title: Screening instruments for predicting return to work in long-term sickness absence.
abstract: BACKGROUND
  Multiple somatic symptoms are common and may cause prolonged sickness absence (SA) and unsuccessful return to work (RTW).
  
  
  OBJECTIVE
  To compare three instruments and their predictive and discriminative abilities regarding RTW.
  
  
  METHODS
  A longitudinal cohort study of participants recruited from two municipal job centres, with at least 8 weeks of SA. The instruments used were the Symptom Check List of somatic distress (SCL-SOM) (score 0-48 points), the Bodily Distress Syndrome Questionnaire (BDSQ) (0-120 points) and the one-item self-rated health (SRH) (1-5 points). The instruments' predictive value was explored in a time-to-event analysis. Different cut-points were analysed to find the highest number of correctly classified RTW cases, identified in a register on public transfer payments.
  
  
  RESULTS
  The study involved 305 subjects. The adjusted relative risk regarding prediction of RTW was 0.89 [95% confidence interval (CI) 0.83-0.95], 0.89 (95% CI 0.83-0.95) and 0.78 (95% CI 0.70-0.86) per 5-, 10- and 1-point increase in the SCL-SOM, BDSQ and SRH, respectively. After mutual adjustment for the three instruments, only the prediction of RTW from SRH remained statistically significant 0.81 (95% CI 0.72-0.92). The highest sensitivity (86%) was found by SRH at the cut-point ≤5, at which 62% were correctly classified.
  
  
  CONCLUSIONS
  All three instruments predicted RTW, but only SRH remained a significant predictor after adjustment for the SCL-SOM and BDSQ. The SRH provides an efficient alternative to more time-consuming instruments such as SCL-SOM or BDSQ for estimating the chances of RTW among sickness absentees.
authors.affiliation: DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, 8000 Aarhus C, Denmark.
authors.forename: A-M H
authors.initials: AH
authors.lastname: Momsen
authors.affiliation: DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, 8000 Aarhus C, Denmark.
authors.forename: C M
authors.initials: CM
authors.lastname: Stapelfeldt
authors.affiliation: Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, 8000 Aarhus C, Denmark.
authors.forename: C V
authors.initials: CV
authors.lastname: Nielsen
authors.affiliation: COWI, 2800 Lyngby, Denmark.|The National Research Centre for the Working Environment, 2100 Copenhagen, Denmark.
authors.forename: M B D
authors.initials: MB
authors.lastname: Nielsen
authors.affiliation: The National Research Centre for the Working Environment, 2100 Copenhagen, Denmark.|Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark.|Department of Psychology, University of Copenhagen, 1353 Copenhagen K, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Rugulies
authors.affiliation: National Centre for Occupational Rehabilitation, 3884 Rauland, Norway.|Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
authors.forename: C
authors.initials: C
authors.lastname: Jensen
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D062707:Return to Work / Q000706:statistics & numerical data*; D018582:Sick Leave / Q000706:statistics & numerical data*; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014938:Work Capacity Evaluation; D017132:Workplace
keywords: Distress; discriminative ability; integrated care; rehabilitation; return to work; screening questionnaires; sickness management; somatization.