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14-08-2011 | General practice | Article

Multidisciplinary rehabilitation reduces sickness absence in patients with chronic pain


Free abstract

MedWire News: Multidisciplinary rehabilitation for patients with chronic pain reduces sickness absences over a prolonged period of time, suggest study findings.

"The results of this study support the notion that comprehensive programs are more (cost-) effective than single treatments, as the goal is work return," say Hillevi Busch (Karolinska Institute, Stockholm, Sweden) and co-authors.

The researchers examined long-term patterns of sickness absence among 214 individuals who were randomized to one of three 4-week rehabilitation interventions or normal routine healthcare (controls) following 1-6-month sick leave due to nonspecific spinal pain.

Interventions included behavior-oriented physical therapy (PT) aimed at enhancing physical functioning and promoting behavioral change; cognitive behavioral therapy (CBT) aimed at improving the ability to manage pain; or behavioral medicine rehabilitation (BM) incorporating PT and CBT programs.

Using records from the Swedish Social Insurance Agency, the researchers found that, during a 10-year follow-up period, individuals assigned to BM, PT, and CBT had 43, 17, and 12.5 fewer dayson sickness absence per year, respectively, compared with controls. However, findings were significant only for BM.

When the team analyzed the impact of the interventions on sick leave and disability pension, a significant difference was seen between the BM and control group for disability pension but not for sick leave. However, combining data for both sick leave and disability pension resulted in a mean reduction of 436 days of sickness absence in the BM group versus controls.

Regression analysis revealed that individuals assigned to the BM group were 24% less likely than controls to have been granted a full-time disability pension 10 years after the intervention, but the association was not statistically significant.

By contrast, each increased year of age significantly increased the risk for receiving a disability pension by 7%, while patients with more than 60 sick days in the period preceding the intervention had a significant 73% increased risk for receiving a disability pension compared with those with less sick days.

When all direct and indirect costs were considered, rehabilitation of the average BM participant was found to cost 533,821 SEK (US$ 82,234, € 57,761) less than the average person in the control group.

Writing in the journal Pain, the researchers say: "The high sickness absence post-intervention may also indicate a need for improving the rehabilitation efforts for chronic pain patients. Especially subgroups of patients - like women, older persons, and individuals with a long history of sickness absence, or individuals with psychosocial difficulties - should be targeted."

In an associated editorial, Antti Malmivaara (Finnish Institute for Health and Welfare, Helsinki, Finland) said: "A new trial should include a full health economic analysis, which will provide a societal perspective to the results. In addition, data on all important outcomes… should be reported. In the absence of this information the evidence should be considered preliminary."

By Ingrid Grasmo

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