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Stigmar K.1,2, Holmberg S.3, Petersson I.F.4,5, Grahn B.2,3,4
1Lund University, Department of Health Sciences, Lund, Sweden, 2Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden, 3Region Kronoberg, Research and Development Kronoberg, Växjö, Sweden, 4Lund University, Department of Clinical Sciences, Lund, Sweden, 5Region Skåne, Skåne University Hospital, Lund, Sweden
Background: Musculoskeletal disorders (MSD) are one of the most common reasons for sick leave in the western world and patients with MSD are often primarily seen in physical therapy (PT) practice. To early identify patients at risk for developing long standing work disability and involving the workplace in rehabilitation could positively influence health and work ability. In general, PTs in primary care in Sweden do not take contact with the work place and the employer. A method to support contacts with the employer has been developed: “Convergence Dialogue Meetings” (CDM). This method has been tested in patients with mental disorders, but not in MSD and also not in a PT setting.
Purpose: To compare a structured, evidence-based PT intervention including the workplace intervention CDM with treatment as usual for patients with acute/subacute neck and/or back pain in primary care.
Methods: We conducted a prospective pair wise cluster randomized trial at 32 primary care units in southern Sweden. Structured, evidence based PT interventions including the work place intervention CDM was compared to treatment as usual. Patients that applied for PT due to acute/subacute neck and/or back pain were consecutively included during 2013-2014. We did follow-ups on three, six and twelve month, using patient-reported outcomes as well as clinician-reported outcomes. Weekly short text-messages were also answered during the 12 month follow-up. Primary outcome was work ability. This was defined as being at work or eligible to the labor market for at least four weeks in a row without sick leave.
Results: 352 patients (65 % women) were included (mean age 44 years). At baseline 97 % in the intervention group (n=146) were employed and in the reference group (n=206) 94 %. Furthermore, 35 % and 36 % were on sick leave in the intervention group and in the reference group, respectively. Significantly more individuals in the intervention group (86 %) compared to the reference group (74%) reported work ability and were not on sick leave (p = 0.012) after one year. The intervention had a more positive impact on work ability for patients on sick leave compared to those with no sick leave at baseline (p=0.033). At 12 month follow-up, a greater proportion in the intervention group (90 %) compared to the reference group
(81 %) had a health related quality of life as measured with EQ-5D corresponding to having work ability
(p= 0.043).
We conducted this study in regular PT practice in primary care. The study was carried out in a region where the population represents approximately 20 percent of the Swedish population and the sociodemographic characteristics can be compared to Sweden as a whole. This means promising potential to generalize the results.
Conclusion(s): A structured PT intervention including an early dialogue with the employer based on the CDM, significantly improved work ability and health related quality of life in patients with acute/subacute neck and/or back pain at one year follow up.
Implications: It is important to include work factors in MSD rehabilitation and we believe that the CDM can be a useful tool for PTs.
Funding acknowledgements: This work was funded by Rehsam, Sweden.
Topic: Occupational health & ergonomics
Ethics approval: This Clinical trial (ClinicalTrials.gov ID: NCT02609750) was approved by the Ethical review board at Lund University, Sweden. Dnr 2012/497.
All authors, affiliations and abstracts have been published as submitted.
