Predictors of return-to-work in patients with chronic musculoskeletal pain: A randomized clinical trial
Randi Brendbekken, Arild Vaktskjold, Anette Harris, Tone Tangen
Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, NO-2312 Ottestad, Norway. E-mail: firstname.lastname@example.org
Objective: To assess the predictive effect of a multidisciplinary intervention programme, pain, work-related factors and health, including anxiety/depression and beliefs, on return-to-work for patients sick-listed due to musculoskeletal pain.
Design: A randomized clinical study.
Methods: A total of 284 patients were randomized to either a multidisciplinary intervention programme (n = 141) or to a less resource-demanding brief intervention (n = 143). Work participation was estimated monthly from register data for 12 months. Return-to-work was defined as increased work participation in 3 consecutive months.
Results: In the adjusted model, return-to-work by 3 months was associated with a multidisciplinary intervention programme (odds ratio (OR) = 2.7, 95% confidence interval (95% CI) = 1.1–6.9), the factor “belief that work was cause of the pain” (OR = 2.2, 95% CI = 1.1–4.3), anxiety and depression (OR = 0.5, 95% CI = 0.2–0.98), and by an interaction between the multidisciplinary intervention and perceived support at work (OR = 0.3, 95% CI = 0.1–0.9). At 12 months, only duration of sick leave was associated with return-to-work (OR = 0.6, 95% CI = 0.5–0.8).
Conclusion: Multidisciplinary intervention may hasten return-to-work and benefit those who perceive low support at work, but at 12 months only duration of sick leave at baseline was associated with return-to-work.
A novel, clinical intervention hastened the return-to-work (RTW) process in patients sick-leaved with chronic musculoskeletal pain. In this study we compared the effects on RTW of a novel, comprehensive treatment involving a physician, a social worker and a physiotherapist with the effects of a less resource demanding treatment involving a physician and a physiotherapist. The new approach had a particular focus at psychosocial factors and the work situation and applied a visual, educational communication tool. The new intervention was superior to the control intervention in promoting RTW at 3 months follow-up but not at 12 months. The new intervention is more costly, so further studies are needed before we can conclude if this approach should be recommended before the control intervention.