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Logo of oenvmedOccupational and Environmental MedicineCurrent TOCInstructions for authors
Occup Environ Med. Jun 2003; 60(Suppl 1): i21–i25.
PMCID: PMC1765726

Quality of rehabilitation among workers with adjustment disorders according to practice guidelines; a retrospective cohort study


Aims: To assess the quality of occupational rehabilitation for patients with adjustment disorders and to determine whether high quality of care is related to a shorter period of sickness absence.

Methods: A retrospective cohort study was conducted by means of an audit of 100 files of patients with adjustment disorders who visited their occupational physicians. Quality of rehabilitation was assessed by means of 10 performance indicators, derived from the guidelines for the treatment of employees with mental health disorders. Performance was dichotomised into optimal and deviant care according to explicit criteria. The performance rates were related to time until work resumption during a one year follow up period. Kaplan-Meier survival analyses and Cox proportional hazards analysis were used to study this relation.

Results: Four of 10 performance rates were below 50%: continuity of care (34%), interventions aimed at providers of care in the curative sector (39%), assessment of impediments in the return to work process (41%), and assessment of symptoms (45%). The highest performance rate concerned assessment of work related causes (94%). Overall optimal care was found in 10% of the cases. Median time to complete recovery was 195 days (IQR 97 to 365), and 73% of all patients recovered completely after one year. Optimal continuity of care was significantly related to a shorter time to both partial and complete work resumption (hazard ratio (HR) 0.3; CI 0.2 to 0.6) independently of other performance indicators. Performance regarding interventions aimed at the organisation was also related to a shorter time until first return to work (HR 0.5; CI 0.3 to 0.9).

Conclusions: This study shows that the rehabilitation process of employees with adjustment disorders leaves significant room for improvement, especially with regard to continuity of care. Quality of care was partly related to a better outcome. More rigorous study designs are needed to corroborate these findings.

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Selected References

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  • Brämer GR. International statistical classification of diseases and related health problems. Tenth revision. World Health Stat Q. 1988;41(1):32–36. [PubMed]
  • Hulshof CT, Verbeek JH, van Dijk FJ, van der Weide WE, Braam IT. Evaluation research in occupational health services: general principles and a systematic review of empirical studies. Occup Environ Med. 1999 Jun;56(6):361–377. [PMC free article] [PubMed]
  • van der Weide WE, Verbeek JH, van Dijk FJ, Hulshof CT. Development and evaluation of a quality assessment instrument for occupational physicians. Occup Environ Med. 1998 Jun;55(6):375–382. [PMC free article] [PubMed]
  • van der Weide WE, Verbeek JH, van Dijk FJ. Relation between indicators for quality of occupational rehabilitation of employees with low back pain. Occup Environ Med. 1999 Jul;56(7):488–493. [PMC free article] [PubMed]
  • Agius RM, Seaton A, Lee RJ. Audit of sickness absence and fitness-for-work referrals. Occup Med (Lond) 1995 Jun;45(3):125–130. [PubMed]
  • de Zwart BC, Broersen JP, van der Beek AJ, Frings-Dresen MH, van Dijk FJ. Occupational classification according to work demands: an evaluation study. Int J Occup Med Environ Health. 1997;10(3):283–295. [PubMed]
  • Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422. [PubMed]
  • Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700–705. [PubMed]
  • van der Klink JJ, Blonk RW, Schene AH, van Dijk FJ. The benefits of interventions for work-related stress. Am J Public Health. 2001 Feb;91(2):270–276. [PMC free article] [PubMed]
  • Mintz J, Mintz LI, Arruda MJ, Hwang SS. Treatments of depression and the functional capacity to work. Arch Gen Psychiatry. 1992 Oct;49(10):761–768. [PubMed]
  • Tohen M, Hennen J, Zarate CM, Jr, Baldessarini RJ, Strakowski SM, Stoll AL, Faedda GL, Suppes T, Gebre-Medhin P, Cohen BM. Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. Am J Psychiatry. 2000 Feb;157(2):220–228. [PubMed]
  • Agius RM. Auditing occupational medicine. Occup Med (Lond) 1999 May;49(4):261–264. [PubMed]

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