Process and outcome evaluation of vocational rehabilitation interventions in patients with prolonged fatigue complaints.
BACKGROUND
Prolonged fatigue can cause physical, mental and occupational disability. Fatigue often persists because of a combination of biopsychosocial factors.


OBJECTIVE
To evaluate the process and outcomes of three existing outpatient vocational rehabilitation interventions (VRI) in patients with prolonged fatigue complaints. The VRIs differ with regard to the content and treatment duration, enrolment procedure and financing.


METHODS
A pre-post design was used with repeated measurements before treatment, after treatment and 3 months after treatment. Primary outcomes (fatigue and work participation) and secondary outcomes (physical and social functioning, mental health and physiological indicators (heart rate variability)) were assessed over time using linear mixed models analysis. A process evaluation (i.e. patient reach, content completeness and patient satisfaction) was conducted as well.


RESULTS
One hundred patients participated. Post-treatment, fatigue decreased (p < .001) and work participation (p < .010), physical functioning (p < .001) and mental health (p < .001) improved considerably in all three VRIs. Social functioning improved in one VRI (p = .022), but did not in the other two (p = .442, p = .196, respectively). Physiologically, heart rate variability improved in two VRIs (p = .044, p = .038, respectively). VRIs were administered according to the programme protocol. Almost all patients met their personal goals and the majority was satisfied with the outcomes of diminished constraints at work.


CONCLUSIONS
Three VRIs showed significant and clinically relevant outcomes over time regarding decreased fatigue and improved functioning and work participation in fatigued patients. The VRIs administered patient-tailored biopsychosocial interventions as planned and patients were satisfied with the interventions.
Joosen
Margot
M
Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. m.c.joosen@amc.nl
Frings-Dresen
Monique
M
Sluiter
Judith
J
D006233:Persons with Disabilities; D005221:Fatigue / Q000534:rehabilitation*; D006801:Humans; D008603:Mental Health; D017060:Patient Satisfaction; D015397:Program Evaluation; D012050:Rehabilitation, Vocational; D011795:Surveys and Questionnaires; D016896:Treatment Outcome