Sickness certificates: what information do they provide about rehabilitation?

Abstract

Purpose: To investigate whether patients are prescribed rehabilitation early in a new sick leave period, and whether this prescription is associated with sex, age, diagnosis, description of functioning, and affiliation of certifying physician. Method:A cross-sectional study using data from sickness certificates issued during a total sick leave period, collected consecutively during 2 weeks in 2007 in Östergötland County, Sweden. Rehabilitation prescribed in the first certificate or within 28 days after the start of sick leave was defined as early rehabilitation.Results: Musculoskeletal diseases (MSD) were the largest diagnostic group, followed by mental disorders (MD). The mean duration of sick leave was 94 days (SD 139), longest for MD patients. Early rehabilitation was prescribed in 27% of all certificates and in 45% of certificates for MSD and MD diagnoses. Logistic regression analysis indicated that prescription of early rehabilitation was associated with certificates issued for MSD and MD, youngest patients, and certificates issued by primary health care physicians. The final model explained 29% of variation in the prescription of early rehabilitation. Conclusions:There is a modest prescription of early rehabilitation in sickness certificates, based on younger age and MSD or MD diagnosis. This indicates that patients' rehabilitation needs may not have been identified.

Quality in sickness certificates in a Swedish social security system perspective

“…On the other hand, scarce information on interventions in the sickness certificate may limit the ability of the employer to enable RTW for the employee [4]. Such a lack of information can also restrict the social insurance officer from coordinating the RTW interventions [4]. For those reasons, communication between actors involved in the sick leave process must increase.…”

“…Incomplete description of the patient’s ongoing treatment and rehabilitation may not be crucial for assessing entitlement to sickness benefit. On the other hand, scarce information on interventions in the sickness certificate may limit the ability of the employer to enable RTW for the employee [4]. Such a lack of information can also restrict the social insurance officer from coordinating the RTW interventions [4].…”

“…through adjustments at the workplace. Some studies have shown that sickness certificates do not contain all the information that is required [2–4]. An incomplete sickness certificate can delay both the payment of benefits and the rehabilitation process, which in turn may lead to an extended period of sick leave or impair the individual’s entitlement to sickness benefit [2].…”

Confidence, attitudes, beliefs and determinants of implementation behaviours among physiotherapists towards clinical management of low back pain before and after implementation of the BetterBack model of care

“…There are several evidence-based clinical guidelines for the management of patients with LBP aiming at different health care practitioners (HCPs) [3]. In Sweden, a previous study by our research group has suggested that the health care process for patients with LBP tends to be fragmented and that only a third of patients on sick leave for musculoskeletal disorders receive evidencebased interventions in primary care [4]. Furthermore, there are still interventions that physiotherapists (PTs) in primary care consider to be relevant despite lack of evidence or treatments effects [5].…”