Return to Work After Medical Rehabilitation for Musculoskeletal Disorders in Times of the COVID-19 Pandemic: A Retrospective Cohort Study

Abstract

Objective

To describe and explain the effect of the coronavirus disease 2019 pandemic and its related measures on return to work (RTW) outcomes after multimodal medical rehabilitation for musculoskeletal disorders.

Design

Retrospective cohort study.

Setting

Three cohorts: reference (rehabilitation and RTW prepandemic), pandemic 1 (rehabilitation prepandemic, RTW during pandemic), and pandemic 2 (rehabilitation and RTW during pandemic).

Participants

Individuals who underwent multimodal medical rehabilitation for musculoskeletal disorders through the German Pension Insurance system between January 2018 and December 2021 (N=688,127).

Interventions

Not applicable.

Main Outcome Measures

A successful and stable RTW was operationalized as having employment subject to social insurance contributions from 9 to 12 months after rehabilitation.

Results

Descriptive analysis revealed an RTW rate of 67.2% in the reference cohort, a slight decline in pandemic cohort 1 (66.3%), and a more pronounced decrease in pandemic cohort 2 (63.1%). In contrast, average marginal predictions from a logistic model including various covariates showed that both pandemic cohorts (63.8% and 64.4%) exhibited similarly reduced predicted probabilities of RTW compared with the reference cohort (66.5%). Individuals with sick leave durations exceeding 6 months, compared with those with shorter sick leaves, were more negatively affected by pandemic cohort 1; however, this effect recovered in pandemic cohort 2. The interaction between cohort and income did not show any amplifying effect of the pandemic.

Conclusions

The logistic model revealed no differences in predicted probabilities of RTW between pandemic cohort 2 and pandemic cohort 1, suggesting that orthopedic rehabilitation remained robust in maintaining RTW outcomes despite pandemic-related challenges. The findings offer mixed evidence regarding the question of whether the pandemic amplified preexisting barriers to RTW.