¹Amsterdam UMC, locatie AMC, Amsterdam, Netherlands
²Nij Smellinghe hospital, Drachten, Netherlands
³Nij Smellinghe Ziekenhuis, Drachten, Netherlands
⁴Elabo bv, Amersfoort, Netherlands
⁵UMCG Beatrixoord, Haren, Netherlands
⁶Maastricht UMC+, Maastricht, Netherlands

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Background: 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 usual care in the Netherlands.

Method: In this multicenter controlled study of matching cohorts, working patients who had primary KA were included. Patients in two Dutch hospitals (BAAS cohort, n=145) 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 separate control cohorts (Expect TO work: n=179; ACTIVE: n=133) from 15 hospitals/clinics received usual care. Primary outcomes were time to first day of RTW and time to full RTW within 12 months. IPTW 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 76% 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; p=0.01). The odds of full RTW at 12 months were higher in the BAAS cohort compared to Expect TO work, namely odds ratio (OR) 3.9 (CI:1.2-12.9) and ACTIVE OR 9.3 (CI:2.9-29.7).

Discussion: BAAS shifts the focus from symptom relief to meaningful recovery by enabling earlier and more successful work participation. The observed effects exceed MCID thresholds. Even without randomization, the real-world setting, strong methodology, and high implementation feasibility make BAAS a promising model for value-based perioperative care.

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

References

[1] Strijbos DO, van der Sluis G, van Houtert WFC, Straat AC, van Zaanen Y, de Groot S, Klomp S, Krijnen WP, Kooijman CM, van den Brand I, Reneman MF, Boymans TAEJ, Kuijer PPFM. Protocol for a multicenter study on effectiveness and economics of the Back At work After Surgery (BAAS): a clinical pathway for knee arthroplasty. BMC Musculoskelet Disord. 2023 Mar 16;24(1):199. DOI: 10.1186/s12891-023-06203-5