Sickness certificates: what information do they provide about rehabilitation?

To investigate whether patients are prescribed rehabilitation early in a new sick leave period, and whether this prescription is associated with sex, age, diagnosis, description of functioning and affiliation of certifying physician.

A cross-sectional study using data from sickness certificates issued during a total sick leave period, collected consecutively during 2 weeks in 2007 in Östergötland County, Sweden. Rehabilitation prescribed in the first certificate or within 28 days after the start of sick leave was defined as early rehabilitation.

Musculoskeletal diseases (MSD) were the largest diagnostic group, followed by mental disorders (MD). The mean duration of sick leave was 94 days (SD 139), longest for MD patients. Early rehabilitation was prescribed in 27% of all certificates and in 45% of certificates for MSD and MD diagnoses. Logistic regression analysis indicated that prescription of early rehabilitation was associated with certificates issued for MSD and MD, youngest patients, and certificates issued by primary health care physicians. The final model explained 29% of variation in the prescription of early rehabilitation.

There is a modest prescription of early rehabilitation in sickness certificates, based on younger age and MSD or MD diagnosis. This indicates that patients' rehabilitation needs may not have been identified.

Sickness certificates are the decision basis for entitlement to sickness benefits and return to work (RTW) measures conveyed between the health care, the social insurance office and employers. Sickness certificates were found to provide modest information about early rehabilitation and RTW measures, indicating that patients' rehabilitation needs may not have been identified. As a communication tool, this scarce information might have implications for the patient regarding RTW measures or work modifications.