How one question can provide knowledge about the path back to work

Physiotherapist Mari Nilsen Skinnes defended her doctoral thesis on November 13 at the Faculty of Medicine, University of Oslo. In her thesis Work ability and work participation in rehabilitation, she investigated work ability and work participation in rehabilitation. 

– Our findings show that patients' own assessment of their ability to work can provide important knowledge about who may need more support to be able to stay in work, says Skinnes. 

Work ability improved throughout the year 

The doctoral work is part of RehabNytte, a large Norwegian research project with 17 rehabilitation institutions. The studies on work include data from around 2,700 adults of working age. Around 42 percent had rheumatic diseases or musculoskeletal diseases. 

The researchers followed the patients' own assessment of their ability to work. They linked the responses to data from Nav on sick leave, work assessment benefits (AAP) and disability benefits. 

In the first study, they examined how the patients themselves experienced their ability to work during the year after rehabilitation began.  

Participants were given a simple question: “Suppose your work ability at its best has been rated 10. What number would you give your current work ability today?” They were asked to answer on a scale from zero to ten. Zero means that you cannot work, while ten is the best work ability you have ever had. 

When patients started rehabilitation, the average self-rated work ability was 3.53. After 12 months, it had increased to 4.59. 
 
How the participants assessed their own health also mattered. Those who experienced good health at the start more often had high work ability one year later. More health complaints and pain were associated with lower work ability. 

– Work ability is about more than what diagnosis you have. The results show that both pain, other health complaints and how one experiences one's own health are related to work ability. If we are to help more people stay in work, we must look at the whole person and not just the disease, says Skinnes. 

What happens to work participation? 

Experiencing improved work ability is not necessarily the same as being back at work. Therefore, Skinnes and colleagues also investigated how the use of health-related Nav benefits developed before, during and after rehabilitation. 
 
The researchers compared the participants with a control group of 37,760 people. In the analysis, they took into account, among other things, age, gender and previous use of Nav benefits. 

The participants who received rehabilitation used more of these benefits overall than the control group throughout the period. In the year after rehabilitation, they had an average of 0.6 fewer sick leave days per month than the control group. They also had more days of work-related disability benefits and disability insurance. 

– This should not be interpreted as meaning that rehabilitation leads to more people dropping out of the workforce. Those who are referred to rehabilitation often have complex and long-term health challenges. Although we have tried to make the groups comparable, we cannot rule out that there are differences between them that affect the results, explains Skinnes. 

One question may indicate a need for follow-up 

In the third study, the researchers investigated whether patients' own assessment of their ability to work was related to later use of Nav benefits. 

Here they found that participants who rated their work ability as higher had, on average, fewer days of work assessment benefits and disability benefits the following year. 

One point higher on the work ability scale, three months after the rehabilitation started, was associated with 9.5 fewer days of work assessment benefits and five fewer days of disability benefits the following year. The same pattern emerged when work ability was measured after twelve months. 

The connections were still there even after the researchers took into account health, previous work ability and use of Nav benefits. 

– The interesting thing is that such a simple question can give us information about how patients may fare later. It takes very little time to ask the question, but the answer can be a good starting point for talking about work ability and the need for further follow-up, says Skinnes. 

– I hope the results can help us become better at identifying patients who need extra support. We should not only be concerned with how the patient functions during rehabilitation, but also with how things go in the time afterwards. This is when many will find their way back to an everyday life where work is part of life. 

From clinical experience to research 

Skinnes is a physiotherapist and holds a master's degree in interdisciplinary health research from the University of Oslo. She has worked with rehabilitation at Vikersund Bad Rehabilitation Center, where she has been employed throughout her doctoral studies. During her master's studies, she also worked for a short period as a research coordinator at Diakonhjemmet Hospital. In 2022, she returned to complete her doctoral studies. 

“I became curious about what happens to the patients when their rehabilitation stay is over. It is important to know whether they are able to use what they have learned, and whether they feel they have the opportunity to participate in working life,” she says. 

The work on the doctoral degree has taken place at Diakonhjemmet Hospital and the research center REMEDY.  

– It has been educational to be part of a research environment with so much expertise in rehabilitation. I have worked with people with different professional backgrounds. It has given me new perspectives on how we can understand and investigate what good rehabilitation is. 

Wants research to benefit patients 

The research through the doctoral degree provides new knowledge about rehabilitation.

The path back to work can be challenging for people with long-term health problems. Health, pain, function and previous employment can all be important. Therefore, rehabilitation should not be assessed based on a single goal. 

– If I were to wish for one change, it would be that we follow up work ability more closely even after rehabilitation. Many people have health challenges that last a long time, and then it is not certain that a rehabilitation stay alone is enough. We need more knowledge about what kind of follow-up actually helps people to be in work over time, says Skinnes. 

After she submitted her thesis, Skinnes returned to her job at Vikersund Bad Rehabilitation Center. 

– It is curiosity and the desire to research and learn something new that has led me here, to a doctorate. So we'll see what happens next, says Skinnes. 

About the doctorate 

Doctor: Mari Nilsen Skinnes

Dissertation: November 13, 2026

Degree: Philosophiae doctor (PhD)

Dissertation: Work ability and work participation in rehabilitation

Institution: University of Oslo, Faculty of Medicine, Department of Clinical Medicine

Research environment: Diakonhjemmet Hospital and the research center REMEDY

User contributors: Anne Elisabeth Simonsen and Andreas Habberstad 

Supervisors: Rikke Helene Moe (main supervisor), Till Uhlig, Thomas Johansen and Nina Østerås 

Funding: The project has received support from the Dam Foundation through the Norwegian Association of Disabled Persons. 

Sample lecture: Beyond discharge: How should patients be followed after multidisciplinary rehabilitation to maintain and further improve functioning, self-management and work participation. 

Rehabilitation institutions in the research project RehabNytte

Cato Center, Evje Clinic, Health Partner Rehabilitation, Hernes Institute, HLF Briskeby, Montebellosenteret, Muritunet, NKS Health Center, Ravneberghaugen, Red Cross Haugland Rehabilitation Center, Røysumtunet, Selli Rehabilitation Center, Skogli Rehabilitation Center, Sørlandet Rehabilitation Center, Viker Health, Vikersund Rehabilitation Center and Åstveit Health Center and Virke Rehabilitation Research and Development.