Outcome of an 8-week multiprofessional work-related rehabilitation programme for patients suffering from persistent musculoskeletal-related pain

Abstract

The prevalence of persistent pain is estimated to be 40-50 % in a normal population. Musculoskeletal-related pain represents the main part of persistent pain with a reported prevalence of about 38 % for women and 31 % for men. This has led to more people on long-term sick-leave, increased amount of early retirements and to rising social costs. Patients suffering from persistent musculoskeletal-related pain were offered an 8-week multiprofessional work-related rehabilitation programme at the Pain Unit at the Department of Rehabilitation Medicine, Huddinge University Hospital. The objectives were: 1) Return-to-work 2) Increased activity level 3) Reduced pain intensity.

The main objective of the studies reported in this thesis was to evaluate the programme at follow-ups at 1, 3 and 6 years. Further aims were to find predictors for those patients who would gain most from the programme and whether immigrants had more difficulties to reach the objectives than nonimmigrants. An economic analysis was carried out to evaluate whether the programme was cost effective or not.

Sixty-seven patients enrolled in the programme were analysed after 1 and 3 years and another 122 patients after 6 years. The socioeconomic cost of the programme was analysed at the one-year followup. The multiprofessional rehabilitation team evaluated impairment and disability (IDEA) to assess possible work ability. The patients' own perceptions of returning to work were evaluated. The return-to-work rate was also evaluated using the modified somatic perception questionnaire (MSPQ) and the disability rating index (DRI) before the clients entered the programme. For comparison, a group of patients completed an evaluation but were not referred to a work-related multiprofessional rehabilitation programme.

At the one-year follow up, 63 % of the patients had returned to work or were in work-related activities. There was a positive, statistically significant correlation (p< 0.01) between the IDEA and the actual return-to-work rate. The results on MSPQ or DRI, the patients' own perceptions of returning to work, the pain intensity, age or the period of time out of work did not predict the return-to-work ability. It was not possible to predict the return-to-work rate at an individual level but it was possible at group level. At the 3-year follow up 50 % of the patients were working and at the 6-year follow up 52% had returned to work (p <0.001). In the control group 13 % had returned to work (p <0.001). There was a statistically significant higher level of activity (p =0.037), pain reduction was experienced by 51% of the patients (p <0.001) and 47% of the patients had decreased their consumption of analgesics (p <0.001). There was no significant difference in the return-to-work rate between immigrants and native Swedes. However, the patients' prediction of the ability to return to work was higher among the nonimmigrants. The level of activity was lower, and the pain intensity and use of analgesics higher, among the immigrants than among the non-immigrants.

Investigation of the cost effectiveness showed that the successful patients had to work between 6 and 8 months for the benefits to just outweigh the costs. After having worked for 6-8 months, their contribution in terms of increased production had paid not only for their own rehabilitation but also for that of those who did not return to work. Thus the rehabilitation programme was estimated to be economically beneficial within a year of the successfully rehabilitated patient's return to work. After three years, the gain had increased to more than five times the running cost. After six years the economic benefit for society will be at least ten times the running cost.

In conclusion, the results of this work support the hypotheses that within a structured, multiprofessional, rehabilitation programme the majority of the patients on long term sick-leave and suffering from persistent musculoskeletal-related pain can gain and can return to work and remain at work, despite their pain. It demonstrates that it is not too late to achieve good results even if the patients have been on sick-leave for months or years. The programme was as effective, concerning the return-to-work rate, for immigrants as for non-immigrants. In economic terms, the rehabilitation programme paid off within a year after the successfully rehabilitated patients returned to work and after that would generate substantial net economic gains for society and this included the rehabilitation costs for the patients who did not return to work.