Long-term outcomes following vocational rehabilitation treatments in patients with prolonged fatigue

Abstract

Background: Multi-component vocational rehabilitation (VR) provides positive short-term outcomes in patients with prolonged fatigue.

Purpose: The purpose of this study is to evaluate the long-term outcomes of Dutch multi-component VR up to 18 months after treatment.

Method: In a pre-post-study, measurements were taken before treatment (t0), after treatment (t1) and in long-term follow-ups at 6 (t2), 12 (t3) and 18 months (t4) after treatment. Primary outcomes (fatigue, work participation and workability) and secondary outcomes [physical and social functioning, mental health and heart rate variability (HRV)] were assessed over time using linear mixed models analyses. Post hoc long-term outcomes were compared with t0 and t1.

Results: Sixty patients with severe fatigue complaints participated. The primary outcomes significantly (p < 0.001) improved at follow-ups compared with t0 and showed no relapse compared with t1. Moreover, fatigue decreased (p < 0.002) whereas workability (p < 0.001) and work participation (p < 0.001) increased further after treatment (t1). The secondary outcomes, physical functioning, mental health, social functioning and HRV, improved significantly (p < 0.001, p < 0.001, p < 0.001 and p = 0.049, respectively) over the long term compared with t0. At 6-month follow-up (t2), mental health (p < 0.003) and social functioning (p = 0.003) further increased after the treatment was stopped.

Conclusion: Multi-component VR treatments seem to significantly and in a clinically relevant way decrease fatigue symptoms and improve individual functioning and work participation in patients with severe prolonged fatigue over the long term and without showing relapse.

Fig. 1

Flow chart of patients through the study

Fig. 2

Primary outcomes: fatigue severity, work-related fatigue, vitality return to original work, return to work and work ability. Mean scores (95% confidence intervals) on primary outcomes at t0 (baseline), t1 (at completion of the treatment), t2 (6 months follow-up), t3 (12 months follow-up) and t4 (18 months follow-up) and p values for the differences between follow-up measures and t1. *p < 0.001, significant post hoc outcome within subjects compared with t0. Significant when p < 0.0083 (Bonferroni corrected). ^p < 0.0083, significant post hoc outcome within subjects compared with t1 (p < 0.0083 Bonferroni corrected)