title: Assessment of health-related quality of life of clients in vocational rehabilitation: association with depressive symptoms and type of services.
abstract: BACKGROUND
  Health-related quality of life (HRQOL) has been frequently used as an outcome measure in disability-related studies, yet little is known about HRQOL in vocational rehabilitation (VR).
  
  
  OBJECTIVE
  To evaluate HRQOL in VR clients and identify factors associated with their HRQOL DESIGN, SETTING AND POPULATION: Cross-sectional study of 149 clients from 5 VR centers in Switzerland and Germany
  
  
  METHODS
  HRQOL was measured by 8 dimensions of the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and compared with sex-matched German population norms. Multiple regression analyses were conducted to identify whether VR-related variables (VR duration and type, sick leave duration) and depressive symptoms were associated with HRQOL dimensions independent of sociodemographics (age, sex, education) and clinical characteristics (type of disorders, number of comorbidities)
  
  
  RESULTS
  HRQOL in VR clients was significantly lower in all dimensions measured by the SF-36 compared to the general population. Returning to the former workplace and being oriented to a new job were associated with less functional limitation due to physical problems, less pain and better mental health. Being oriented to a new job was also associated with better vitality. Presence of depressive symptoms was negatively related with all dimensions of HRQOL. Overall, the regression models explained 10%-25% variance of the physical HRQOL domain and 18%-27% variance of the mental HRQOL domain.
  
  
  CONCLUSIONS
  Multiple dimensions of HRQOL were significantly decreased in VR clients. Depressive symptoms were prevalent and contributed significantly to poorer HRQOL, thus should be considered in the VR process. Further research is needed to ascertain the effect of different VR types to HRQOL and to elaborate the role of depressive symptoms in HRQOL over time.
  
  
  CONCLUSIONS
  Rehabilitation professionals should be informed of the level of HRQOL in VR clients in order to tailor effective interventions to improve HRQOL by not only focusing on functional ability but also the psychological well-being.
authors.affiliation: Department of Health Sciences Community and Occupational Medicine University Medical Center Groningen University of Groningen, Groningen, The Netherlands - a.ferdiana@umcg.nl.
authors.forename: A
authors.initials: A
authors.lastname: Ferdiana
authors.forename: M W
authors.initials: MW
authors.lastname: Post
authors.forename: M
authors.initials: M
authors.lastname: Finger
authors.forename: U
authors.initials: U
authors.lastname: Bültmann
authors.forename: R
authors.initials: R
authors.lastname: Escorpizo
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D008297:Male; D008603:Mental Health; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012050:Rehabilitation, Vocational / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires