Long-term course and factors influencing work ability and return to work in post-COVID patients 12 months after inpatient rehabilitation 2024 Müller+

[Andy]

Abstract

Background
Rehabilitation plays a crucial role in restoring work ability and facilitating the reintegration of post-COVID patients into the workforce. The impact of rehabilitation on work ability and return to work (RTW) of post-COVID patients remains poorly understood. This study was conducted to assess the work ability and RTW of post-COVID patients before rehabilitation and 12 months after rehabilitation and to identify physical and neuropsychological health factors influencing RTW 12 months after rehabilitation.

Methods
This longitudinal observational study included 114 post-COVID patients with work-related SARS-CoV-2 infection who underwent inpatient post-COVID rehabilitation with indicative focus on pulmonology and/or psychotraumatology (interval between date of SARS-CoV-2 infection and start of rehabilitation: M = 412.90 days). Employment status, work ability, and the subjective prognosis of employment (SPE) scale were assessed before rehabilitation (T1) and 12 months after rehabilitation (T4). The predictors analysed at T4 were functional exercise capacity, physical activity, subjective physical and mental health status, fatigue, depression, and cognitive function. Longitudinal analyses were performed via the Wilcoxon signed-rank test. Logistic and linear regression analyses identified predictors of work ability and return to work (RTW), whereas mediation analyses examined the relationships between these predictors and work ability.

Results
At T4, the median of WAI total score indicated poor work ability, which significantly worsened over time (p < 0.001; r = 0.484). The SPE scale significantly increased from T1 to T4 (p = 0.022, r = -0.216). A total of 48.6% of patients had returned to work 12 months after rehabilitation. Fatigue was identified as the main predictor of reduced work ability and RTW, with each unit increase in fatigue severity decreasing the odds of RTW by 3.1%. In addition, physical capacity and subjective health status were significant predictors of perceived work ability.

Conclusions
The findings highlight the significant challenges that post-COVID patients face in regaining work ability and achieving successful RTW 12 months after rehabilitation. Fatigue appears to be an important predictor of work ability and RTW. To optimize recovery and enhance both biopsychosocial health and work ability, it is crucial to develop and implement personalised interventions that address fatigue, improve physical capacity, and support mental health.

Open access, https://occup-med.biomedcentral.com/articles/10.1186/s12995-024-00443-4

 

[Jonathan Edwards]

Rehabilitation plays a crucial role in restoring work ability and facilitating the reintegration of post-COVID patients into the workforce. The impact of rehabilitation on work ability and return to work (RTW) of post-COVID patients remains poorly understood.

Nice to start your abstract with the second statement contradicting the first.

 

[Kitty]

Conclusions
The findings highlight the significant challenges that post-COVID patients face in regaining work ability and achieving successful RTW 12 months after rehabilitation.

So rehab doesn't help. Good to have that cleared up.

 

[rvallee]

So:

1. They assume that rehabilitation works
2. They don't know that it works
3. They worked on rehabilitating some patients
4. They can't say if it works, how, or whether it makes any difference, actually it seems to make no difference
5. They have to justify the work they did, so they should develop #3, because they #1, and are still stuck at #2

This study provides valuable insights into the long-term outcomes of the work ability of post-COVID patients 12 months after rehabilitation.

Their conclusion is literally that if rehabilitation worked, it would work, they just have to figure out how to make it work, as people funded to provide exactly this based on the assumption that it works.

Fundamentally, most of this type of research or clinical work around rehabilitation takes the form of:

1. Let's do the thing
2. We did the thing, we have to argue that the thing has worked, even if we can't show it, or that it failed
3. Go to #1

And, oh lookie here, you have to read a bit further to find this:

Twelve months after rehabilitation program, the WAI total (Mdn = 21) indicated a poor work ability and was significantly worse than at T1

So it doesn't work. But they feel that it should work. And therefore should get money to figure out how to make it work. Even though, as they literally opened the paper with, they assume it works. They just don't know how. Also it doesn't work anyway. Hence why they should get paid to figure out how to make it work.

This is the kind of fake work you expect out of princes in large aristocratic families. People paid to do nothing useful, who will never run out of work because achieving results is never part of any consideration.

Some patients suffer other chronic diseases after SARS-CoV-2 infection, which may further impair their work ability (Dimension 3). Second, the results of Dimension 4 demonstrate an increase in the patient’s estimated loss of work ability due to illness. Finally, the worker’s own prognosis of future work ability is worsening as well. One reason for the poor work ability may be the continued high prevalence of post-COVID symptoms in this study population, as reported in Müller et al.

Yes, being ill would be the reason why people are out of work for illness-related reasons. Good work, chumps! I don't know why they have to cite another paper for this, since they could have easily asked their own participants. Because it really sounds like the patients have a good grasp of their limitations and situation. Which would mean, let's pull the quote:

In addition, physical capacity and subjective health status were significant predictors of perceived work ability.

That their assessment of 'perceived' work ability is actually a rather good assessment of their work ability, perception not needed.

Now let's open the floor to wild speculation, common in medical culture:

Furthermore, compared with prior rehabilitation Rutsch and Deck [57] could lead to an improvement in the ability to work over time. This discrepancy may be attributed to the high number of healthcare workers in our study, a population whose biopsychosocial health has been negatively affected by the COVID-19 pandemic due to changes in working condition [58, 59].

Sounds like their biological health has been negatively impacted plenty.

Reading more speculation following the one above, the authors don't seem to understand much about the consequences of illness. Seem utterly baffled at the concept of illness affecting lives in dramatically impactful ways. Such as financial losses leading to financial hardship in societies that require stable personal finances. How could we ever function as a society without insights like this?

Our findings suggest that personalized interventions should include gradually introducing patients to the required workload and teaching them suitable self-management strategies (e.g., the PACING technique, recognition their own tolerance thresholds, and organisation of working time)

They don't seem to have paid attention to what pacing is either, or that it isn't a 'technique'. And in this very paper they dismiss the recognition of tolerance thresholds as a problem of perception.

The results of our own study revealed that the severity of fatigue worsened even 12 months after rehabilitation [69]. Given these challenges, the treatment of fatigue is a crucial element in ensuring patients’ long-term occupational and social participation. On the basis of Greenhalgh et al. [67] and Weise et al. [70], the following comprehensive approaches to managing fatigue in daily life can be summarized: multidisciplinary care (e.g., with doctors from different disciplines, occupational therapists, psychological staff, social workers), attention to self-management according to prioritizing, planning, pacing to increase exercise tolerance and to avoid post exertional malaise (PEM) and the education of patients to have a full understanding of fatigue.

Ah, yes, let's have people who clearly don't understand any of those concepts teach patients who clearly understand them far better. Very smart. Why cite Greenhalgh's useless papers here? Another mystery of the universe, as she had nothing to do with those concepts and this multidisciplinary approach is entirely useless as well, is literally the current standard of care for inexplicable reasons.

In general, fatigue may influence post-COVID patients’ work ability in part because of alterations in focused and sustained attention

They don't even have a solid grasp of what fatigue is. No, it's not alterations in focused and sustained attention, you goofs. Come on.

These findings suggest that the improvement of patients’ physical capacity e.g., through individualized physical exercise training, considering the presence of PEM, and the strengthening of self-awareness of one’s own health e.g., through mediations or body scan methods, may mitigate the negative consequences of fatigue on patients’ ability to work.

Ah, yes, the thing no one has ever thought of or tried before. If they could simply figure out how to rehabilitate people, they could rehabilitate people. Which they claim is effective. Even though it's not. Ah well. The mysteries of the universe, I guess.

Therefore, it is necessary to assess and monitor fatigue.

What does that even mean? How does one "assess and monitor fatigue"? To do what with it?!!

The chances of full recovery in patients who have suffered from post-COVID for 2 years or more appear to be low [66]. These circumstances can affect the ability to work

Yes, illness affects ability to function. You figured that out. Mostly. Somewhat. Good on you.

Individualized, tailored, and targeted interventions need to be developed and implemented in the rehabilitation process to contribute to disease recovery as well as the biopsychosocial health and work ability of post-COVID patients.

Isn't that what you just tried?! And has been tried countless times before? And is literally the standard of care??!!!

For sure this study adds to the overwhelming body of evidence that the biopsychosocial model of illness and all its derived concepts are entirely useless for any and all intents and purposes.

 

[rvallee]

Nice to start your abstract with the second statement contradicting the first.

How the hell are we even supposed to counter an ideology that can't be bothered to make sense in adjacent sentences? This kind of nonsense would yield a fail in primary school. The authors need blame for this but a bunch of people read those sentences and thought nothing wrong of it. It's going downstairs and finding nothing wrong with ending up on the roof level of nonsense.

And somehow we're not getting through?!

 

[SNT Gatchaman]

Twelve months after rehabilitation program, the WAI total (Mdn = 21) indicated a poor work ability and was significantly worse than at T1

Journal of Occupational Medicine and Toxicology -> Journal of Toxic Occupational Medicine

 

[Joan Crawford]

Methods
This longitudinal observational study included 114 post-COVID patients with work-related SARS-CoV-2 infection who underwent inpatient post-COVID rehabilitation with indicative focus on pulmonology and/or psychotraumatology (interval between date of SARS-CoV-2 infection and start of rehabilitation: M = 412.90 days).

I've not looked closely. Not sure this tells us much.

What were they actually doing? Three groups? "pulmonology and/or psychotraumatology" All different groups with differing needs. Seems to have been all merged into one group! What the heck does someone with poor pulmonary capacity post Covid have in common with a pt with PTSD due to traumatic time in ICU? Or someone with both.

How much of this is capturing a natural recovery process, for those that improve?

Issues seem to have only been assessed by questionaries - which is poor practice. The psychotraumatology bods did not appear to have at least a structured clinical interview by independent person (pre and post) to see if they met criteria for PTSD or not. Did they then do trauma focused therapy? If so, what type? Did it matter? And what was the outcome? Moving on and not meeting criteria anymore? Seems they did badly - but why?

 

[bobbler]

Abstract

Background
Rehabilitation plays a crucial role in restoring work ability and facilitating the reintegration of post-COVID patients into the workforce. The impact of rehabilitation on work ability and return to work (RTW) of post-COVID patients remains poorly understood. This study was conducted to assess the work ability and RTW of post-COVID patients before rehabilitation and 12 months after rehabilitation and to identify physical and neuropsychological health factors influencing RTW 12 months after rehabilitation.

Methods
This longitudinal observational study included 114 post-COVID patients with work-related SARS-CoV-2 infection who underwent inpatient post-COVID rehabilitation with indicative focus on pulmonology and/or psychotraumatology (interval between date of SARS-CoV-2 infection and start of rehabilitation: M = 412.90 days). Employment status, work ability, and the subjective prognosis of employment (SPE) scale were assessed before rehabilitation (T1) and 12 months after rehabilitation (T4). The predictors analysed at T4 were functional exercise capacity, physical activity, subjective physical and mental health status, fatigue, depression, and cognitive function. Longitudinal analyses were performed via the Wilcoxon signed-rank test. Logistic and linear regression analyses identified predictors of work ability and return to work (RTW), whereas mediation analyses examined the relationships between these predictors and work ability.

Results
At T4, the median of WAI total score indicated poor work ability, which significantly worsened over time (p < 0.001; r = 0.484). The SPE scale significantly increased from T1 to T4 (p = 0.022, r = -0.216). A total of 48.6% of patients had returned to work 12 months after rehabilitation. Fatigue was identified as the main predictor of reduced work ability and RTW, with each unit increase in fatigue severity decreasing the odds of RTW by 3.1%. In addition, physical capacity and subjective health status were significant predictors of perceived work ability.

Conclusions
The findings highlight the significant challenges that post-COVID patients face in regaining work ability and achieving successful RTW 12 months after rehabilitation. Fatigue appears to be an important predictor of work ability and RTW. To optimize recovery and enhance both biopsychosocial health and work ability, it is crucial to develop and implement personalised interventions that address fatigue, improve physical capacity, and support mental health.

Open access, https://occup-med.biomedcentral.com/articles/10.1186/s12995-024-00443-4

Well those last lines are a contradiction in terms unless we are finally looking to blow the bps school out of the water and look at proper situational support interpretation of the real intended application of that model

 

[Sean]

psychotraumatology

Oh boy, yet another marketing term to deal with.

How the hell are we even supposed to counter an ideology that can't be bothered to make sense in adjacent sentences? This kind of nonsense would yield a fail in primary school.

This is one of the most persistent features of BPS promoting papers. Not only do the abstracts not accurately reflect what is in the body of the paper and the data, often the abstract contradicts itself.

How many have we seen that reported no or marginal evidence – typically from BPS friendly subject self-report data – in favour of their hypothesis, yet the abstract still somehow ends with some version of recommending the failed intervention/therapy/claim they were testing?

There is something profoundly rotten in the peer review journal system when it comes to the sacred BPS, um, philosophy. Despite that emperor being stark bollocks naked in full daylight in the main street, they still cannot see it or call it out.