Daniël O Strijbos, Geert van der Sluis, Wim F C van Houtert, A Carlien Straat, Yvonne van Zaanen, Carolien M Kooijman, Igor van den Brand, Stephan E de Groot, Michiel F Reneman, Tim Boymans, P Paul F M Kuijer
{"title":"手术后重返工作（BAAS）工作-综合护理途径对膝关节置换术患者重返工作的有效性：荷兰三个比较队列的研究。","authors":"Daniël O Strijbos, Geert van der Sluis, Wim F C van Houtert, A Carlien Straat, Yvonne van Zaanen, Carolien M Kooijman, Igor van den Brand, Stephan E de Groot, Michiel F Reneman, Tim Boymans, P Paul F M Kuijer","doi":"10.1007/s10926-025-10331-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Considering the increase in the demand from working age patients seeking knee arthroplasty (KA) and the low return-to-work (RTW) rates, optimization of care for patients getting KA with a focus on RTW is essential. We evaluated a work-integrated care pathway-Back At work After Surgery (BAAS)-aimed at improving RTW compared with care-as-usual in the Netherlands.</p><p><strong>Methods: </strong>In this multicenter study of three comparative cohorts, working patients who had primary KA were included. Patients in two Dutch hospitals (BAAS cohort) received integrated medical and occupational care, including structured pre- and postoperative consultations, goal setting, activity tracking, and interdisciplinary team meetings with both medical and occupational health professionals. Two independent control cohorts with comparable patient inclusion criteria (Expect TO work and ACTIVE) from 15 hospitals/clinics received care-as-usual. The primary outcomes were the time to first day of RTW and time to full RTW within 12 months. Inverse Probability of Treatment Weighting was used with known prognostic factors as covariates to account for possible differences in baseline characteristics.</p><p><strong>Results: </strong>A total of 457 patients were included (BAAS n = 145; Expect TO work n = 179; ACTIVE n = 133). The median time to first day of RTW was 16-25 days shorter in the BAAS cohort (27 days) compared to Expect TO work (52 days; hazard ratio [HR] 2.7; 95% confidence interval [CI]:2.1-3.4) and ACTIVE cohort (43 days; HR:1.95; CI:1.5-2.6). At three months, 90% of BAAS patients had started RTW versus 63% and 77% in the control cohorts. BAAS patients also achieved full RTW earlier, with a median time reduced by 27 days compared to the ACTIVE cohort (HR:1.4; CI:1.1-1.8). The odds of full RTW at 12 months were higher in the BAAS cohort compared to Expect TO work, namely odds ratio (OR) 5.0 (CI:1.3-18.5) and ACTIVE OR 9.3 (CI:2.5-34.8).</p><p><strong>Conclusion: </strong>The BAAS work-integrated care pathway was more effective than care-as-usual in improving RTW after KA in the Netherlands.</p><p><strong>Trail registration: </strong>This study was retrospectively registered at clinicaltrails.gov ( https://clinicaltrials.gov/ct2/show/NCT05690347 , date of first registration: 19-01-2023).</p>","PeriodicalId":48035,"journal":{"name":"Journal of Occupational Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Effectiveness of the Back At work After Surgery (BAAS) Work-Integrated Care Pathway on Return to Work for Patients Receiving Knee Arthroplasty: A Study of Three Comparative Cohorts in the Netherlands.\",\"authors\":\"Daniël O Strijbos, Geert van der Sluis, Wim F C van Houtert, A Carlien Straat, Yvonne van Zaanen, Carolien M Kooijman, Igor van den Brand, Stephan E de Groot, Michiel F Reneman, Tim Boymans, P Paul F M Kuijer\",\"doi\":\"10.1007/s10926-025-10331-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Considering the increase in the demand from working age patients seeking knee arthroplasty (KA) and the low return-to-work (RTW) rates, optimization of care for patients getting KA with a focus on RTW is essential. We evaluated a work-integrated care pathway-Back At work After Surgery (BAAS)-aimed at improving RTW compared with care-as-usual in the Netherlands.</p><p><strong>Methods: </strong>In this multicenter study of three comparative cohorts, working patients who had primary KA were included. Patients in two Dutch hospitals (BAAS cohort) received integrated medical and occupational care, including structured pre- and postoperative consultations, goal setting, activity tracking, and interdisciplinary team meetings with both medical and occupational health professionals. Two independent control cohorts with comparable patient inclusion criteria (Expect TO work and ACTIVE) from 15 hospitals/clinics received care-as-usual. The primary outcomes were the time to first day of RTW and time to full RTW within 12 months. Inverse Probability of Treatment Weighting was used with known prognostic factors as covariates to account for possible differences in baseline characteristics.</p><p><strong>Results: </strong>A total of 457 patients were included (BAAS n = 145; Expect TO work n = 179; ACTIVE n = 133). The median time to first day of RTW was 16-25 days shorter in the BAAS cohort (27 days) compared to Expect TO work (52 days; hazard ratio [HR] 2.7; 95% confidence interval [CI]:2.1-3.4) and ACTIVE cohort (43 days; HR:1.95; CI:1.5-2.6). At three months, 90% of BAAS patients had started RTW versus 63% and 77% in the control cohorts. BAAS patients also achieved full RTW earlier, with a median time reduced by 27 days compared to the ACTIVE cohort (HR:1.4; CI:1.1-1.8). The odds of full RTW at 12 months were higher in the BAAS cohort compared to Expect TO work, namely odds ratio (OR) 5.0 (CI:1.3-18.5) and ACTIVE OR 9.3 (CI:2.5-34.8).</p><p><strong>Conclusion: </strong>The BAAS work-integrated care pathway was more effective than care-as-usual in improving RTW after KA in the Netherlands.</p><p><strong>Trail registration: </strong>This study was retrospectively registered at clinicaltrails.gov ( https://clinicaltrials.gov/ct2/show/NCT05690347 , date of first registration: 19-01-2023).</p>\",\"PeriodicalId\":48035,\"journal\":{\"name\":\"Journal of Occupational Rehabilitation\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-09-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Occupational Rehabilitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10926-025-10331-1\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"REHABILITATION\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Occupational Rehabilitation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10926-025-10331-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"REHABILITATION","Score":null,"Total":0}
引用次数: 0
摘要
目的：考虑到工作年龄患者对膝关节置换术（KA）需求的增加和低重返工作（RTW）率，以RTW为重点优化KA患者的护理是必要的。我们评估了一种工作-综合护理途径-手术后重返工作(BAAS)-旨在改善RTW，与荷兰的常规护理相比。方法：在这项包括三个比较队列的多中心研究中，纳入了原发性KA的工作患者。两家荷兰医院（BAAS队列）的患者接受了综合医疗和职业护理，包括结构化的术前和术后咨询、目标设定、活动跟踪以及与医疗和职业卫生专业人员的跨学科小组会议。来自15家医院/诊所的患者纳入标准（期望工作和积极活动）相同的两个独立对照队列接受常规护理。主要结果为12个月内至第一天的RTW时间和完全RTW时间。使用治疗加权逆概率与已知预后因素作为协变量来解释基线特征的可能差异。结果：共纳入457例患者（BAAS n = 145; Expect TO work n = 179; ACTIVE n = 133）。与Expect to work（52天，风险比[HR] 2.7； 95%可信区间[CI]:2.1-3.4）和ACTIVE队列（43天，风险比：1.95;CI:1.5-2.6）相比，BAAS队列中至RTW第一天的中位时间（27天）缩短了16-25天。3个月时，90%的BAAS患者开始了RTW治疗，而对照组为63%和77%。BAAS患者也更早地实现了完全RTW，与ACTIVE组相比，中位时间减少了27天（HR:1.4; CI:1.1-1.8）。与Expect to work相比，BAAS队列在12个月时完全RTW的几率更高，即比值比（OR） 5.0 （CI:1.3-18.5）和ACTIVE OR 9.3 （CI:2.5-34.8）。结论：在荷兰，BAAS工作整合护理途径在改善KA后RTW方面比照旧护理更有效。试验注册：本研究在clinicaltrails.gov （https://clinicaltrials.gov/ct2/show/NCT05690347，首次注册日期：19-01-2023）上回顾性注册。
The Effectiveness of the Back At work After Surgery (BAAS) Work-Integrated Care Pathway on Return to Work for Patients Receiving Knee Arthroplasty: A Study of Three Comparative Cohorts in the Netherlands.
Purpose: Considering the increase in the demand from working age patients seeking knee arthroplasty (KA) and the low return-to-work (RTW) rates, optimization of care for patients getting KA with a focus on RTW is essential. We evaluated a work-integrated care pathway-Back At work After Surgery (BAAS)-aimed at improving RTW compared with care-as-usual in the Netherlands.
Methods: In this multicenter study of three comparative cohorts, working patients who had primary KA were included. Patients in two Dutch hospitals (BAAS cohort) received integrated medical and occupational care, including structured pre- and postoperative consultations, goal setting, activity tracking, and interdisciplinary team meetings with both medical and occupational health professionals. Two independent control cohorts with comparable patient inclusion criteria (Expect TO work and ACTIVE) from 15 hospitals/clinics received care-as-usual. The primary outcomes were the time to first day of RTW and time to full RTW within 12 months. Inverse Probability of Treatment Weighting was used with known prognostic factors as covariates to account for possible differences in baseline characteristics.
Results: A total of 457 patients were included (BAAS n = 145; Expect TO work n = 179; ACTIVE n = 133). The median time to first day of RTW was 16-25 days shorter in the BAAS cohort (27 days) compared to Expect TO work (52 days; hazard ratio [HR] 2.7; 95% confidence interval [CI]:2.1-3.4) and ACTIVE cohort (43 days; HR:1.95; CI:1.5-2.6). At three months, 90% of BAAS patients had started RTW versus 63% and 77% in the control cohorts. BAAS patients also achieved full RTW earlier, with a median time reduced by 27 days compared to the ACTIVE cohort (HR:1.4; CI:1.1-1.8). The odds of full RTW at 12 months were higher in the BAAS cohort compared to Expect TO work, namely odds ratio (OR) 5.0 (CI:1.3-18.5) and ACTIVE OR 9.3 (CI:2.5-34.8).
Conclusion: The BAAS work-integrated care pathway was more effective than care-as-usual in improving RTW after KA in the Netherlands.
Trail registration: This study was retrospectively registered at clinicaltrails.gov ( https://clinicaltrials.gov/ct2/show/NCT05690347 , date of first registration: 19-01-2023).
期刊介绍：
The Journal of Occupational Rehabilitation is an international forum for the publication of peer-reviewed original papers on the rehabilitation, reintegration, and prevention of disability in workers. The journal offers investigations involving original data collection and research synthesis (i.e., scoping reviews, systematic reviews, and meta-analyses). Papers derive from a broad array of fields including rehabilitation medicine, physical and occupational therapy, health psychology and psychiatry, orthopedics, oncology, occupational and insurance medicine, neurology, social work, ergonomics, biomedical engineering, health economics, rehabilitation engineering, business administration and management, and law. A single interdisciplinary source for information on work disability rehabilitation, the Journal of Occupational Rehabilitation helps to advance the scientific understanding, management, and prevention of work disability.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
