Methods in Measuring Return to Work: A Comparison of Measures of Return to Work Following Treatment of Coronary Heart Di
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Methods in Measuring Return to Work: A Comparison of Measures of Return to Work Following Treatment of Coronary Heart Disease Karin Biering • Niels Henrik Hjøllund Thomas Lund
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Published online: 25 November 2012 Ó Springer Science+Business Media New York 2012
Abstract Purpose Methods of measuring return to work (RTW) following temporary disability are diverse. The purpose of this study was to compare different measures of RTW within a 12-month period using a well-defined population of patients treated with Percutaneous Coronary Intervention (PCI) and weekly administrative data on transfer payments. Methods Different RTW measures were defined based on weekly data from 12 months follow-up after PCI and agreement between definitions was expressed as Cohen’s kappa. Prognostic factors for RTW were compared using logistic regression. Results Among those working before the PCI, 70 % were back to work at 6 months after the PCI and 76 % 1 year after when using cross-sectional measures and excluding those who left the workforce permanently during follow up. When using a time to event measure, 77 % experienced RTW during follow up, while only 60 % experienced RTW without recurrent sick-leave events during the following year. We found moderate to near perfect agreement when comparing the measures, with lowest agreement between the time-
K. Biering (&) N. H. Hjøllund T. Lund Department of Occupational Medicine, Regional Hospital West Jutland, DK-7400 Herning, Denmark e-mail: [email protected] K. Biering T. Lund Danish Ramazzini Centre, Central Region Denmark, Aarhus, Denmark N. H. Hjøllund Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark T. Lund National Research Centre for Occupational Rehabilitation, Rauland, Norway
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to-event measure without relapses compared to the other measures. When comparing prognostic factors for the different RTW outcomes, we found most associations similar in size, except from the clinical measure left ventricular ejection fraction, possibly related to recurrent sick leave. Conclusions Different measures revealed some differences in proportions of RTW. However, high agreement between RTW-definitions was found. Choice of RTW-definitions should depend on study purpose; simple cross-sectional methods are sufficient in prediction of RTW and analysis of risk factors, while methods capturing relapses are recommended when sustainability, prognosis and vulnerability are in focus. Keywords Return to work Methods Definitions Percutaneous coronary intervention Recurrent sick leave Work participation
Introduction While the term return to work (RTW) is commonly used, a clear, consensual and operational definition of the term is lacking. RTW can be referred to as an intervention, a process and an outcome [1]. In this paper we will refer to RTW as an outcome. Return to work following temporary work disability is often measured as a dichotomous outcome measured at a specified point in time preceding a specific event, e.g. onset of disability or a specific interventi
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