Clinical reasoning in occupational health services for individuals with musculoskeletal and mental disorders

Abstract

Aims: To investigate whether there are associations between the professional assessment of a patient's main clinical problem and the patient's self-reported health among patients with musculoskeletal disorders and/or mental disorders. To investigate differences in self-reported health and work-related measures in patients who were recommended clinical versus work-related interventions. Method: A cross-sectional study, including a convenience sample of 210 patients, visiting occupational health service. Patients answered a questionnaire on demographic variables, dimensions of health, functioning, work ability and working conditions. Patients’ main clinical problem and type of intervention was classified by physiotherapists. Activity limitations were identified using the Patient-Specific Functional Scale. Findings: The main clinical problems were: medical/organic problems (39%), psychosocial problems (46%) and physical work-related problems (15%). The psychosocial group reported more problems in mental functioning and the medical/organic group had worse physical functioning. There were significant differences for the main clinical problem, educational level, work ability, social interaction skills and mobility in patients who were recommended clinical versus work-related interventions. Conclusions: There are associations between the professional biopsychosocial classification and the patient's self-reported health and functioning. Clinical reasoning may be improved by including systematic biopsychosocial assessment of specific health and working conditions, and activity limitations according to Patient-Specific Functional Scale.

Key words::

• Biopsychosocial model
• Patient-Specific Functional Scale
• professional assessment
• self-report
• work ability

Acknowledgements

A special thank you to all the participants in the study who completed the questionnaire and healthcare professionals at the occupational health service unit who were involved in the study. We would also like to thank Henrik Magnusson for statistical support.

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

This study was supported by grants from the Swedish Council for Working Life and Social Research (FAS), and from the Department of Medi cal and Health Sciences, Linköping University.