Long-term course and factors influencing work ability and return to work in post-COVID patients 12 months after inpatient rehabilitation 2024 Müller+

Abstract

Background
Rehabilitation plays a crucial role in restoring work ability and facilitating the reintegration of post-COVID patients into the workforce. The impact of rehabilitation on work ability and return to work (RTW) of post-COVID patients remains poorly understood. This study was conducted to assess the work ability and RTW of post-COVID patients before rehabilitation and 12 months after rehabilitation and to identify physical and neuropsychological health factors influencing RTW 12 months after rehabilitation.

Methods
This longitudinal observational study included 114 post-COVID patients with work-related SARS-CoV-2 infection who underwent inpatient post-COVID rehabilitation with indicative focus on pulmonology and/or psychotraumatology (interval between date of SARS-CoV-2 infection and start of rehabilitation: M = 412.90 days). Employment status, work ability, and the subjective prognosis of employment (SPE) scale were assessed before rehabilitation (T1) and 12 months after rehabilitation (T4). The predictors analysed at T4 were functional exercise capacity, physical activity, subjective physical and mental health status, fatigue, depression, and cognitive function. Longitudinal analyses were performed via the Wilcoxon signed-rank test. Logistic and linear regression analyses identified predictors of work ability and return to work (RTW), whereas mediation analyses examined the relationships between these predictors and work ability.

Results
At T4, the median of WAI total score indicated poor work ability, which significantly worsened over time (p < 0.001; r = 0.484). The SPE scale significantly increased from T1 to T4 (p = 0.022, r = -0.216). A total of 48.6% of patients had returned to work 12 months after rehabilitation. Fatigue was identified as the main predictor of reduced work ability and RTW, with each unit increase in fatigue severity decreasing the odds of RTW by 3.1%. In addition, physical capacity and subjective health status were significant predictors of perceived work ability.

Conclusions
The findings highlight the significant challenges that post-COVID patients face in regaining work ability and achieving successful RTW 12 months after rehabilitation. Fatigue appears to be an important predictor of work ability and RTW. To optimize recovery and enhance both biopsychosocial health and work ability, it is crucial to develop and implement personalised interventions that address fatigue, improve physical capacity, and support mental health.

Open access, https://occup-med.biomedcentral.com/articles/10.1186/s12995-024-00443-4

 

Nice to start your abstract with the second statement contradicting the first.

 

So rehab doesn't help. Good to have that cleared up.

 

So:

1. They assume that rehabilitation works
2. They don't know that it works
3. They worked on rehabilitating some patients
4. They can't say if it works, how, or whether it makes any difference, actually it seems to make no difference
5. They have to justify the work they did, so they should develop #3, because they #1, and are still stuck at #2

Their conclusion is literally that if rehabilitation worked, it would work, they just have to figure out how to make it work, as people funded to provide exactly this based on the assumption that it works.

Fundamentally, most of this type of research or clinical work around rehabilitation takes the form of:

1. Let's do the thing
2. We did the thing, we have to argue that the thing has worked, even if we can't show it, or that it failed
3. Go to #1

And, oh lookie here, you have to read a bit further to find this:

So it doesn't work. But they feel that it should work. And therefore should get money to figure out how to make it work. Even though, as they literally opened the paper with, they assume it works. They just don't know how. Also it doesn't work anyway. Hence why they should get paid to figure out how to make it work.

This is the kind of fake work you expect out of princes in large aristocratic families. People paid to do nothing useful, who will never run out of work because achieving results is never part of any consideration.

Yes, being ill would be the reason why people are out of work for illness-related reasons. Good work, chumps! I don't know why they have to cite another paper for this, since they could have easily asked their own participants. Because it really sounds like the patients have a good grasp of their limitations and situation. Which would mean, let's pull the quote:

That their assessment of 'perceived' work ability is actually a rather good assessment of their work ability, perception not needed.

Now let's open the floor to wild speculation, common in medical culture:

Sounds like their biological health has been negatively impacted plenty.

Reading more speculation following the one above, the authors don't seem to understand much about the consequences of illness. Seem utterly baffled at the concept of illness affecting lives in dramatically impactful ways. Such as financial losses leading to financial hardship in societies that require stable personal finances. How could we ever function as a society without insights like this?

They don't seem to have paid attention to what pacing is either, or that it isn't a 'technique'. And in this very paper they dismiss the recognition of tolerance thresholds as a problem of perception.

Ah, yes, let's have people who clearly don't understand any of those concepts teach patients who clearly understand them far better. Very smart. Why cite Greenhalgh's useless papers here? Another mystery of the universe, as she had nothing to do with those concepts and this multidisciplinary approach is entirely useless as well, is literally the current standard of care for inexplicable reasons.

They don't even have a solid grasp of what fatigue is. No, it's not alterations in focused and sustained attention, you goofs. Come on.

Ah, yes, the thing no one has ever thought of or tried before. If they could simply figure out how to rehabilitate people, they could rehabilitate people. Which they claim is effective. Even though it's not. Ah well. The mysteries of the universe, I guess.

What does that even mean? How does one "assess and monitor fatigue"? To do what with it?!!

Yes, illness affects ability to function. You figured that out. Mostly. Somewhat. Good on you.

Isn't that what you just tried?! And has been tried countless times before? And is literally the standard of care??!!!

For sure this study adds to the overwhelming body of evidence that the biopsychosocial model of illness and all its derived concepts are entirely useless for any and all intents and purposes.

 

How the hell are we even supposed to counter an ideology that can't be bothered to make sense in adjacent sentences? This kind of nonsense would yield a fail in primary school. The authors need blame for this but a bunch of people read those sentences and thought nothing wrong of it. It's going downstairs and finding nothing wrong with ending up on the roof level of nonsense.

And somehow we're not getting through?!

 

Journal of Occupational Medicine and Toxicology -> Journal of Toxic Occupational Medicine

 

I've not looked closely. Not sure this tells us much.

What were they actually doing? Three groups? "pulmonology and/or psychotraumatology" All different groups with differing needs. Seems to have been all merged into one group! What the heck does someone with poor pulmonary capacity post Covid have in common with a pt with PTSD due to traumatic time in ICU? Or someone with both.

How much of this is capturing a natural recovery process, for those that improve?

Issues seem to have only been assessed by questionaries - which is poor practice. The psychotraumatology bods did not appear to have at least a structured clinical interview by independent person (pre and post) to see if they met criteria for PTSD or not. Did they then do trauma focused therapy? If so, what type? Did it matter? And what was the outcome? Moving on and not meeting criteria anymore? Seems they did badly - but why?

 

Well those last lines are a contradiction in terms unless we are finally looking to blow the bps school out of the water and look at proper situational support interpretation of the real intended application of that model