Busch Hillevi, Björk Brämberg Elisabeth, Hagberg Jan, Bodin Lennart, Jensen Irene
a Public Health Agency of Sweden , Stockholm , Sweden.
b Unit of Intervention and Implementation Research for Worker Health , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.
Disabil Rehabil. 2018 Jul;40(14):1646-1653. doi: 10.1080/09638288.2017.1305456. Epub 2017 Mar 27.
The aim of the current study was to examine the effects on sickness absence of multimodal rehabilitation delivered within the framework of a national implementation of evidence based rehabilitation, the rehabilitation guarantee for nonspecific musculoskeletal pain.
This was an observational matched controlled study of all persons receiving multimodal rehabilitation from the last quarter of 2009 until the end of 2010. The matching was based on age, sex, sickness absence the quarter before intervention start and pain-related diagnosis. The participants were followed by register data for 6 or 12 months. The matched controls received rehabilitation in accordance with treatment-as-usual.
Of the participants, 54% (N = 3636) were on registered sickness absence at baseline and the quarter before rehabilitation. The average difference in number of days of sickness absence between the participants who received multimodal rehabilitation and the matched controls was to the advantage of the matched controls, 14.7 days (CI 11.7; 17.7, p ≤ 0.001) at 6-month follow-up and 9.5 days (CI 6.7; 12.3, p ≤ 0.001) at 12-month follow-up. A significant difference in newly granted disability pensions was found in favor of the intervention.
When implemented nationwide, multimodal rehabilitation appears not to reduce sickness absence compared to treatment-as-usual. Implications for Rehabilitation A nationwide implementation of multimodal rehabilitation was not effective in reducing sickness absence compared to treatment-as-usual for persons with nonspecific musculoskeletal pain. Multimodal rehabilitation was effective in reducing the risk of future disability pension for persons with nonspecific musculoskeletal pain compared to treatment-as-usual. To be effective in reducing sick leave multimodal rehabilitation must be started within 60 days of sick leave. The evidence for positive effect of multimodal rehabilitation is mainly for sick listed patients. Prevention of sick leave for persons not being on sick leave should not be extrapolated from evidence for multimodal rehabilitation.
本研究旨在探讨在全国实施循证康复框架（非特异性肌肉骨骼疼痛康复保障）内提供的多模式康复对病假的影响。
这是一项观察性匹配对照研究，研究对象为2009年最后一个季度至2010年底接受多模式康复的所有人。匹配基于年龄、性别、干预开始前一个季度的病假情况以及疼痛相关诊断。通过登记数据对参与者进行6个月或12个月的随访。匹配对照组按照常规治疗接受康复。
在参与者中，54%（N = 3636）在基线时以及康复前一个季度处于登记病假状态。接受多模式康复的参与者与匹配对照组之间病假天数的平均差异对匹配对照组有利，6个月随访时为14.7天（CI 11.7；17.7，p≤0.001），12个月随访时为9.5天（CI 6.7；12.3，p≤0.001）。在新发放的残疾抚恤金方面发现了有利于干预组的显著差异。
在全国范围内实施时，与常规治疗相比，多模式康复似乎并未减少病假。
与针对非特异性肌肉骨骼疼痛患者的常规治疗相比，在全国范围内实施多模式康复在减少病假方面并不有效。与常规治疗相比，多模式康复在降低非特异性肌肉骨骼疼痛患者未来领取残疾抚恤金的风险方面是有效的。要有效减少病假，多模式康复必须在病假开始后的60天内启动。多模式康复产生积极效果的证据主要针对列入病假名单的患者。不应从多模式康复的证据推断对未休病假人员预防病假的情况。
