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D. Riese1, B. Jansen2, M. Schindl3, M. Trippolini4, P. Oesch1, J. Kool1, J. Sieben5, R.A. de Bie5
1Kliniken Valens, Valens Rehabilitationclinic, Valens, Switzerland, 2Reha Bellikon, Bellikon, Switzerland, 3Rehabilitationszentrum Weisser Hof, Klosterneuburg, Austria, 4Berner Fachhochschule, Bern, Switzerland, 5Maastricht University, Maastricht, Netherlands
Background: Musculoskeletal pain syndromes (MSDs) are among the main causes of long-term work disability and early retirement. Return to work is often an important participationlevel goal in rehabilitation. Patientcentered care should consider riskfactors for predicting return to work to tailor interventions accordingly. The SELF(formerly modified Spinal Function Sort) is a patient-reported outcome to assess physical function. It contains 20 drawings of physical activities rated on a 5-point Likert scale, ranging from "capable“ (4 points) to "limited" (3, 2, or 1 point) to "not capable" (0 points), resulting in a total of 0-80 points. Previous research supports the test retest reliability and construct validity of the SELF. The objective of this study was to evaluate the discriminative accuracy and overall performance of the SELF inpredicting no return to work (NRTW) and to determine cut off points for a three-level risk stratification.
Purpose: The objective of this study was to evaluate the discriminative accuracy and overall performance of the SELF in predicting no return to work (NRTW) and to determine cut off points for a three-level risk stratification.
Methods: Multicenter prospective cohort study.
Patients with MSDs with the allocation goal "returntowork" were included at four in-patient rehabilitation clinics. Participants answered the SELF at the beginning of inpatient rehabilitation. 90 days after rehabilitation the participants' work status was assessed. To generate a binary outcome from these data, we agreed that a return to work occurred if the participant returned to work at least 50% of the time for at least 45 days. The predictive performance of the SELF was calculated by estimating the discrimination using the Receiver Operating Characteristic Curve (ROC) Area under the Curve (AUC). In addition, logistic regression was used to test overall performance. To determine cutoff points for risk stratification, all points on the ROC were analyzed, the SELF score with a minimum specificity (SP) of 0.9 was determined to be the cutoff point for moderate risk for NRTW, and the score with a minimum sensitivity (SE) of 0.9 was determined to be the cutoff point for high risk for NRTW. For each of the identified risk categories, we calculated the odds ratio (OR) for NRTW.
Patients with MSDs with the allocation goal "returntowork" were included at four in-patient rehabilitation clinics. Participants answered the SELF at the beginning of inpatient rehabilitation. 90 days after rehabilitation the participants' work status was assessed. To generate a binary outcome from these data, we agreed that a return to work occurred if the participant returned to work at least 50% of the time for at least 45 days. The predictive performance of the SELF was calculated by estimating the discrimination using the Receiver Operating Characteristic Curve (ROC) Area under the Curve (AUC). In addition, logistic regression was used to test overall performance. To determine cutoff points for risk stratification, all points on the ROC were analyzed, the SELF score with a minimum specificity (SP) of 0.9 was determined to be the cutoff point for moderate risk for NRTW, and the score with a minimum sensitivity (SE) of 0.9 was determined to be the cutoff point for high risk for NRTW. For each of the identified risk categories, we calculated the odds ratio (OR) for NRTW.
Results: Complete data were obtained from 193 participans. 42% did not return to work. Performance of the SELF, related to the SELF and NRTW, the AUC was 0.848 (95%CI 0.789 - 0.895). With this result, the discriminatory ability achieves a good level. The overall performance was Nagelkerke R2=0.42. The cutoff value for a moderate risk NRTW was ≤58 (SE=0.91/SP=0.66. For a high risk, ≤42 points (SE=0.43/SP0.9) was determined.
Conclusions: The SELF indicates good discriminatory accuracy and a strong effect size, showing a good prognostic validity regarding NRTW. The cut off values allow estimation of NRTW risk and support stratified planning of work capacity interventions.
Implications: To plan patient-centered interventions, early stratification with simple assessments is a useful approach. The use of the SELF at the beginning of rehabilitation in patients with MSDs can be recommended if the rehabilitation goal is a return to work.
Funding acknowledgements: Predictive validity
Keywords:
Musculoskeletal disorders
Work rehabilitation
Predictive validity
Musculoskeletal disorders
Work rehabilitation
Predictive validity
Topics:
Musculoskeletal
Occupational health & ergonomics
Disability & rehabilitation
Musculoskeletal
Occupational health & ergonomics
Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: Kliniken Valens
Committee: Medical Ethics Committees Eastern Switzerland EKOS, Northwest and Central Switzerland EKNZ
Ethics number: BASEC Nr. 2018-01054
All authors, affiliations and abstracts have been published as submitted.
