Subgroups of Long-Term Sick-Listed Based on Prognostic Return to Work Factors Across Diagnoses: A Cross-Sectional Latent Class Analysis

Abstract

Comorbidity is common among long-term sick-listed and many prognostic factors for return to work (RTW) are shared across diagnoses. RTW interventions have small effects, possibly due to being averaged across heterogeneous samples. Identifying subgroups based on prognostic RTW factors independent of diagnoses might help stratify interventions. The aim of this study was to identify and describe subgroups of long-term sick-listed workers, independent of diagnoses, based on prognostic factors for RTW. Latent class analysis of 532 workers sick-listed for eight weeks was used to identify subgroups based on seven prognostic RTW factors (self-reported health, anxiety and depressive symptoms, pain, self-efficacy, work ability, RTW expectations) and four covariates (age, gender, education, physical work). Four classes were identified: Class 1 (45% of participants) was characterized by favorable scores on the prognostic factors; Class 2 (22%) by high anxiety and depressive symptoms, younger age and higher education; Class 3 (16%) by overall poor scores including high pain levels; Class 4 (17%) by physical work and lack of workplace adjustments. Class 2 included more individuals with a psychological diagnosis, while diagnoses were distributed more proportionate to the sample in the other classes. The identified classes illustrate common subgroups of RTW prognosis among long-term sick-listed individuals largely independent of diagnosis. These classes could in the future assist RTW services to provide appropriate type and extent of follow-up, however more research is needed to validate the class structure and examine how these classes predict outcomes and respond to interventions.

Insomnia is Associated with the Effect of Inpatient Multimodal Occupational Rehabilitation on Work Participation in Workers with Musculoskeletal or Mental Health Disorders: Secondary Analyses of a Randomized Clinical Trial

“…Furthermore, more research is needed on which interventions are most effective for certain individuals. It has been suggested that subgroups should be identified based on prognostic return-to-work factors; 7 therefore, our findings are important, as they suggest that insomnia should be addressed before sick-listed individuals take part in occupational rehabilitation programs, and that insomnia may assist in early identification of individuals at high risk for long-term sick leave.…”

“…2 However, results on the effect of such programs are inconsistent, [3][4][5][6] possibly because of the large heterogeneity among workers with musculoskeletal and mental health disorders. 7,8 Considering the high costs of providing inpatient programs, it is essential to gain further insight about subgroups that would benefit the most.…”

Effectiveness of 'motivational interviewing' on sick leave: a randomized controlled trial in a social insurance setting

“…Previous research on RTW interventions has often focused on specific diagnoses ( 7 , 10 ). However, there is substantial overlap in symptoms and prognostic factors among sick-listed individuals ( 24 , 25 ), and RTW is therefore argued to be a general process ( 26 ). Interventions that can be offered more broadly will also have the potential to reach more people.…”