Subjective health complaints, functional ability, fear avoidance beliefs, and days on sickness benefits after work rehabilitation - a mediation model

Irene Øyeflaten; Jon Opsahl; Hege R Eriksen; Tore Norendal Braathen; Stein Atle Lie; Søren Brage; Camilla M Ihlebæk; Kyrre Breivik

doi:10.1186/s12891-016-1084-x

Subjective health complaints, functional ability, fear avoidance beliefs, and days on sickness benefits after work rehabilitation - a mediation model

BMC Musculoskelet Disord. 2016 May 23:17:225. doi: 10.1186/s12891-016-1084-x.

Authors

Irene Øyeflaten^{1

2}, Jon Opsahl³, Hege R Eriksen^{3

4}, Tore Norendal Braathen^{5

6}, Stein Atle Lie⁷, Søren Brage⁸, Camilla M Ihlebæk⁹, Kyrre Breivik³

Affiliations

¹ National Centre for Occupational Rehabilitation, Haddlandsvegen 20, NO-3864, Rauland, Norway. irene.oyeflaten@air.no.
² Uni Research Health, Bergen, Norway. irene.oyeflaten@air.no.
³ Uni Research Health, Bergen, Norway.
⁴ Department of Sport and Physical Activity, Bergen University College, Bergen, Norway.
⁵ National Centre for Occupational Rehabilitation, Haddlandsvegen 20, NO-3864, Rauland, Norway.
⁶ Faculty of Health and Social Studies, Telemark University College, Porsgrunn, Norway.
⁷ Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
⁸ The Directorate of Labour and Welfare, Oslo, Norway.
⁹ Section of Public Health Science, ILP, Norwegian University of Life Sciences, Ås, Norway.

Abstract

Background: Long-term sick leave and withdrawal from working life is a concern in western countries. In Norway, comprehensive inpatient work rehabilitation may be offered to sick listed individuals at risk of long-term absence from work. Knowledge about prognostic factors for work outcomes after long-term sick leave and work rehabilitation is still limited. The aim of this study was to test a mediation model for various hypothesized biopsychosocial predictors of continued sick leave after inpatient work rehabilitation.

Methods: One thousand one hundred fifty-five participants on long-term sick leave from eight different work rehabilitation clinics answered comprehensive questionnaires at arrival to the clinic, and were followed with official register data on sickness benefits for 3 years. Structural equation models were conducted, with days on sickness benefits after work rehabilitation as the outcome.

Results: Fear avoidance beliefs for work mediated the relation between both musculoskeletal complaints and education on days on sickness benefits after work rehabilitation. The relation between musculoskeletal complaints and fear avoidance beliefs for work was furthermore fully mediated by poor physical function. Previous sick leave had a strong independent effect on continued sick leave after work rehabilitation. Fear avoidance beliefs for work did not mediate the small effect of pseudoneurological complaints on continued sick leave. Poor coping/interaction ability was neither related to continued sick leave nor fear avoidance beliefs for work.

Conclusions: The mediation model was partly supported by the data, and provides some possible new insight into how fear avoidance beliefs for work and functional ability may intervene with subjective health complaints and days on sickness benefits after work rehabilitation.

Keywords: Fear avoidance beliefs; Functional ability; Mental disorders; Musculoskeletal diseases; Prognostic factors; Rehabilitation; Return to work; Sick leave; Sickness absence; Subjective health complaints.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Adaptation, Psychological*
Adult
Avoidance Learning
Cognitive Remediation
Diagnostic Self Evaluation
Fear
Female
Humans
Male
Mental Disorders / psychology
Mental Disorders / rehabilitation*
Middle Aged
Musculoskeletal Diseases / psychology
Musculoskeletal Diseases / rehabilitation*
Norway
Prognosis
Prospective Studies
Rehabilitation, Vocational / methods*
Return to Work*
Sick Leave / statistics & numerical data*
Surveys and Questionnaires