Behavioral Medicine Physiotherapy in the Context of Return to Work for Chronic Pain: A Single-Case Experimental Design Study

Abstract

Effective interventions are needed for return-to-work (RTW) for individuals with chronic pain on long-term sick leave. In this study, a behavioral medicine physiotherapy protocol was systematically replicated and added to workplace components. The intervention was evaluated for fidelity and effects on target activities and work ability. A single-case experimental design was used with five participants. Daily and weekly ratings of personalized target activities at work as well as work ability were carried out throughout the study period of 26–28 weeks. Effects of the behavioral medicine physiotherapy intervention were evaluated for each individual using visual analysis of displayed graphs and quantitative non-overlap methods. Goal achievement for target activities was reviewed. Three participants completed the intervention. The results indicated an effect from the behavioral medicine physiotherapy intervention on task-specific self-efficacy for target activities, but no consistent effect on experience of target activities or work ability. All three participants had increased function in target activities in line with pre-defined goals. Fidelity to the intervention manual was good. Behavioral medicine physiotherapy can be successfully adapted to work disability and was here replicated in an RTW context for individuals with chronic pain. The intervention protocol should be further evaluated in large-scale studies.

Including a Three-Party Meeting Using the Demand and Ability Protocol in an Interdisciplinary Pain Rehabilitation Programme for a Successful Return to Work Process

“…Previous studies have highlighted the importance of involving the workplace in the rehabilitation process, even before the worker has made a full recovery [ 23 , 58 ], and suggested the benefits of continuous supervision of vocational issues [ 23 ]. A rehabilitation programme may further benefit from including features with a concrete focus on vocational issues [ 23 ], e.g., by specified goals achieved based on personalised target activities [ 59 ] for RTW and the early identification of factors that hinder RTW. The RTW is an outcome of relevance after participating in an IPRP, and the programme could be better tailored to address the reciprocal relationship between work and health [ 23 ].…”

Psychologically informed health care

“…Variants of this model have been developed and tested for whiplash-associated disorders [ 46 ], pediatric pain [ 47 ], occupational rehabilitation [ 48 ], physical activity, and eating behaviors in obstructive sleep apnea [ 49 ], and physical exercise during adjuvant cancer treatment [ 50 ].…”