Employment after rehabilitation for Musculoskeletal Impairments: The Impact of Vocational rehabilitation and Working on a Trail basis.

Objective: To investigate to what extent vocational rehabilitation and working on a trial basis have an impact on employment after rehabilitation. Design: Follow-up survey, conducted in 1991, among all patients, aged 14 to 64, who were treated between 1984 and 1987. Setting: An out-clinic department of a rehabilitation center in the west of The Netherlands. Subjects: 395 patients (59% of the original sample) participated in the study. They suffer from musculoskeletal impairments due to back pain (41%), brain injury (20%), neurological disorder (12%), trauma to the upper and/or lower extremities (8%), rheumatoid arthritis (7%), or other disorders (12%). No differences were found between those who did and those who did not respond with regard to age, gender, marital status, disorder, work experience, and participation in vocational rehabilitation. Main Outcome Measure: Odds ratio of having a paid job after rehabilitation. Results: Participation in vocational rehabilitation and working on a trial basis depends on age, gender, work experience, and disorder. When statistically controlled for these variables vocational rehabilitation (odds ratio 1.96; 95% confidence interval 1.12 to 3.42) and working on a trial basis (odds ratio 3.26; 95% confidence interval 1.74 to 6.11) proved to have a significant impact on employment after rehabilitation. Conclusions: The findings suggest that rehabilitation programs that aim specifically at promoting employment for people with disabilities are effective, in particular when they take place in both a laboratory and a natural setting. The validity of this suggestion must be further tested by means of an experimental design. (C) 1995 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitatio