Clinical Scorecard: A Coordinated Return-to-Work Approach Decreases Sick Leave Following Hip or Knee Replacement Surgery: Insights from a Registry Study
At a Glance
Category
Detail
Condition
Osteoarthritis requiring total hip or knee arthroplasty
Key Mechanisms
Integration of fast-track surgical recovery with occupational health services to support individualized return-to-work planning and workplace adjustments
Target Population
Working-age patients (25–62 years) undergoing hip or knee arthroplasty who have access to employer-provided occupational health services
Care Setting
Surgical hospitals and occupational health services in Finland
Key Highlights
The Coordinated Return-to-Work (CRTW) model prescribes short hospital sick leave and systematic referral to occupational health services to support return to work.
CRTW includes occupational physiotherapy guidance, occupational health specialist referrals, and workplace negotiations involving employer, employee, and OHS representatives.
Registry study using benchmarking controlled trial design showed CRTW effectiveness in reducing time to return to work after hip or knee arthroplasty.
Guideline-Based Recommendations
Diagnosis
Identify patients eligible for occupational health services by linking employment and pension data.
Confirm primary osteoarthritis diagnosis or developmental dysplasia of the hip prior to arthroplasty.
Management
Prescribe approximately one month of sick leave post-arthroplasty by the surgeon.
Refer patients systematically to occupational health services for individualized assessment of work ability and return-to-work planning.
Utilize occupational physiotherapy and specialist rehabilitation referrals as needed.
Conduct occupational health negotiations involving employer, employee, and OHS to plan workplace adjustments.
Monitoring & Follow-up
Track time to return to work using sickness absence registers.
Monitor sustained return to work by evaluating consecutive sickness absence periods with consistent diagnostic codes.
Risks
Inconsistent application of the CRTW model due to human factors may reduce effectiveness.
Patients without access to occupational health services (e.g., unemployed or entrepreneurs) are not covered by this model.
Patient & Prescribing Data
Working-age patients undergoing hip or knee arthroplasty with employer-provided occupational health coverage
Surgeon-prescribed sick leave aligned with CRTW protocol was associated with improved return-to-work outcomes compared to usual care.
Clinical Best Practices
Integrate surgical fast-track protocols with occupational health strategies for holistic recovery.
Ensure systematic referral to occupational health services immediately post-surgery.
Engage multidisciplinary teams including surgeons, occupational health specialists, physiotherapists, employers, and patients in return-to-work planning.
Customize return-to-work timing and workplace adjustments based on individual job demands and recovery status.
Utilize registry data and sickness absence records to evaluate and optimize return-to-work interventions.
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