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European Journal of Physical and Rehabilitation Medicine 2014 June;50(3):343-53


language: English

Assessment of health-related quality of life of clients in vocational rehabilitation: association with depressive symptoms and type of services

Ferdiana A. 1, 2, Post M. W. 3, 4, Finger M. 3, Bültmann U. 1, Escorpizo R. 3, 5, 6

1 Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; 2 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; 3 Swiss Paraplegic Research (SPF), Nottwil, Switzerland; 4 Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat, Utrecht, The Netherlands; 5 Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA, USA; 6 ICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Nottwil, Switzerland


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).
AIM: 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.
CONCLUSION: 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.
CLINICAL REHABILITATION IMPACT: 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.

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