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Sickness certificates: what information do they provide about rehabilitation?
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
2014 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 36, no 15, 1299-1304 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate whether patients are prescribed rehabilitation early in a new sick leave period, and whether this prescription is associated with age, sex, diagnosis, description of functioning, and affiliation of certifying physician.

Methods: A cross-sectional study using data from sickness certificates issued during a total sick leave period, collected consecutively during 2 weeks in 2007 in Östergötland County, Sweden. Rehabilitation prescribed in the first certificate or within 28 days after the start of sick leave was defined as early rehabilitation.

Results: Musculoskeletal diseases (MSD) were the largest diagnostic group, followed by mental disorders (MD). The mean certified duration of sick leave was 94 days (SD 139), longest for MD patients. Early rehabilitation was prescribed in 27% of all certificates and in 45% of certificates for MSD and MD diagnoses. Logistic regression analysis indicated that prescription of early rehabilitation was associated with certificates issued for MSD and MD, youngest patients, and certificates issued by primary health care physicians. The final model explained 29% of variation in the prescription of early rehabilitation.

Conclusion: There is a modest prescription of early rehabilitation in sickness certificates, based on younger age and MSD or MD diagnosis. This indicates that patients’ rehabilitation needs may not have been identified.

Place, publisher, year, edition, pages
2014. Vol. 36, no 15, 1299-1304 p.
Keyword [en]
Sick leave, musculoskeletal diseases, mental disorders, physicians, physiotherapy, vocational rehabilitation, Sweden
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:liu:diva-89837DOI: 10.3109/09638288.2013.836252ISI: 000340450300010PubMedID: 24063292OAI: oai:DiVA.org:liu-89837DiVA: diva2:609919
Available from: 2013-03-08 Created: 2013-03-08 Last updated: 2017-12-06
In thesis
1. The Sick Leave Process: Sick Leave Guidelines, Sickness Certificates, and Experiences of Professionals
Open this publication in new window or tab >>The Sick Leave Process: Sick Leave Guidelines, Sickness Certificates, and Experiences of Professionals
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Decisions on entitlement to sickness benefits and return to work interventions have substantial impact on individuals’ lives and on society. In most Western European countries, such decisions are based on sickness certificates, which should provide information on how a disease or injury reduces the individual’s work ability. These are challenging and complex assessments. In 2008, guidelines for the management of sick leave were implemented in Sweden, emphasizing early assessments of work ability and return to work, and increasing the quality demands of sickness certificates by underscoring descriptions of activity limitations related to work. The overall aim of this thesis was to gain a deeper knowledge of the sick leave process with special emphasis on the content of sickness certificates and primary health care (PHC) professionals’ experiences with the process. Specific aims were to compare the quality of sickness certificates regarding descriptions of functioning by the use of WHO’s International Classification of Functioning, disability, and health (ICF), as well as the prescribed interventions before versus after implementation of the Swedish sick leave guidelines.

The thesis comprises three studies. A cross-sectional design was used in studies I and II, which included 475 and 501 new sickness certificates consecutively collected in Östergötland County, Sweden, in 2007 and 2009, respectively. Text on functioning was analysed with a deductive content analysis using the ICF. Study III was an exploratory study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals (n=18) in Östergötland County. An inductive content analysis was used in this study.

The thesis comprises three studies. A cross-sectional design was used in studies I and II, which included 475 and 501 new sickness certificates consecutively collected in Östergötland County, Sweden, in 2007 and 2009, respectively. Text on functioning was analysed with a deductive content analysis using the ICF. Study III was an exploratory study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals (n=18) in Östergötland County. An inductive content analysis was used in this study.

An overall conclusion drawn from this thesis is that patient functioning and needs might not be adequately communicated in the sick leave process. Despite the implementation of sick leave guidelines, this information is limited in sickness certificates and the collaboration is poor among the involved stakeholders, i.e., health care, the social insurance office, the employer and the OHS. The basis for decisions on entitlement to sickness benefits could be improved by including a description of the patients’ activity limitations or participation restrictions related to work demands. One way to enhance the decision basis might be to use the available team competencies at the PHC.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 75 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1354
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89838 (URN)978-91-7519-689-3 (ISBN)
Public defence
2013-04-05, Aulan, Hälsans Hus ingång 16, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-03-08 Created: 2013-03-08 Last updated: 2013-03-08Bibliographically approved

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Nilsing Strid, EmmaSöderberg, ElsyÖberg, Birgitta

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