Prognostic Factors for Staying at Work for Partially Sick-Listed Workers with Subjective Health Complaints: A Prospective Cohort Study, 2020, Anema et

Andy

Andy

Retired committee member
Abstract
Examination of prognostic factors for staying at work for long-term sick-listed workers with subjective health complaints (SHC) who partially work in a paid job, and to evaluate whether these factors are comparable with those of workers with other disorders.

We used data of 86 partially sick-listed workers with SHC (57 females, 29 males, mean age 47.1 years) and 433 with other disorders (227 females, 206 males, mean age 50.9 years), from an existing prospective cohort study consisting of 2593 workers aged 18–65 years and registered as sick-listed with different health complaints or disorders for at least 84 weeks in the database of the Dutch Social Security Institute. We performed univariable logistic regression analyses (p ≤ 0.157) for all independent variables with the dependent variable staying at work for the workers with SHC.

We then performed multivariable logistic regression analyses with forward selection (p ≤ 0.157) and combined the remaining factors in a final, multivariable model (p ≤ 0.05), which we also used for logistic regression analysis in the workers with other disorders. The following factors were significant prognostic factors for staying at work for workers with SHC: full work disability benefits (odds ratio (OR) 0.07, 95% confidence interval (95% CI) 0.01–0.64), good mental health (OR 1.08, 95% CI 1.02–1.14), positive expectations for staying at work (OR 6.49, 95% CI 2.00–21.09), previous absenteeism for the same health complaint (OR 0.31, 95% CI 0.10–0.96) and good coping strategies (OR 1.13, 95% CI 1.04–1.23). For workers with other disorders, full work disability benefits, good mental health and positive expectations for staying at work were also prognostic factors for staying at work. Individual and policy factors seem to be important for staying at work of sick-listed workers with SHC and those with other disorders alike, but several biopsychosocial factors are particularly important for workers with SHC.
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Open access, https://www.mdpi.com/1660-4601/17/19/7184/htm

My bolding.
If the insurance physician reported one of the 10 functional somatic syndromes (somatic (pain) syndrome; somatization disorder; pelvic girdle pain; tension headache; Tietze syndrome; irritable bowel syndrome; chronic fatigue syndrome; fibromyalgia; whiplash; and repetitive strain injury) or one of the 25 health complaints that matches with the 23 (partially) unexplained physical complaints of the Robbins list [18], then participants were indicated as having SHC (subjective health complaints). If the insurance physician reported another diagnosis, participants were indicated as having other disorders than SHC, and were used in the present study as a reference group.
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Subjective health complaints - interesting term.

Ultimately, aren't all health complaints subjective?

We can only experience them through our own perception and the same symptom could have different effects on different people. Difficulty walking might be more of a factor in employment for a traffic warden than an office worker, for example.

Two individuals diagnosed with the same well understood disease might have different levels of severity or be physically affected in different ways. I don't think that's terribly unusual.

Where treatments are available some patients tolerate certain treatments and others don't. Or treatment is more effective for some. The reasons aren't always understood.

Isn't calling health complaints subjective a tautology?

This demonstrates very obvious bias to me. Just because something is not yet understood or explained does not make it a psychosomatic (or should that be psychogenic?) condition.

Claiming yet to be understood conditions are subjective when all health conditions are subjective seems like a clumsy attempt diminish the severity and impact the condition has on people's lives.
 
Trish said:
I think subjective health complaints is shorthand for complaints for which there is not objective test or sign the doctor can see.
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Sure but it's still wildly inaccurate. Lots of diseases that can be tested for and where severity can be physically assessed by tests later on in the disease can't always be seen or don't show obvious signs in the early stages.

By all means use shorthand but they could at least aim for accuracy.

No, given the nature of the document I'm not inclined to cut 'em slack.
 
It is interesting that they found that full works disability benefits was a factor that helped everyone stay in work. Does that mean that letting people go off sick just as long as they needed to instead of forcing them to work when they were sick had a good outcome?
 
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