Does additional acute phase inpatient rehabilitation help people return to work? A subgroup analysis from a randomized controlled trial

Abstract

Objective: To investigate if a Saturday rehabilitation service in addition to usual care improved return to work outcomes 12 months post discharge and to report predictors of return to work.

Design: Subgroup analysis of a single-blind randomized controlled trial.

Setting: General inpatient rehabilitation service.

Subjects: A mixed cohort of 137 adults previously engaged in work, who were admitted for inpatient rehabilitation and allocated to a control group (n=63) or an intervention group (n=74).

Intervention: The control group received usual care rehabilitation from Monday to Friday and the intervention group received usual care plus an additional rehabilitation service on Saturdays (physiotherapy and occupational therapy).

Main outcome: Return to paid or unpaid work.

Results: After 12 months, 36 participants (57%) in the control group and 38 participants (51%) in the intervention group had returned to work. There was no difference between groups (mean difference -1.06 hours per week, 95% CI -8.70 to 6.57) in return to work outcomes. Functional status on discharge (OR 1.05, 95%CI 1.00 to 1.10), an orthopaedic diagnosis (OR 4.92, 95%CI 2.01 to 12.03) and engagement in unpaid work prior to rehabilitation (OR 5.08, 95%CI 1.39 to 18.58) were predictive of return to work at 12 months.

Conclusion: A Saturday rehabilitation service in addition to usual care showed no improvement in return to work outcomes at 12 months. Predictors of return to work may help identify those at risk of not returning to work and who require follow-up vocational rehabilitation services.

Keywords: Australia; Rehabilitation; allied health; occupational therapy; physiotherapy; randomized controlled trial; return to work; vocational rehabilitation.