Aim. The purpose was to analyse the properties of two models for the assessment of return to work after sickness certification, a manual one based on clinical judgement including non-measurable information (‘gut feeling’), and a computer-based one.

Study population. All subjects aged 18 to 63 years, sickness-certified at a primary health care centre in Sweden during 8 months (n = 943), and followed up for 3 years.

Methods. Baseline information included age, sex, occupational status, sickness certification diagnosis, full-time or part-time current sick-leave, and sick-leave days during the past year. Follow-up information included first and last day of each occurring sick spell. In the manual model all subjects were classified, based on baseline information and gut feeling, into a high-risk (n = 447) or a low-risk group (n = 496) regarding not returning to work when the present certificate expired. It was evaluated with a Cox’s analysis, including time and return to work as dependent variables and risk group assignment as the independent variable, while in the computer-based model the baseline variables were entered as independent variables.

Results. Concordance between actual return to work and return to work predicted by the analysis model was 73%–76% during the first 28–180 days in the manual model, and approximately 10% units higher in the computer-based model. Based on the latter, three nomograms were constructed providing detailed information on the probability of return to work.

Conclusion. The computer-based model had a higher precision and gave more detailed information than the manual model.

Key words::

• Gut feeling
• long-term sick-leave
• nomogram
• return to work
• risk assessment
• sickness certification

Acknowledgements

The study was supported by grants from Samordningsförbundet RAR, Sörmland; Centre for Clinical Research Sörmland; Uppsala University, Eskilstuna; Sörmland County Council; and Uppsala University, Sweden. Thanks are due to Professor Hans Wedel, Gothenburg, for valuable comments on the analysis model and to Hans G. Eriksson, Eskilstuna, for help with the data set. A.S.v.C. was responsible for the conception and design of the study and data collection. K.S. analysed the data. A.S.v.C., T.W., and K.S. drafted the manuscript. All authors participated in the interpretation of the results, the revision of the manuscript, and the approval of the final manuscript version.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.