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The effects of multimodal rehabilitation on pain-related sickness absence: an observational study
Public Health Agency of Sweden, Stockholm, Sweden.
Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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2018 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 14, p. 1646-1653Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of the current study was to examine the effects on sickness absence of multimodal rehabilitation delivered within the framework of a national implementation of evidence based rehabilitation, the rehabilitation guarantee for nonspecific musculoskeletal pain.

Method: This was an observational matched controlled study of all persons receiving multimodal rehabilitation from the last quarter of 2009 until the end of 2010. The matching was based on age, sex, sickness absence the quarter before intervention start and pain-related diagnosis. The participants were followed by register data for 6 or 12 months. The matched controls received rehabilitation in accordance with treatment-as-usual.

Results: Of the participants, 54% (N = 3636) were on registered sickness absence at baseline and the quarter before rehabilitation. The average difference in number of days of sickness absence between the participants who received multimodal rehabilitation and the matched controls was to the advantage of the matched controls, 14.7 days (CI 11.7; 17.7, p ≤ 0.001) at 6-month follow-up and 9.5 days (CI 6.7; 12.3, p ≤ 0.001) at 12-month follow-up. A significant difference in newly granted disability pensions was found in favor of the intervention.

Conclusions: When implemented nationwide, multimodal rehabilitation appears not to reduce sickness absence compared to treatment-as-usual.

Implications for Rehabilitation

  • A nationwide implementation of multimodal rehabilitation was not effective in reducing sickness absence compared to treatment-as-usual for persons with nonspecific musculoskeletal pain.

  • Multimodal rehabilitation was effective in reducing the risk of future disability pension for persons with nonspecific musculoskeletal pain compared to treatment-as-usual.

  • To be effective in reducing sick leave multimodal rehabilitation must be started within 60 days of sick leave.

  • The evidence for positive effect of multimodal rehabilitation is mainly for sick listed patients. Prevention of sick leave for persons not being on sick leave should not be extrapolated from evidence for multimodal rehabilitation.

Place, publisher, year, edition, pages
Taylor & Francis, 2018. Vol. 40, no 14, p. 1646-1653
Keywords [en]
Multimodal rehabilitation, observational study, sick leave
National Category
Occupational Health and Environmental Health
Identifiers
URN: urn:nbn:se:oru:diva-66159DOI: 10.1080/09638288.2017.1305456ISI: 000428516800005PubMedID: 28345360Scopus ID: 2-s2.0-85016110515OAI: oai:DiVA.org:oru-66159DiVA, id: diva2:1193376
Available from: 2018-03-26 Created: 2018-03-26 Last updated: 2018-09-05Bibliographically approved

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