A Cross-Provider Healthcare Management Program for Musculoskeletal Disorders: Results of a Randomized Controlled Trial in 22 German Companies

Abstract

Musculoskeletal disorders (MSDs) are among the most common cause for reduced work capacity and sick leave. Workplace health promotion programs are often neither tailored to the workplace nor the individual needs of the employees. To counteract lacking intersectional care, this four-year randomized controlled trial (RCT) aimed to investigate the effects of modular coordinating case management (treatment group) compared to supported self-management (control group) on MSD specific sick leave days (routine data), workability (WAI), self-efficacy (self-efficacy scale), and pain (German pain questionnaire, GPQ). The study network comprised 22 companies, 15 company health insurance funds, and 12 pension funds in Germany. Overall, 852 participants (Module A/early intervention: n = 651, Module B/rehabilitation: n = 190, Module C/reintegration: n = 10) participated. Both groups achieved fewer sick leave days, higher workability, and less pain (p < 0.0001) at follow-up compared to baseline. At follow-up, the coordinating case management group showed fewer disability days (GPQ), lower disability scores (GPQ), and lower pain intensities (GPQ) than the supported self-management group (p < 0.05), but no superiority regarding MSD specific sick leave days, workability, nor self-efficacy. Module A showed more comprehensive differences. The accompanying process evaluation shows barriers and facilitators for the implementation of the program, especially in a RCT setting.

The Role of Psychological Wellbeing in a Cross-Provider Worksite Healthcare Management Program for Employees with Musculoskeletal Disorders

“…In Module A, the case management group had superior performance compared to the self-management group, as the case management group had fewer disability days, lower disability scores, lower pain intensity, higher self-efficacy values, and higher work ability at t1 than the self-management group. However, changes over time were significant not only in the case management group but also in the self -management group for disability days, disability scores, and work ability (see [19]). The results of this study supplement the original study results [19] by providing orientation for future adaption of Module A's case management intervention.…”

“…The program was part of a broader randomized controlled trial (RCT) that was conducted from April 2017 to March 2021. Twenty-two German companies (mainly steel and metal manufacturing, automotive industry, and trade and service), 12 pension funds, and 15 company health insurance funds were part of the study network [19]. The RCT included two study arms-the case management group (intervention group) and self-management group (control group)-and three modules in each study arm-module A, module B, and module C (see Figure 1).…”

“…Participants in the case management group received thorough work-related diagnostics and support from the case managers of the company's health insurance funds. Treatment in the self-management group was oriented towards standard care, as participants received tailored information on their possibilities in regular health care [19]. Participants were recruited from August 2017 to February 2020 in 22 study centers in Germany.…”

“…Before participants were randomly assigned to one of the two study arms by case managers, company doctors and case managers decided which of the three modules would fit the employees' needs most. Case managers were responsible for obtaining written informed consent [19].…”

“…Most participants in this study sample worked in the industrial sector (87.2%) with predominantly mental (47.2%) or equally mental and physical (35.0%) work tasks. For further information on the study sample, see also [19].…”