轻度伤残职业康复者生活质量状况及其与不同层次复工结局的关联

doi:10.3969/j.issn.1006-9771.2026.09.010

Abstract

Abstract:

Objective To explore the impact of comprehensive vocational rehabilitation on quality of life and return-to-work outcomes for individuals with mild work-related disability.

Methods A longitudinal observational study was conducted. A total of 343 work-injured employees receiving comprehensive vocational rehabilitation intervention in Guangdong Work Injury Rehabilitation Hospital from June, 2023 to December, 2024 were selected. The 36-item Short Form Health Survey (SF-36) was adopted to assess their health-related quality of life at admission and discharge. All subjects were followed up within one year after discharge to collect their return-to-work status. The differences in each dimension score of SF-36 among patients with different return-to-work outcomes (return to original post, transfer to new post and non-return to work) were compared, and the independent influencing factors of return-to-work outcomes were identified.

Results Comprehensive vocational rehabilitation intervention significantly improved the scores of physical functioning (PF), role-physical (RP) and role-emotional (RE) among work-injured employees (P < 0.05). At discharge, compared with patients who failed to return to work, patients returning to original post obtained significantly higher scores in PF, RP, bodily pain (BP), general health (GH), vitality (VT), social functioning (SF) and mental health (MH), patients transferred to new post achieved significantly higher scores in PF, BP, GH and SF (P < 0.05). Taking non-return-to-work status as the reference category, the multinomial logistic regression model showed the adverse factors for return to original post included low educational attainment (college diploma or below), on-site placement service, increased lost workdays and low employment intention (pre-contemplation and contemplation stages); the protective factor was positive evaluation of health transition (HT); for patients transferred to new posts, adverse factors were low employment intention (pre-contemplation stage) and increased lost workdays, while protective factors covered on-site placement service and positive HT evaluation.

Conclusion Comprehensive vocational rehabilitation can improve the quality of life for injured workers. Better quality of life is positively associated with return-to-work outcomes. HT, education level, job placement mode, lost workdays and employment willingness are independent factors impacting return-to-work outcomes.

Key words: mild work-related disability, injured workers, vocational rehabilitation, return-to-work outcomes, the 36-item Short Form Health Survey, health changes, lost workdays

CLC Number:

R492

Zhou Huiling, Zeng Jiayan, Chen Bing. Quality of life among vocational rehabilitation patients with mild work-related disability and its association with return-to-work outcomes[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(9): 1078-1086.

Figures/Tables 5

Table 1

Table 2

Table 3

Table 4

Table 5

Multiclass logistic regression model parameter estimation for resumption of work (non-return to work as reference)"

变量	原岗位vs.未复工		新岗位vs.未复工
变量	Exp(B) (95%CI)	P值	Exp(B) (95%CI)	P值
就业意愿(准备)
就业意愿(考虑前)	3×10^-8(3×10^-9~3×10^-7)	< 0.001	2×10^-8(6×10^-9~7×10^-8)	< 0.001
就业意愿(考虑)	8×10^-8(1×10^-8~6×10^-7)	< 0.001	2×10^-8(2×10^-9~2×10^-8)	—
就业意愿(行动)	9.104(< 0.001~上限不可估)	0.999	2.998(< 0.001~上限不可估)	1.000
学历(大专及以上)
学历(小学及以下)	0.025(0.003~0.199)	< 0.001	0.312(0.031~3.184)	0.326
学历(初中/高中)	0.039(0.007~0.206)	< 0.001	0.713(0.096~5.290)	0.741
损失工作日(线性项)	0.981(0.976~0.986)	< 0.001	0.986(0.980~0.991)	< 0.001
损失工作日(二次项)	1.000(1.000~1.000)	< 0.001	1.000(1.000~1.000)	< 0.001
出院时
PF	1.005(0.978~1.033)	0.708	1.006(0.976~1.037)	0.693
RP	1.009(0.989~1.028)	0.380	1.007(0.986~1.028)	0.553
BP	0.998(0.962~1.036)	0.925	0.980(0.941~1.021)	0.332
GH	0.995(0.960~1.031)	0.780	0.999(0.964~1.035)	0.944
VT	0.980(0.939~1.022)	0.341	0.991(0.947~1.038)	0.709
SF	1.006(0.978~1.035)	0.688	1.014(0.981~1.048)	0.401
RE	0.984(0.968~1.000)	0.047	0.985(0.969~1.002)	0.077
MH	1.044(0.998~1.093)	0.063	1.011(0.963~1.061)	0.661
HT	1.772(1.184~2.651)	0.005	1.693(1.104~2.597)	0.016
性别(女)
性别(男)	0.469(0.128~1.727	0.255	0.757(0.194~2.947)	0.688
工种(专业技术人员)
工种(行政及文职人员)	0.072(0.008~0.681)	0.022	0.107(0.008~1.382)	0.087
工种(一线工人)	0.553(0.111~2.756)	0.470	0.489(0.079~3.030)	0.442
工种(商业服务业人员)	0.557(0.087~3.579)	0.537	0.499(0.064~3.915)	0.508
参保地(省直及其他地市)
参保地(广州)	0.639(0.204~2.005)	0.443	0.559(0.168~1.859)	0.343
安置服务(远程安置)
安置服务(现场安置)	0.110(0.031~0.391)	0.001	7.065(2.230~22.380)	0.001

Table 5

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维度	干预前	干预后	生活质量变化方向(提升例数/下降例数)	Z值	P值
PF	60.00 (40.00, 80.00)	70.00 (50.00, 80.00)	提升(184/105)	-4.534	< 0.001
RP	0.00 (0.00, 25.00)	0.00 (0.00, 50.00)	提升(96/65)	-3.225	0.001
BP	46.00 (33.50, 57.00)	46.00 (37.00, 69.00)	提升(158/93)	-4.697	< 0.001
GH	50.00 (40.00, 65.00)	51.00 (40.00, 66.00)	提升(152/143)	-0.699	0.485
VT	55.00 (45.00, 70.00)	55.00 (45.00, 70.00)	提升(144/140)	-0.933	0.351
SF	50.00 (37.50, 62.50)	62.50 (50.00, 75.00)	提升(148/103)	-2.709	0.007
RE	33.33 (0.00, 66.67)	33.33 (0.00, 100.00)	提升(109/74)	-3.185	0.001
MH	64.00 (52.00, 76.00)	64.00 (52.00, 80.00)	提升(157/141)	-0.366	0.715

维度	模型Omnibus χ² (P)	干预前得分B (95%CI)	干预前得分P值	其他显著协变量(P值)
PF	177.280 (< 0.001)	0.012 (0.010~0.014)	< 0.001	—
RP	7.969 (0.093)	0.003 (0.000~0.005)	0.023	—
BP	118.855 (< 0.001)	0.011 (0.009~0.013)	< 0.001	病程(0.003)、学历(0.026)
GH	158.485 (< 0.001)	0.013 (0.011~0.015)	< 0.001	—
VT	164.895 (< 0.001)	0.013 (0.011~0.015)	< 0.001	病程(0.049)
SF	92.107 (< 0.001)	0.009 (0.007~0.011)	< 0.001	学历(0.047)
RE	13.274 (0.010)	0.002 (0.001~0.004)	< 0.001	—
MH	157.267 (< 0.001)	0.010 (0.009~0.012)	< 0.001	—

维度	原岗位复工组 (n = 201)	新岗位复工组 (n = 79)	未复工组 (n = 63)	Kruskal-Wallis H检验		Mann-Whitney U检验两两比较P值
维度	原岗位复工组 (n = 201)	新岗位复工组 (n = 79)	未复工组 (n = 63)	H值	P值	a	b	c
PF	70.00 (52.50, 82.50)	70.00 (55.00, 80.00)	50.00 (25.00, 70.00)	24.256	< 0.001	1.000	< 0.001	< 0.001
RP	0.00 (0.00, 50.00)	0.00 (0.00, 50.00)	0.00 (0.00, 25.00)	9.941	0.007	0.195	0.010	0.854
BP	57.00 (46.00, 69.50)	46.00 (37.00, 69.00)	46.00 (24.50, 57.00)	15.185	0.001	0.831	< 0.001	0.040
GH	55.00 (43.00, 66.00)	51.00 (40.00, 65.00)	40.00 (35.00, 56.00)	13.902	0.001	1.000	0.001	0.043
VT	60.00 (50.00, 70.00)	55.00 (45.00, 70.00)	55.00 (40.00, 65.00)	10.835	0.004	0.372	0.004	0.375
SF	62.50 (50.00, 75.00)	50.00 (50.00, 75.00)	50.00 (25.00, 62.50)	16.587	< 0.001	0.789	< 0.001	0.028
RE	66.67 (0.00, 100.00)	33.33 (0.00, 100.00)	33.33 (0.00, 66.67)	4.479	0.107	1	1	1
MH	68.00 (56.00, 80.00)	60.00 (52.00, 76.00)	60.00 (52.00, 72.00)	16.768	< 0.001	0.59	< 0.001	0.431

Quality of life among vocational rehabilitation patients with mild work-related disability and its association with return-to-work outcomes

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变量		原岗位复工组(n = 201)	新岗位复工组(n = 79)	未复工组(n = 63)
年龄/岁		40.43±9.70	39.97±10.17	42.22±11.20
性别/n	男	150	66	51
	女	51	13	12
学历/n	小学及以下	18	10	12
	初中~高中	128	65	45
	大专及以上	55	4	6
工种/n	行政及文职人员	28	5	8
	一线工人	113	56	36
	商业服务业人员	35	13	13
	专业技术人员	25	5	6
参保地/n	广州	153	62	48
	省直及其他地市	48	17	15
诊断/n	骨折	130	50	41
	手外伤	45	21	12
	关节及软组织损伤	19	5	6
	其他^a	7	3	4
职业康复时长/d		39.17±12.44	43.24±13.14	49.10±12.60
病程(入院时)/n	≤ 0.5年	77	30	15
	0.5~1年	72	27	28
	1年以上	52	22	20
病程(出院时)/n	≤ 0.5年	49	19	9
	0.5~1年	90	36	28
	1年以上	62	24	26
就业意愿/n	考虑前	43	16	29
	考虑	126	48	34
	准备	4	5	0
	行动	28	10	0
工作安置服务/n	现场安置^b	16	58	18
	远程安置^c	185	21	45
损失工作日/d		252(184.00,425.00)	275(192.00,451.00)	699(582.00,850.00)

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