Transitioning hospital care towards participation-integrated care Development, evaluation, and implementation of the back at work after surgery (BAAS) work-integrated pathway as an illustrative example

This thesis examines how hospital care can better support patients in returning to meaningful participation in society, using return to work after knee arthroplasty as an illustrative example. Traditional hospital outcomes such as complications, pain, mobility and implant survival provide only a partial view of recovery. For many patients, recovery also means resuming valued roles and activities, including work.
The Back At work After Surgery (BAAS) work-integrated pathway was developed to bridge the gap between medical care and occupational participation. BAAS is hospital-led and integrates work-related goal setting, functional assessment, occupational guidance, interdisciplinary coordination and structured follow-up into the perioperative pathway.
The studies in this thesis show that BAAS is feasible in routine care and improves return-to-work outcomes compared with usual care. Patients receiving BAAS returned to work earlier and more often, while the economic evaluation showed substantial benefits for both employers and society, mainly through reduced absenteeism. The thesis also identifies clinical, occupational and personal factors associated with return to work, including preoperative sick leave, physical work demands, patient expectations and physical activity patterns.
Together, these findings show that clinical recovery and participation recovery are not the same. Hospital care can extend beyond restoring physical function by also addressing whether patients are able to resume the roles and activities that matter in their daily lives.