Defining and predicting outcomes of a work-injuries rehabilitation program through multivariate baseline phenotypes and longitudinal modeling

To characterize short-term pain and health-related quality-of-life (HRQoL) recovery trajectories in injured workers undergoing standardized musculoskeletal rehabilitation. We also examined whether multidimensional baseline phenotypes derived from brief self-report measures predicted these trajectories and subsequent recovery.

Adults with work-related musculoskeletal injuries were enrolled at entry into a community-based rehabilitation program (N = 146), of whom 134 contributed to pain and 138 to HRQoL trajectory analyses. Participants were classified into one of 4 latent profiles at intake from a prior analysis: Localized/Resilient (57.0%), Mood-Dominant (21.8%), Neurosensory-Dominant (12.7%), and Complex/Central (8.5%). Pain (Numeric Pain Rating Scale, NPRS) and HRQoL (EQ-5D-5L index) were measured at baseline, 4, and 8 weeks; self-rated global recovery, self-reported return-to-work status, and administrative discharge/ongoing-care codes were collected at 8 weeks. Growth mixture modeling defined NPRS and EQ-5D-5L trajectories. Odds ratios (ORs) quantified associations between baseline classes and "No Recovery/No Improvement" trajectories, as well as point outcomes.

Three pain trajectories (Rapid Recovery 34.1%, Incomplete Recovery 42.2%, No Recovery 23.7%) and two QoL trajectories (Good QoL 86.2%, No Improvement 13.8%) were identified. Compared with the Localized/Resilient baseline class, odds of NPRS No Recovery were higher in the Mood-Dominant (OR 3.97, 95%CI 1.32-11.92), Neurosensory‑Dominant (OR 10.99, 3.20-37.38), and Complex, Central (OR 22.67, 4.76-107.90) classes, with similarly graded increases for EQ‑5D‑5L No Recovery (ORs 9.00, 7.50, and 150.00, respectively), although estimates for the small Complex/Central subgroup were imprecise. The Complex /Central class also had higher odds of self-reported "not fully returned to work" (OR 4.18, 1.05-16.64) and being coded as "requires ongoing care" (OR 5.74, 1.93-17.11) relative to Localized/Resilient, whereas self-rated global recovery showed no significant between-class differences.

Brief, fully self-reported, multivariate phenotypes obtained at program entry stratify acutely injured workers into likely rehabilitation outcomes in the short term. These findings support the potential value of integrating mechanism-informed phenotyping with trajectory modeling to inform stratified, risk-guided musculoskeletal rehabilitation.