Return-to-Work Following Occupational Rehabilitation for Long COVID: Descriptive Cohort Study

Abstract

Background Emerging evidence suggests that worldwide, between 30% and 50% of those who are infected with COVID-19 experience long COVID (LC) symptoms. These symptoms create challenges with return-to-work (RTW) in a high proportion of individuals with LC. To tailor rehabilitation programs to LC sequelae and help improve RTW outcomes, more research on LC rehabilitation program outcomes is needed. Objective This study describes the characteristics and outcomes of workers who participated in an LC occupational rehabilitation program. Methods A cohort study was conducted. Descriptive variables included demographic and occupational factors as well as patient-reported outcome measures (PROMs, ie, the Fatigue Severity Scale [FSS], the Post-COVID Functional Scale [PCFS], the 36-item Short Form Health Survey [SF-36], the Pain Disability Index [PDI], the pain Visual Analogue Scale [VAS], the 9-item Patient Health Questionnaire [PHQ-9], the 7-item Generalized Anxiety Disorder Questionnaire [GAD-7], and the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition [DSM-5] posttraumatic stress disorder [PTSD] checklist [PCL-5]). The main outcome variable was the RTW status at discharge. Descriptive statistics were calculated. Logistic regression examined predictors of RTW. Results The sample consisted of 81 workers. Most workers were female (n=52, 64%) and from health-related occupations (n=43, 53%). Only 43 (53%) individuals returned to work at program discharge, with 40 (93%) of these returning to modified duties. Although there were statistically significant improvements on the pain VAS (mean 11.1, SD 25.6, t31=2.5, P=.02), the PDI (mean 9.4, SD 12.5, t32=4.3, P<.001), the FSS (mean 3.9, SD 8.7, t38=2.8, P=.01), the SF-36 PCS (mean 4.8, SD 8.7, t38=–3.5, P=.001), the PHQ-9 (mean 3.7, SD 4.0, t31=5.2, P<.001), and the GAD-7 (mean 1.8, SD 4.4, t22=1.8, P=.03), there were no significant improvements in the PCFS, the overall mental component score (MCS) of the SF-36, or on the PCL-5. The availability of modified duties (odds ratio [OR] 3.38, 95% CI 1.26-9.10) and shorter time between infection and admission for rehabilitation (OR 0.99, 95% CI 0.99-1.00) predicted RTW even when controlling for age and gender. Conclusions Workers undergoing LC rehabilitation reported significant but modest improvements on a variety of PROMs, but only 43 (53%) returned to work. Outcomes would likely improve with increased availability of modified duties and timelier rehabilitation. Additional research is needed, including larger observational cohorts as well as randomized controlled trials to evaluate the effectiveness of LC rehabilitation.

Impact of Rehabilitation on Physical and Neuropsychological Health of Patients Who Acquired COVID-19 in the Workplace

“…In our study, the prevalence of most symptoms decreased after rehabilitation, whereas there were persistent physical, psychological, and cognitive dysfunctions. This is in line with the results from Brehon et al [ 88 ], who showed that neuropsychological symptoms improved in healthcare workers after a rehabilitation program. As fatigue is one of the most commonly reported post-COVID symptoms [ 38 ] and the reported prevalence of fatigue at T2 remains high, sustainable treatments and therapies addressing fatigue must be developed and implemented.…”

“…After rehabilitation discharge, 90 out of 124 patients were still unable to work. Brehon et al [ 88 ] confirm this result and indicate that only 53% of workers with post-COVID symptoms returned to work after a rehabilitation program. In our study, many healthcare workers (60 out of 89) were incapacitated for work at baseline.…”

“…The high rate of inability to work and the high amount of post-COVID symptoms support Böckermann et al [ 108 ], demonstrating that poor health status is linked with a higher rate of unemployment. To increase return-to-work among post-COVID patients, it is necessary to adapt the working conditions (adjustments in workload, working hours, and tasks) and develop a return-to-work plan [ 88 , 109 ]. Strategies supporting the return to work after COVID-19 could be similar to programs developed for chronic diseases [ 110 , 111 , 112 ].…”

Perceived Consequences of Post-COVID-19 and Factors Associated with Low Life Satisfaction

“…This result demonstrates the importance of work for well-being. In a recent cohort study, workplace modifications have been found to be the most important factor in supporting the return to work for persons with post-COVID-19 [ 52 ]. Therefore, in the future, focus should be given to how a return to work and stay at work can be supported after COVID-19.…”

Assessment of Exercise Capacity in Post-COVID-19 Patients: How Is the Appropriate Test Chosen?

“…Among the most commonly reported sequelae are symptoms such as fatigue, dyspnoea, and, in some cases, even a marked deterioration in physical capacity [ 9 , 10 ]. These sequelae affect the quality of life and return to work in the active population [ 11 ]. Thus, it is estimated that the long-term sequelae of COVID-19 in patients after hospital discharge can reach 76% of cases at six months (i.e., at least one symptom at follow-up, such as fatigue, muscle weakness, sleeping difficulties, anxiety, depression, or others), with higher prevalence in women [ 12 ].…”