Return to Work After Medical Rehabilitation for Musculoskeletal Disorders in Times of the COVID-19 Pandemic
A Retrospective Cohort Study
Objective
To describe and explain the effect of the coronavirus disease two thousand nineteen pandemic and its related measures on return to work outcomes after multimodal medical rehabilitation for musculoskeletal disorders.
Design
Retrospective cohort study.
Setting
Three cohorts: reference (rehabilitation and return to work prepandemic), pandemic one (rehabilitation prepandemic, return to work during pandemic), and pandemic two (rehabilitation and return to work during pandemic).
Participants
Individuals who underwent multimodal medical rehabilitation for musculoskeletal disorders through the German Pension Insurance system between January two thousand eighteen and December two thousand twenty one (number equals six hundred eighty eight thousand one hundred twenty seven).
Interventions
Not applicable.
Main Outcome Measures
A successful and stable return to work was operationalized as having employment subject to social insurance contributions from nine to twelve months after rehabilitation.
Results
Descriptive analysis revealed a return to work rate of sixty seven point two percent in the reference cohort, a slight decline in pandemic cohort one (sixty six point three percent), and a more pronounced decrease in pandemic cohort two (sixty three point one percent). In contrast, average marginal predictions from a logistic model including various covariates showed that both pandemic cohorts (sixty three point eight percent and sixty four point four percent) exhibited similarly reduced predicted probabilities of return to work compared with the reference cohort (sixty six point five percent). Individuals with sick leave durations exceeding six months, compared with those with shorter sick leaves, were more negatively affected by pandemic cohort one; however, this effect recovered in pandemic cohort two. The interaction between cohort and income did not show any amplifying effect of the pandemic.
Conclusions
The logistic model revealed no differences in predicted probabilities of return to work between pandemic cohort two and pandemic cohort one, suggesting that orthopedic rehabilitation remained robust in maintaining return to work outcomes despite pandemic related challenges. The findings offer mixed evidence regarding the question of whether the pandemic amplified preexisting barriers to return to work.
