31.10.2018

Functioning measures used among rehabilitation patients in OHS

Functioning measures used among rehabilitation patients in OHS

Pauliina Liinavirta, Anne Lamminpää, Terveystalo Ltd, Finland

Introduction
Assessment of functional capacity and work ability are important duties in occupational health services (OHS). Finnish National Institute of Health and Welfare provides functioning measures database TOIMIA (www.toimia.fi) for clinicians and research. The functioning measures in the database have been assessed by experts regarding reliability, validity and usability. Measures give a structured chance for planning and follow up, where the results can show the effectiveness of the rehabilitation measures.  Measures also have a role in medical reports provided when patients need social allowances.

Describing the functional capacity and following its development among patients with work disabilities in OHS is important.  Our solution to enhance the assessment of functioning is to test selected valid functioning measures especially from the TOIMIA database and  and as a part of developing the consultations regarding rehabilitation patients in OHS.

Methods

In February 2018 altogether five physicians in OHS began to use functioning measures in their appointments with rehabilitation working age patients. Our object was to test indicators related to two common health conditions that lead to rehabilitation and most often need of social benefits: bone-and joint diseases and depression.  The indicators chosen for testing and assessing among the patients were Oswestry questionnaire, Beck’s Depression Inventory questionnaire, return to work (RTW) readiness, pain VAS or pain screening questionnaire (Linton and variates of Linton).

A questionnaire and interview for the clinicians using these measures in Jan-July 2018 was done in August. The usefulness and use of the indicators were assessed.

Results

During the period the five physicians made rehabilitation assessment for 242 patients. 80% had used all the functioning measures under interest, BDI and pain screening was used by all. The anamnesis and former diagnosis were the basis for the selection of functioning measures used. The rate of usage varied from just testing the indicator to using it for 90% of the patients.

Table 1. Experienced usefulness (0-10) of the functioning measures
Measure Average Median Range Positive open comments
Oswestry 7 8 4-8 2/4
BDI 8 8 6-10 4/5
Return to work 8 8,5 5-10 4/4
Pain screening 7 7 5-9 3/4

Discussion and conclusions

Using structured and valid functioning indicators offer a tool for planning medical, vocational and social  rehabilitation, to measure the effectiveness of rehabilitation in OHS and for long term follow up. The measures also give additional information that cannot be obtained from anamnesis and status. Our hypothesis was that using functioning measures enhances planning and following effects of rehabilitation. In general they were experienced useful in assessment and follow up. Especially Return To Work readiness was seen useful as it broadens the perspective of working ability. The sample for the study was very small and thus diminishes the possibility for generalisation of the results.