Can a workplace dialogue impact the perceived influence of neck and/or backpain on everyday activities and performance at work? A secondary analysis from the randomized controlled trial WorkUp

Background: Neck- and back- pain are highly prevalent conditions in Sweden and world-wide. Such pain often has consequences on everyday activities, work- and personal life. One consequence is work absence and decreased productivity at work. Adding a workplace dialogue to structured physiotherapy was recently found to lead to increased workability, i.e., not being on sick leave during the 12th month of follow up. Aim: The aim of the study was to explore the effect of a workplace dialogue intervention on secondary outcomes: perceived impact of neck and/or back pain on everyday activities and on performance at work, and total days of sick leave during 12 month follow up. A further aim was to examine associations between perceived influence of pain, and sick leave. Method: Patients with neck and/or back pain in primary care in the south of Sweden were randomized into structured physiotherapy alone (n = 206) or with the addition of a workplace dialogue (n = 146). Data regarding the pain’s influence on everyday activities and on performance at work were collected using weekly text messages for 52 weeks. The pattern of change in perceived influence of neck and/or back pain on everyday activities and performance at work was compared between the groups with linear mixed models. Cross sectional correlations between perceived influence of neck and/or back pain on everyday activities and performance at work, and days of sick leave, during the preceding four weeks at months 3, 6, 9 and 12 were examined. Result: We found no differences in change of perceived influence of neck and/or back pain on daily activities or perceived performance at work, or total days of sick leave during the 12 months of follow up between the groups with structured physiotherapy with or without a workplace dialogue. There was a weak to moderate positive correlation between days of sick leave and perceived influence of neck and/or back pain on everyday activities and performance at work (rho 0.28–0.47). Conclusion: A workplace dialogue was not found to affect the perceived impact of neck and/or back pain on everyday activities and performance at work. Trial registration: ClinicalTrials.gov ID: NCT02609750

Long-term effects on function, health-related quality of life and work ability after structured physiotherapy including a workplace intervention. : A secondary analysis of a randomised controlled trial (WorkUp) in primary care for patients with neck and/or back pain

Objective: To study the long-term effects of a workplace intervention in addition to structured physiotherapy regarding self-reported measures in patients with acute/subacute neck and/or back pain. Design: WorkUp – a cluster-randomised controlled trial in 32 primary care centers in Sweden, from January 2013 through December 2014 (ClinicalTrials.gov ID: NCT02609750). Intervention: Structured physiotherapy with the workplace dialogue ‘Convergence Dialogue Meeting’ (CDM), conducted by the treating physiotherapist as an add-on. Reference group received structured physiotherapy. Subjects: Adults, 18–67 years (mean 43.7, standard deviation (SD) 12.2), 65.3% women with acute/subacute neck and/or back pain who had worked ≥4 weeks past year, considered at risk of sick leave or were on short-term sick leave (≤60 days) were included (n = 352).Outcome measures: Self-reported function, functional rating index (FRI), health-related quality of life (EQ-5D-3L) and work ability (Work Ability Score, WAS) at 12 months follow-up. Results: The mean differences in outcomes between intervention and reference group were; −0.76 (95% confidence interval (CI): −2.39, 0.88; FRI), 0.02 (95% CI: −0.04, 0.08; EQ-5D-3L) and −0.05 (95% CI: −0.63, 0.53; WAS). From baseline to 12 months, the intervention group improved function from 46.5 (SD 19.7) to 10.5 (SD 7.3) on FRI; health-related quality of life from 0.53 (SD 0.29) to 0.74 (SD 0.20) on EQ-5D and work ability from 5.7 (SD 2.6) to 7.6 (SD 2.1) on WAS. Conclusion: Despite a clinically relevant improvement over time, there were no significant differences in improvement between groups, thus we conclude that CDM had no effect on self-reported measures in this study

Referring to multimodal rehabilitation for patients with musculoskeletal disorders - a register study in primary health care

BACKGROUND: In 2008, the Swedish government introduced a National Rehabilitation Program, in which the government financially reimburses the county councils for evidence-based multimodal rehabilitation (MMR) interventions. The target group is patients of working age with musculoskeletal disorders (MSD), expected to return to work or remain at work after rehabilitation. Much attention in the evaluations has been on patient outcomes and on processes. We lack knowledge about how factors related to health care providers and community can have an impact on how patients have access to MMR. The aim of this study was therefore to study the impact of health care provider and community related factors on referrals to MMR in patients with MSD applying for health care in primary health care.METHODS: This was a primary health care-based cohort study based on prospectively ascertained register data. All primary health care centres (PHCC) contracted in Region Skåne in 2010-2012, referring to MMR were included (n = 153). The health care provider factors studied were: community size, PHCC size, public or private PHCC, whether or not the PHCCs provided their own MMR, burden of illness and the community socioeconomic status among the registered population at the PHCCs. The results are presented with descriptive statistics and for the analysis, non-parametric and multiple linear regression analyses were applied.RESULTS: PHCCs located in larger communities sent more referrals/1000 registered population (p = 0.020). Private PHCCs sent more referrals/1000 registered population compared to public units (p = 0.035). Factors related to more MMR referrals/1000 registered population in the multiple regression analyses were PHCCs located in medium and large communities and with above average socioeconomic status among the registered population at the PHCCs, private PHCC and PHCCs providing their own MMR. The explanation degree for the final model was 24.5%.CONCLUSIONS: We found that referral rates to MMR were positively associated with PHCCs located in medium and large sized communities with higher socioeconomic status among the registered population, private PHCCs and PHCCs providing their own MMR. Patients with MSD are thus facing significant inequities and were thus not offered the same opportunities for referrals to rehabilitation regardless of which PHCC they visited

"Blue flags", development of a short clinical questionnaire on work-related psychosocial risk factors : A validation study in primary care

Background: Working conditions substantially influence health, work ability and sick leave. Useful instruments to help clinicians pay attention to working conditions are lacking in primary care (PC). The aim of this study was to test the validity of a short "Blue flags" questionnaire, which focuses on work-related psychosocial risk factors and any potential need for contacts and/or actions at the workplace. Methods: From the original"The General Nordic Questionnaire" (QPSNordic) the research group identified five content areas with a total of 51 items which were considered to be most relevant focusing on work-related psychosocial risk factors. Fourteen items were selected from the identified QPSNordic content areas and organised in a short questionnaire "Blue flags". These 14 items were validated towards the 51 QPSNordic items. Content validity was reviewed by a professional panel and a patient panel. Structural and concurrent validity were also tested within a randomised clinical trial. Results: The two panels (n = 111) considered the 14 psychosocial items to be relevant. A four-factor model was extracted with an explained variance of 25.2%, 14.9%, 10.9% and 8.3% respectively. All 14 items showed satisfactory loadings on all factors. Concerning concurrent validity the overall correlation was very strong rs = 0.87 (p &lt; 0.001).). Correlations were moderately strong for factor one, rs = 0.62 (p &lt; 0.001) and factor two, rs = 0.74 (p &lt; 0.001). Factor three and factor four were weaker, bur still fair and significant at rs = 0.53 (p &lt; 0.001) and rs = 0.41 (p &lt; 0.001) respectively. The internal consistency of the whole "Blue flags" was good with Cronbach's alpha of 0.76. Conclusions: The content, structural and concurrent validity were satisfactory in this first step of development of the "Blue flags" questionnaire. In summary, the overall validity is considered acceptable. Testing in clinical contexts and in other patient populations is recommended to ensure predictive validity and usefulness.Validerad; 2017; Nivå 2; 2017-08-15 (andbra)</p

Evaluation of a multimodal pain rehabilitation programme in primary care based on clinical register data: a feasibility study

Aim: Investigate the feasibility of identifying a well-defined treatment group and a comparable reference group in clinical register data. Background: There is insufficient knowledge on how to avert neck/back pain from turning chronic or to impair work ability. The Swedish Government implemented a national multimodal rehabilitation (MMR) programme in primary care intending to promote work ability, reduce sick leave and increase return to work. Since randomised control trial data for effect is lacking, it is important to evaluate existing observational data from clinical settings. Methods: We identified all unique patients with musculoskeletal pain (MSP) diagnoses undergoing the MMR programme in primary care in the Skåne Health care Register (n = 2140) during 2010–2011. A reference cohort in primary care (n = 56 300) with similar MSP diagnoses, same ages and the same level of sick leave before baseline was identified for the same period. The reference cohort received ordinary care and treatment in primary care. The final study group consisted of 603 eligible MMR patients and 2874 eligible reference patients. Socio-economic and health-related baseline data including sick leave one year before up to two years after baseline were compared between groups. Findings: There were significant socio-economic and health differences at baseline between the MMR and the reference patients, with the MMR group having lower income, higher morbidity and more sick leave days. Sick leave days per year decreased significantly in the MMR group (118–102 days, P < 0.001) and in the reference group (50–42 days, P < 0.001) from one year before baseline to two years after. Conclusions: It was not feasible to identify a comparable reference group based on clinical register data. Despite an ambitious attempt to limit selection bias, significant baseline differences in socio-economic and health were present. In absence of randomised trials, effects of MMR cannot be sufficiently evaluated in primary care