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en studie av motivationens betydelse i rehabiliteringsprocessen för långvarigt sjukskrivna

Ulla Gerner

Stockholm, Socialhögskolan, 2002, 148 s. (Rapport i socialt arbete 105) ; ISBN 91-7265-492-9
Bogomtale fra forlaget.

The primary aim of the study was to illuminate the meaning of mo­ti­va­tion in the rehabilitation process against a background of increas­ing sick-listings and disability pensions during the 1990s. Since then, these figures have tended to rise still higher. The government authorities have commissioned many inquiries to overcome this prob­lem and have for many years attempted to identify various means of en­suring satis­fac­tory rehabilitation, but the results have been meagre.

The analytical perspective used in the study took into account both the individual’s micro-level the various individual factors and attitude towards rehabilitation and a macro-level, which considered the health in­surance scheme and its incentives, sick-listing by physicians, and any medicalisation for e.g. social problems.

To study motivation, two different questionnaires were designed. The first reflects the expectations that persons on the sick list may have prior to rehabilitation, while the other is based on a theoretical action model that attempts to illuminate the scope for action perceived by the individual as enabling him or her to return to work.

The empirical base of the study is a prospective cohort study of a number of individuals on the sick list whose progress was monitored by three surveys carried out over one year with follow-up after a fur­ther year. The response population consists of 185 subjects who re­sponded to the first questionnaire. The second questionnaire was an­swered by 151 persons and they formed the population that was ana­lysed more closely. In this population, women were over-represented, as were those who were over 40 and those with a low level of formal education. This result is well in accordance with the findings of other studies. Two thirds had returned to work at follow-up two years later. Over one third had not received vocationally oriented rehabilitation in any form, while 23% had received rehabilitation with a rehabilitation allowance and 41% had received some other form of vocational reha­bilitation. The men had more often received rehabilitation with a reha­bilitation allowance than the women, although there was otherwise no difference between the sexes.

The significance of the various independent variables for rehabilitation and a return to work was investigated in regression analy­ses. All ana­lyses showed a strong negative relationship between rehabili­tation and return to work. Those who had received rehabilita­tion had far fewer chances of returning to work than those who had not. Part of the explanation may be the strong relationship between poor health and re­ha­bilitation programmes and the fact that rehabilitation programmes had consequently tended to concentrate on the worst cases. Those in better health had managed to return to work without the assis­tance of the social insurance office.

The so-called action variables were also found to be of good predic­tive value both as an analysis per se and as included in a regression analysis in which other variables were also taken into account. Subjects who had assessed their potential for returning to work as great had in fact returned to work at follow-up, while those who deemed them­selves to have little potential had returned to work less frequently. In terms of expectations, the subjects expected to receive an exact diagnosis and attain an improvement in their physical performance, while their expectation of receiving a disability pension was low.

In conclusion, it was established that the questionnaires tested in the study could be used to advantage in the practical rehabilitation programmes organised by the insurance offices. Persons on sick leave would then become more involved in their own rehabilitation process and resources could be directed to areas in which they are needed.