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Purpose <p>Considering the increase in the demand from working age patients seeking knee arthroplasty (KA) and the low return-to-work (RTW) rates, optimization of care for patients getting KA with a focus on RTW is essential. We evaluated a work-integrated care pathway—Back At work After Surgery (BAAS)—aimed at improving RTW compared with care-as-usual in the Netherlands.</p> Methods <p>In this multicenter study of three comparative cohorts, working patients who had primary KA were included. Patients in two Dutch hospitals (BAAS cohort) received integrated medical and occupational care, including structured pre- and postoperative consultations, goal setting, activity tracking, and interdisciplinary team meetings with both medical and occupational health professionals. Two independent control cohorts with comparable patient inclusion criteria (Expect TO work and ACTIVE) from 15 hospitals/clinics received care-as-usual. The primary outcomes were the time to first day of RTW and time to full RTW within 12&#xa0;months. Inverse Probability of Treatment Weighting was used with known prognostic factors as covariates to account for possible differences in baseline characteristics.</p> Results <p>A total of 457 patients were included (BAAS <i>n</i> = 145; Expect TO work n = 179; ACTIVE <i>n</i> = 133). The median time to first day of RTW was 16–25&#xa0;days shorter in the BAAS cohort (27&#xa0;days) compared to Expect TO work (52&#xa0;days; hazard ratio [HR] 2.7; 95% confidence interval [CI]:2.1–3.4) and ACTIVE cohort (43&#xa0;days; HR:1.95; CI:1.5–2.6). At three months, 90% of BAAS patients had started RTW versus 63% and 77% in the control cohorts. BAAS patients also achieved full RTW earlier, with a median time reduced by 27&#xa0;days compared to the ACTIVE cohort (HR:1.4; CI:1.1–1.8). The odds of full RTW at 12&#xa0;months were higher in the BAAS cohort compared to Expect TO work, namely odds ratio (OR) 5.0 (CI:1.3–18.5) and ACTIVE OR 9.3 (CI:2.5–34.8).</p> Conclusion <p>The BAAS work-integrated care pathway was more effective than care-as-usual in improving RTW after KA in the Netherlands.</p> Trail Registration <p>This study was retrospectively registered at clinicaltrails.gov ( <a href="https://clinicaltrials.gov/ct2/show/NCT05690347">https://clinicaltrials.gov/ct2/show/NCT05690347</a>, date of first registration: 19-01-2023).</p>

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The Effectiveness of the Back At work After Surgery (BAAS) Work-Integrated Care Pathway on Return to Work for Patients Receiving Knee Arthroplasty: A Study of Three Comparative Cohorts in the Netherlands

  • 期刊论文

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  • 发表日期：

    2025年9月16日

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  • Daniël O. Strijbos,
  • Geert van der Sluis,
  • Wim F. C. van Houtert,
  • A. Carlien Straat,
  • Yvonne van Zaanen,
  • Carolien M. Kooijman,
  • Igor van den Brand,
  • Stephan E. de Groot,
  • Michiel F. Reneman,
  • Tim Boymans,
  • P. Paul F. M. Kuijer

摘要

Purpose

Considering the increase in the demand from working age patients seeking knee arthroplasty (KA) and the low return-to-work (RTW) rates, optimization of care for patients getting KA with a focus on RTW is essential. We evaluated a work-integrated care pathway—Back At work After Surgery (BAAS)—aimed at improving RTW compared with care-as-usual in the Netherlands.

Methods

In this multicenter study of three comparative cohorts, working patients who had primary KA were included. Patients in two Dutch hospitals (BAAS cohort) received integrated medical and occupational care, including structured pre- and postoperative consultations, goal setting, activity tracking, and interdisciplinary team meetings with both medical and occupational health professionals. Two independent control cohorts with comparable patient inclusion criteria (Expect TO work and ACTIVE) from 15 hospitals/clinics received care-as-usual. The primary outcomes were the time to first day of RTW and time to full RTW within 12 months. Inverse Probability of Treatment Weighting was used with known prognostic factors as covariates to account for possible differences in baseline characteristics.

Results

A total of 457 patients were included (BAAS n = 145; Expect TO work n = 179; ACTIVE n = 133). The median time to first day of RTW was 16–25 days shorter in the BAAS cohort (27 days) compared to Expect TO work (52 days; hazard ratio [HR] 2.7; 95% confidence interval [CI]:2.1–3.4) and ACTIVE cohort (43 days; HR:1.95; CI:1.5–2.6). At three months, 90% of BAAS patients had started RTW versus 63% and 77% in the control cohorts. BAAS patients also achieved full RTW earlier, with a median time reduced by 27 days compared to the ACTIVE cohort (HR:1.4; CI:1.1–1.8). The odds of full RTW at 12 months were higher in the BAAS cohort compared to Expect TO work, namely odds ratio (OR) 5.0 (CI:1.3–18.5) and ACTIVE OR 9.3 (CI:2.5–34.8).

Conclusion

The BAAS work-integrated care pathway was more effective than care-as-usual in improving RTW after KA in the Netherlands.

Trail Registration

This study was retrospectively registered at clinicaltrails.gov ( https://clinicaltrials.gov/ct2/show/NCT05690347, date of first registration: 19-01-2023).