Multidisciplinary intervention in patients with musculoskeletal pain: a randomized clinical trial

Background Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive. Purpose The purpose of this study is to compare a multidisciplinary intervention (MI), including use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), with a brief intervention (BI), on effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain. Method Two hundred eighty-four adults aged 18–60, referred to a specialist clinic in physical rehabilitation, were randomized to MI or BI. Patients received a medical examination at baseline and completed a comprehensive questionnaire at baseline, 3 months and 12 months. Results Both groups reported improvements in mental and physical symptoms, including pain, and improved functioning ability at 3 and 12 months, but the MI group improved faster than the BI group except from reports of pain, which had a similar course. Significant interactions between group and time were found on mental symptoms (anxiety (p < 0.05), depression (p < 0.01), somatization (p < 0.01)) and functioning ability (p < 0.01) due to stronger effects in the MI group at 3 months. At 3 and 12 months, the MI group reported significantly less use of health services (general practitioner (p < 0.05)). At 12 months, the MI group reported better self-evaluated capability of coping with complaints (p < 0.001) and they took better care of their own health (p < 0.001), compared to the BI group. Conclusion The results indicate that the MI may represent an important supplement in the treatment of musculoskeletal pain.publishedVersio

Return to work in patients with chronic musculoskeletal pain: multidisciplinary intervention versus brief intervention: a randomized clinical trial

Objective: This randomized clinical trial was performed to compare the effect of a new multidisciplinary intervention (MI) programme to a brief intervention (BI) programme on return to work (RTW), fully and partly, at a 12-month and 24-month follow-up in patients on long-term sick leave due to musculoskeletal pain. Methods: Patients (n = 284, mean age 41.3 years, 53.9 % women) who were sick-listed with musculoskeletal pain and referred to a specialist clinic in physical rehabilitation were randomized to MI (n = 141) or BI (n = 143). The MI included the use of a visual educational tool, which facilitated patienttherapist communication and self-management. The MI also applied one more profession, more therapist time and a comprehensive focus on the psychosocial factors, particularly the working conditions, compared to a BI. The main features of the latter are a thorough medical, educational examination, a brief cognitive assessment based on the non-injury model, and a recommendation to return to normal activity as soon as possible. Results: The number of patients with full-time RTW developed similarly in the two groups. The patients receiving MI had a higher probability to partly RTW during the first 7 months of the follow-up compared to the BI-group. Conclusions: There were no differences between the groups on full-time RTW during the 24 months. However, the results indicate that MI hastens the return to work process in long-term sick leave through the increased use of partial sick leave. Trial Registration: http://www.clinicaltrials.gov with the registration number NCT01346423.publishedVersio

Multidisciplinary intervention versus brief intervention in specialist healthcare. Attempting to improve outcomes for patients on sick leave with musculoskeletal pain

Background: Musculoskeletal pain (MSK), such as low back pain (LBP), neck pain and widespread pain, is among the most common health problems in industrial countries. Subsequently, MSK is associated with substantial healthcare utilization and a leading cause of sick leave and work disability. The impact on individuals, families and working life is substantial and the societal costs are huge. Most patients have MSK with few or no objective findings. Psychosocial factors are of the most important predictors for long-term disability from MSK and subsequently different multidisciplinary treatment models (MDIs) have evolved over recent last decades. As part of this PhD project, a multidisciplinary intervention (MI) was developed, primarily aimed at a quicker return to work (RTW) for MSK patients. The MI involved a particular focus on work and psychosocial factors in addition to the somatic complaints and included strengthened patient education (PE) and communication in treatment. The MI was tested against the more established brief intervention (BI), which is mainly focused on musculoskeletal complaints. Aims: The main purpose was to clarify whether MI can improve RTW rates within two years over BI in patients on sick leave due to MSK. Secondly, we aimed at identifying predictors for sustainable RTW (s-RTW) and compared patient health, functional ability and coping between groups during 12 months of follow-up. Methods: A randomized controlled trial (RCT) was performed with MI and BI as equally sized intervention groups. Patients were referred to specialist healthcare by their general practitioners (GPs) and on sick leave for a maximum of 12 months with MSK. BI is based on the non-injury model (NIM), a non-directive communication and PE approach, and involves a physician and a physiotherapist in the treatment team. Patients in the BI group met twice at the outpatient clinic: at baseline and at the twoweek follow-up stage. The MI was more comprehensive, involved the use of a novel educational communication tool, and focused particularly on psychosocial and workrelated factors. The MI was administered by a physician, a social worker and a physiotherapist on the treatment team, and the patients met three times in the outpatient clinic, at baseline, after two weeks and after three months. Data on work participation and sickness benefits were derived from the social insurance register, providing 100% response rate on follow-up data. Questionnaires to identify demographic and clinical variables were filled out by both groups at baseline, and at the three and 12-month follow-ups. Results: Out of 534 patients referred by GPs, 284 patients (mean age=41.3 years, 53.9% women) were included and randomized to MI (n=141) and BI (n=143). The mean duration of sickness absence at baseline was 147 days. The treatment drop-out rate was low in both groups (MI: n=7, BI: n=15), indicating that both methods were feasible in a clinical setting. The results showed that MI hastened the RTW process through increased use of partial sick leave (PSL) in the first seven months of the study. At 12 months, there were no differences between groups in terms of either full RTW (f-RTW) (45%: both groups) or partial RTW (p-RTW) (MI=14%, BI=10%). The corresponding numbers at 24 months were: f-RTW: MI=43%, BI=37%, p-RTW: MI=13%, BI=6%. The MI predicted s-RTW, defined as increased work participation, compared to the baseline, for three consecutive months, at the three-month follow-up (OR=2.4), and the subgroup of patients who reported to have low support at work benefitted more from MI than BI. The belief that work was the cause of the pain predicted s-RTW at three months irrespective of the intervention. Anxiety/depression and duration of sick leave at baseline were risk factors for an s-RTW. Secondly, the MI hastened improvements in some of the clinical outcomes: anxiety, depression, somatization and physical functioning. Levels of pain and subjective health complaints (SHCs) followed the same course in the two groups. The MI group used fewer healthcare services in terms of consulting a GP, at both the three and 12-month follow-ups, as well as reported significantly better perceived coping, physical fitness and satisfaction with treatment than the BI group at 12 months. Conclusion: An MI with a particular focus on work, psychosocial factors, PE and communication in therapy could speed up the RTW process and the process of improving from mental health complaints and physical functioning among workers on sick leave with MSK, compared to the effects of a BI. Patients receiving MI are more satisfied with treatment, report improved physical fitness and being able to cope with health complaints, and make lesser use of healthcare services, which could also confirm improved coping. Earlier reconnection with working life could be important, as the length of sick leave is a risk factor for RTW. The reported sense of improved coping in the MI group could be associated with a successful earlier reconnection with work or to faster improvements in clinical outcomes. It may also relate to the strengthened educational process and patient involvement in the MI, which can improve patient adherence to treatment and thereby improve a sense of coping. However, results so far do not advocate recommending MI before BI to patients on long-term sick leave with MSK, as effect sizes in this study are small to modest and BI performs equally well in the long run for most outcomes. Results should be further improved and cost-benefit analyses should be part of future studies. The identification of subgroups of patients who might benefit more from comprehensive treatment is another future challenge

Predictors of return to work in patients on sick leave with chronic musculoskeletal pain

Objective: To assess the predictive effect of a multidisciplinary intervention programme, pain, workrelated 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 returnto-work

Predictors of return to work in patients on sick leave with chronic musculoskeletal pain

Objective: To assess the predictive effect of a multidisciplinary intervention programme, pain, workrelated 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 returnto-work

Multidisciplinary Intervention in Patients with Musculoskeletal Pain: a Randomized Clinical Trial

Abstract BACKGROUND: Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive. PURPOSE: The purpose of this study is to compare a multidisciplinary intervention (MI), including use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), with a brief intervention (BI), on effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain. METHOD: Two hundred eighty-four adults aged 18-60, referred to a specialist clinic in physical rehabilitation, were randomized to MI or BI. Patients received a medical examination at baseline and completed a comprehensive questionnaire at baseline, 3 months and 12 months. RESULTS: Both groups reported improvements in mental and physical symptoms, including pain, and improved functioning ability at 3 and 12 months, but the MI group improved faster than the BI group except from reports of pain, which had a similar course. Significant interactions between group and time were found on mental symptoms (anxiety (p < 0.05), depression (p < 0.01), somatization (p < 0.01)) and functioning ability (p < 0.01) due to stronger effects in the MI group at 3 months. At 3 and 12 months, the MI group reported significantly less use of health services (general practitioner (p < 0.05)). At 12 months, the MI group reported better self-evaluated capability of coping with complaints (p < 0.001) and they took better care of their own health (p < 0.001), compared to the BI group. CONCLUSION: The results indicate that the MI may represent an important supplement in the treatment of musculoskeletal pain.Innlandet Hospital Trust (Norway) funded the study.publishedVersio

Return to work in patients with chronic musculoskeletal pain: multidisciplinary intervention versus brief intervention: a randomized clinical trial

Objective: This randomized clinical trial was performed to compare the effect of a new multidisciplinary intervention (MI) programme to a brief intervention (BI) programme on return to work (RTW), fully and partly, at a 12-month and 24-month follow-up in patients on long-term sick leave due to musculoskeletal pain. Methods: Patients (n = 284, mean age 41.3 years, 53.9 % women) who were sick-listed with musculoskeletal pain and referred to a specialist clinic in physical rehabilitation were randomized to MI (n = 141) or BI (n = 143). The MI included the use of a visual educational tool, which facilitated patienttherapist communication and self-management. The MI also applied one more profession, more therapist time and a comprehensive focus on the psychosocial factors, particularly the working conditions, compared to a BI. The main features of the latter are a thorough medical, educational examination, a brief cognitive assessment based on the non-injury model, and a recommendation to return to normal activity as soon as possible. Results: The number of patients with full-time RTW developed similarly in the two groups. The patients receiving MI had a higher probability to partly RTW during the first 7 months of the follow-up compared to the BI-group. Conclusions: There were no differences between the groups on full-time RTW during the 24 months. However, the results indicate that MI hastens the return to work process in long-term sick leave through the increased use of partial sick leave. Trial Registration: http://www.clinicaltrials.gov with the registration number NCT01346423