title: Work and health, a blind spot in curative healthcare? A pilot study.
abstract: BACKGROUND
  Most workers with musculoskeletal disorders on sick leave often consult with regular health care before entering a specific work rehabilitation program. However, it remains unclear to what extent regular healthcare contributes to the timely return to work (RTW). Moreover, several studies have indicated that it might postpone RTW. There is a need to establish the influence of regular healthcare on RTW as outcome; "Does visiting a regular healthcare provider influence the duration of sickness absence and recurrent sick leave due to musculoskeletal disorders?".
  
  
  METHODS
  A cohort of workers on sick leave for 2-6 weeks due to a-specific musculoskeletal disorders was followed for 12 months. The main outcomes for the present analysis were: duration of sickness absence till 100% return to work and recurrent sick leave after initial RTW. Cox regression analyses were conducted with visiting a general health practitioner, physical therapist, or medical specialist during the sick leave period as independent variables. Each regression model was adjusted for variables known to influence health care utilization like age, sex, diagnostic group, pain intensity, functional disability, general health perception, severity of complaints, job control, and physical load at work.
  
  
  RESULTS
  Patients visiting a medical specialist reported higher pain intensity and more functional limitations and also had a worse health perception at start of the sick leave period compared with those not visiting a specialist. Visiting a medical specialist delayed return to work significantly (HR = 2.10; 95%CI 1.43-3.07). After approximately 8 weeks on sick leave workers visiting a physical therapist returned to work faster than other workers. A recurrent episode of sick leave during the follow up quick was initiated by higher pain intensity and more functional limitations at the moment of fully return to work. Visiting a primary healthcare provider during the sickness absence period did not influence the occurrence of a new sick leave period.
  
  
  CONCLUSIONS
  Despite the adjustment for severity of the musculoskeletal disorder, visiting a medical specialist was associated with a delayed full return to work. More attention to the factor 'labor' in the regular healthcare is warranted, especially for those patients experiencing substantial functional limitations due to musculoskeletal disorders.
authors.affiliation: Department of Health Economics, Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands. lotters@bmg.eur.nl
authors.forename: Freek J B
authors.initials: FJ
authors.lastname: Lötters
authors.forename: Marleen
authors.initials: M
authors.lastname: Foets
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000534:rehabilitation; D009426:Netherlands; D010342:Patient Acceptance of Health Care; D010548:Personal Health Services / Q000706:statistics & numerical data*; D026761:Physical Therapy Specialty; D010865:Pilot Projects; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012008:Recurrence; D012044:Regression Analysis; D018582:Sick Leave; D013038:Specialization; D013997:Time Factors; D014937:Work