Relation between indicators for quality of occupational rehabilitation of employees with low back pain.
OBJECTIVE
To assess if the implementation of guidelines for occupational rehabilitation of patients with low back pain by means of process variables--a set of objective criteria for technical performance and continuity of care--led to a better outcome in clinical and return to work variables.


METHODS
The study group consisted of 59 patients with at least 10 days of sick leave because of low back pain. Univariate analyses as well as multiple logistic regression and Cox's regression analyses were performed to assess the relation between quality of care and outcome.


RESULTS
Process indicators for technical competence, continuity of care, and total performance were all significantly related to satisfaction of employees. Continuity of care and total performance were significantly related to working status at 3 months, and time to return to work. None of the process indicators was related to pain or disability after 3 months follow up. Satisfaction was not related to any of the other outcome variables. This indicates that if guidelines for occupational rehabilitation are met, outcome is better.


CONCLUSIONS
Quality of the process of care was related to outcome. Interventions of occupational physicians need improvement in the areas of continuity of care and communication with treating physicians. The effectiveness of an improved intervention should be studied in a subsequent randomised clinical trial.
van der Weide
W E
WE
Coronel Institute for Occupational and Environmental Health, Faculty of Medicine, University of Amsterdam, Academic Medical Center, The Netherlands.
Verbeek
J H
JH
van Dijk
F J
FJ
D000328:Adult; D003266:Continuity of Patient Care / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009787:Occupational Medicine / Q000592:standards*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D012050:Rehabilitation, Vocational / Q000592:standards*; D018582:Sick Leave; D016896:Treatment Outcome