title: Long-term predictors of outcome in fatigued employees on sick leave: a 4-year follow-up study.
abstract: BACKGROUND
  Persistent fatigue is strongly associated with functional status and can lead to absenteeism and work disability. Despite several prognostic studies on chronic fatigue, little attention has been paid to occupational outcomes.
  
  
  METHODS
  A total of 127 fatigued employees on sick leave were followed-up after 4 years to determine long-term predictors of work disability, fatigue caseness and chronic fatigue syndrome (CFS)-like caseness. Measures included fatigue, physical functioning, illness attributions, psychological problems and emotional exhaustion.
  
  
  RESULTS
  Thirty-three participants (26%) were receiving work disability benefits at the 4-year follow-up. Older age and lower levels of physical functioning predicted work disability. Weaker psychological attributions and lower levels of physical functioning were predictors of fatigue caseness. CFS-like caseness was predicted by female gender and lower levels of physical functioning. Self-reported physical functioning remained a strong and statistically significant determinant of work disability [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.24-0.87] and CFS-like caseness (OR 0.20, 95% CI 0.09-0.43) after controlling for confounders.
  
  
  CONCLUSIONS
  This study suggests that physical functioning plays an important role in the persistence of fatigue complaints and work disability in employees on sick leave. The course of fatigue is a complex process, and exploring temporal relationships between fatigue, functional status and work status in future research could provide valuable information for the improvement of fatigue management.
authors.affiliation: Department of Epidemiology, Maastricht University, The Netherlands. Stephanie.Leone@epid.unimaas.nl
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Leone
authors.forename: Marcus J H
authors.initials: MJ
authors.lastname: Huibers
authors.forename: Ijmert
authors.initials: I
authors.lastname: Kant
authors.forename: Constant P
authors.initials: CP
authors.lastname: Van Schayck
authors.forename: Gijs
authors.initials: G
authors.lastname: Bleijenberg
authors.forename: J
authors.initials: J
authors.lastname: André Knottnerus
mesh_terms: D000328:Adult; D000339:Affect; D004185:Disability Evaluation; D004651:Employment / Q000706:statistics & numerical data*; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018582:Sick Leave / Q000706:statistics & numerical data*; D013997:Time Factors