ICF-based prediction of return to work after trauma rehabilitation: Results of the icfPROreha study in patients with severe musculoskeletal injuries.
Sandra Kus, Cornelia Oberhauser, Stefan Simmel and 1 others
PMID 36189052WHAT IT FOUND
Pain at rest and financial concerns at rehab admission strongly predicted failure to return to work 78 weeks after trauma.
A model using these and other factors identified at-risk patients with 65.6% sensitivity, enabling early targeted intervention for delayed return to work.
Key findings
01Patients reporting higher pain at rest had 55% reduced odds of returning to work 78 weeks after discharge.
02Financial concerns at admission were associated with 54% reduced odds of returning to work 78 weeks after discharge.
03Using a predicted probability cutoff of 76.3%, the model detected 65.6% of patients who did not return to work.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study excluded patients who were not fluent in German, limiting generalizability to non-German speakers. Most participants had occupational accidents covered by German Social Accident Insurance, which has a broader rehabilitation mandate than standard health insurance, potentially skewing outcomes. The model's positive predictive value was low (46.4% in training, 31.6% in validation), meaning many flagged patients would have returned to work anyway. Return to work was defined simply as yes/no, without accounting for part-time work or modified duties.
Declared interests
The study was funded by the German Social Accident Insurance (DGUV).
The easy way to misread this
Do not assume that identifying a patient as high-risk based on this model guarantees they will fail to return to work. The positive predictive value is low, meaning more than half of patients flagged as at-risk actually did return to work. Use the model to prioritize monitoring, not to predict individual failure definitively.