Effect of sense of coherence on long-term work participation among rehabilitation patients: a longitudinal study

Abstract

Objective: To investigate the causal effect of sense of coherence on long-term work participation after rehabilitation, including stratification by age and diagnoses.

Design: Longitudinal cohort study.

Participants: Patients aged ≤ 60 years, employed and accepted for somatic interprofessional rehabilitation in 2015 (n = 192).

Methods: Patients reported sense of coherence before rehabilitation in 2015 and mental and physical functioning in 2016. Register data were used to measure work participation during 2018 and days working without social security benefits during 2016-18. Regression models were used to explore the total effect of sense of coherence and the possible mediation of functioning. Results are reported as odds ratios (95% confidence intervals).

Results: During 2018, 77% of the total study cohort participated in work activities. The subgroup with musculoskeletal diagnoses had the fewest days of working without social security benefits. A causal relationship was found between sense of coherence and long-term work participation. Some of the effect of sense of coherence was mediated by mental functioning. The total effect of sense of coherence was strongest for patients with musculo-skeletal diagnoses (work participation: 1.11 (1.05, 1.17), days working without social security benefits: 1.05 (0.01, 109)).

Conclusion: Improving coping resources may be beneficial to facilitate long-term work participation after injury or illness, especially for individuals with musculoskeletal diagnoses.

Fig. 1

Flowchart of the inclusion process of study participants. REKOVE: Rehabilitation cohort west; 1y: 1 year.

Fig. 2

Hypothesizing causality by time. Explanatory variable (sense of coherence) from the baseline survey, mediation variable (functioning) from the 1-year follow-up survey, and outcome variable: (i) work participation during 2018; (ii) days without social security benefits 2 years following completion of the 1-year follow-up survey.

Fig. 3

Visualizing the model: (i) total effect of the 13-item sense of coherence questionnaire (SOC-13) on outcome measure (without mediation). Effect of SOC-13 in a mediation model: (ii) effect of SOC-13 on mediator, (iii) direct effect of SOC-13, (ii+iv) indirect effect of SOC-13 on outcome. MCS: Mental Component Summary; PCS: Physical Component Summary.

Fig. 4

Description of explanatory variable; the 13-item Sense of Coherence questionnaire (SOC-13) at baseline (2015) and mediating variable; Physical Component Summary (PCS) and Mental Component Summary (MCS) at 1 year (2016) as reported by participants. Top 3 figures: reporting values within the study cohort (n = 192) and stratification by work participation in 2018, age (≥ 50/< 50 years) and diagnoses (musculoskeletal/other). Bottom 3 figures: association between SOC-13, PCS and MCS and days without social security benefits 24 months after responding to the 1-year follow-up survey in 2016.

Fig. 5

Causal relationship and effect of the 13-item Sense of Coherence questionnaire (scale 13–91, 91 best) (SOC-13) baseline (2015) and work participation during 2018 (left), days working without social security benefits 24 months after completion of the 1 y survey in 2016 (right). Mediation of Mental Component Summary (scale 0–100, 100 best) (MCS) at 1 year (1y) (2016). Black arrow: relationship/mediation; grey arrow: no relationship/no mediation. Adjusted for age, sex, level of education, diagnoses, comorbidity. OR: odds ratio; 95% CI: 95% confidence interval; B: beta.