Impact on sickness absences of early measures to support work ability and return to work after hip and knee replacement surgeries (Occupational health support for joint replacement surgery)
Approximately 7,000 joint replacement operations are carried out in Finland each year for people of working age, due to arthrosis of the knee and hip. Typically, an orthopaedic surgeon recommends 2–3 months of sickness absence after hip and knee replacement surgery, mostly regardless of the patient's job description.
In 2018–2020, an operational model was adopted at the Central Hospital of Central Finland, the University Hospitals of Helsinki and Oulu, and the Oulaskangas Hospital, in which the orthopaedic surgeon prescribes the patient only one month of sick leave, and the patient is referred to occupational health care to assess their work ability and plan measures to support their return to work.
The objective of the study is to find out the following, in relation to patients of working age who underwent joint replacement surgery in the aforementioned hospitals in 2020–2021:
- How have the sickness absences after joint replacement surgery changed since the introduction of the new approach emphasizing the role of occupational health care?
- What is the connection between sickness absences after joint replacement surgery and different factors such as the patient's own expectations, the size of the workplace, the workload, job modification measures, and measures to support work ability by occupational health care and the workplace?
Materials and techniques
Study package 1 comprises register study carried out as a benchmarking control trail (BCT) on sickness absences before (years 2017−2018) and after (year 2021) increasing the role of occupational health care in the care process. In 2017-2018 and 2021, data on artificial joint surgery due to arthrosis in patients of working age (aged 25-62) in the Central Finland Hospital, University Hospitals of Helsinki and Oulu, and Oulaskangas Hospital will be retrieved, which will be combined with data on Kela's sickness allowance.
Study package 2 is implemented as a cross-sectional survey of patients of working age undergoing surgery in the participating hospitals between October 2020 and May 2021. Data is collected from the study patients 3 and 18 months post surgery.
In addition, a comparison of the sickness absences of patients undergoing surgery in 2013, 2010, and 2017−2018 will be made as a separate study package. This part is carried out using only patient data from the Central Hospital of Central Finland, with the objective of identifying the impact on sickness absences of the improvements made in the process of artificial joint surgery (fast track) carried out in Central Finland in 2011 as well as the optimization of the treatment of artificial joint disorders introduced in 2017. This separate part is implemented as register study in a peer-controlled research setting, and the research is carried out by a research team at the Central Hospital of Central Finland.
Results and effectiveness
The hypothesis of the study is that enhanced guidance on matters related to work ability by occupational health care will facilitate a person's service pathway, support the successful return to work, make better use of measures by occupational health care that support work ability, and reduce the length of sickness absences and related costs. It is important to provide research evidence for these assumptions.
If there is research evidence on the benefits of more effective referral to occupational health care, this will provide grounds for much broader development of co-operation models between occupational health care and other health care actors in Finland. The aim is that as the new operational models take root, they will support the work ability of Finns of working age and thereby increase productivity in Finnish work life.
The research examines effective measures in supporting work ability, meaning measures that are found to be the most connected with the length of the sickness absences after joint replacement surgery. Another aim is to identify factors specific to a particular employee or workplace that are connected to a longer sickness absence following joint replacement surgery, such as the employee's comorbidities, functional capacity, and workload, and the size of the workplace. In the future, this data can be used to better focus work ability support measures.
The study will provide information on the implementation of occupational health co-operation. Information will also be provided on the study patients who do not return to work after joint replacement surgery. In these cases, the study will investigate the factors related to prolonged or permanent incapacity for work and the rehabilitation that is carried out.
The results will be presented at conferences in Finland and abroad, according to opportunities. Peer-reviewed articles on the results will be published in both international and Finnish journals.
hankkeen projektipäällikkö, ylilääkäri
The design phase of the study has been funded as part of the ESF-funded project “TYÖKE – Verkostoilla tehoa soteen, työkyvyn tukeen ja työikäisten terveyteen”. Starting on 1 April 2020, the Finnish Institute of Occupational Health is funding the study as part of the research and development programme for work, health, and work ability.