The effects of multimodal rehabilitation on pain-related sickness absence – an observational study

Busch, Hillevi; Brämberg, Elisabeth Björk; Hagberg, Jan; Bodin, Lennart; Jensen, Iréne

doi:10.1080/09638288.2017.1305456

Cited by 17 publications

(27 citation statements)

References 37 publications

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“…The rehabilitation programme interventions for chronic pain are unique in the sense that the participants themselves play a crucial role in the rehabilitation process and participation in the MMR interventions as an active team member. The findings of improvements in emotional function, pain intensity and activity in daily life in this study confirm the generally positive results found in previous studies of MMR (9,(26)(27)(28)(29).…”

Section: Discussionsupporting

confidence: 92%

Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age

Spinord¹,

Kassberg²,

Stenberg³

et al. 2018

J Rehabil Med

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Section: Discussionsupporting

confidence: 92%

Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age

Spinord¹,

Kassberg²,

Stenberg³

et al. 2018

J Rehabil Med

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“…Since MMRP was initiated as a new rehabilitation intervention, healthcare professionals from the primary healthcare units reported both negative and positive aspects when implementing it (33). They also experienced similar difficulties in managing work ability and return to work in MMRP, as reported from other primary care units in Sweden (37). At the time of the present data collection, the MMRPs did not contain specific work-directed interventions, which have been found to be an important factor for return to work (38).…”

Section: Discussionmentioning

confidence: 90%

Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain

Pietilä-Holmner¹,

Enthoven²,

Gerdle³

et al. 2020

J Rehabil Med

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LAY ABSTRACTFor patients with chronic pain, studies have shown that multimodal rehabilitation programmes at specialist care level have positive effects. Since there is limited knowledge about the long-term effects of multimodal rehabilitation programmes in a primary care setting this study investigated the effects of multimodal rehabilitation programmes in 234 patients with chronic pain, 34 men and 200 women, age range 18-65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. At 1-year follow-up patients reported small improvements in pain, physical and emotional functioning, coping, and health-related quality of life. The proportion of patients on sick leave decreased, while there was no difference regarding the proportion of patients on sickness compensation/ disability pension. This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain.Objectives: To investigate the outcomes one year after multimodal rehabilitation programmes in primary care for patients with chronic pain, both as a whole and for men and women separately. A second aim was to identify predictive factors for not being on sickness absence at follow-up after one year. Methods: A prospective longitudinal cohort study of 234 patients, 34 men and 200 women, age range 18-65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sickness absence (sick leave, sickness compensation/disability pension) were evaluated prior to and one year after multimodal rehabilitation programmes. Results: Patients showed significant improvements at 1-year follow-up for all measures (all p ≤ 0.004) except satisfaction with vocation (p = 0.060). The proportion of patients on sick leave decreased significantly at follow-up (p = 0.027), while there was no significant difference regarding the proportion of patients on sickness compensation/disability pension (p = 0.087). Higher self-rated work ability was associated with not being on sickness absence at 1-year follow-up (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.21-1.06, p = 0.005). Conclusion: This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain, since the outcomes at 1-year follow-up for pain, physical and emotional functioning, coping, and health-related quality of life were positive. However, the effect sizes were small and thus further development of multimodal rehabilitation programmes is warranted in order to improve the outcomes.

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“…Two recently published papers concerning the effects of MMRP on pain-related sickness absence in Sweden and within the rehabilitation warranty presented differing results. Busch et al [60] compared participants of MMRPs with matched controls and found that MMRPs were not effective in reducing sickness absence compared with care as usual. MMRP was, nevertheless, effective in reducing the risk of future disability pension.…”

Section: Discussionmentioning

confidence: 99%

“…There are a few notable differences between these two studies and our study. Busch et al [60] included patients at two different time periods at both specialist and primary healthcare from the last quarter of 2009 until the end of 2010 and retrieved data from the Swedish Social Insurance Agency. Rivano Fischer et al [51] included data from specialist care reported to the SQRP during 2007-2011 supplemented with sickness absence data from the Swedish Social Insurance Agency.…”

Section: Discussionmentioning

confidence: 99%

A cost-utility analysis of multimodal pain rehabilitation in primary healthcare

Eklund

Stålnacke

Stenberg

et al. 2020

Scandinavian Journal of Pain

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ObjectivesMultimodal rehabilitation programs (MMRPs) have been shown to be both cost-effective and an effective method for managing chronic pain in specialist care. However, while the vast majority of patients are treated in primary healthcare, MMRPs are rarely practiced in these settings. Limited time and resources for everyday activities alongside the complexity of chronic pain makes the management of chronic pain challenging in primary healthcare and the focus is on unimodal treatment. In order to increase the use of MMRPs incentives such as cost savings and improved health status in the patient group are needed. The aim of this study was to evaluate the cost-effectiveness of MMRPs for patients with chronic pain in primary healthcare in two Swedish regions. The aim of this study was to evaluate the cost-effectiveness of MMRPs at one-year follow-up in comparison with care as usual for patients with chronic pain in primary healthcare in two Swedish regions.MethodsA cost-utility analysis was performed alongside a prospective cohort study comparing the MMRP with the alternative of continuing with care as usual. The health-related quality of life (HRQoL), using EQ5D, and working situation of 234 participants were assessed at baseline and one-year follow-up. The primary outcome was cost per quality-adjusted life year (QALY) gained while the secondary outcome was sickness absence. An extrapolation of costs was performed based on previous long-term studies in order to evaluate the effects of the MMRP over a five-year time period.ResultsThe mean (SD) EQ5D index, which measures HRQoL, increased significantly (p<0.001) from 0.34 (0.32) to 0.44 (0.32) at one-year follow-up. Sickness absence decreased by 15%. The cost-utility analysis showed a cost per QALY gained of 18 704 € at one-year follow-up.ConclusionsThe results indicate that the MMRP significantly improves the HRQoL of the participants and is a cost-effective treatment for patients with chronic pain in primary healthcare when a newly suggested cost-effectiveness threshold of 19 734 € is implemented. The extrapolation indicates that considerable cost savings in terms of reduced loss of production and gained QALYs may be generated if the effects of the MMRP are maintained beyond one-year follow-up. The study demonstrates potential benefits of MMRPs in primary healthcare for both the patient with chronic pain and the society as a whole. The cost-effectiveness of MMRPs in primary healthcare has scarcely been studied and further long-term studies are needed in these settings.

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The effects of multimodal rehabilitation on pain-related sickness absence – an observational study

Cited by 17 publications

References 37 publications

Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age

Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age

Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain

A cost-utility analysis of multimodal pain rehabilitation in primary healthcare

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