Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
Epidemiology and Register Center South, Skåne University Hospital, Lund, Sweden.
Pain. 2018 Aug;159(8):1456-1464. doi: 10.1097/j.pain.0000000000001216.
Workplace involvement in rehabilitation for patients with musculoskeletal pain may improve work ability. Convergence Dialogue Meeting (CDM) is a model aimed at helping the patient, the care giver, and the employer to support work ability and return-to-work. Our aim was to study the effect on work ability when adding a workplace dialogue according to CDM in physiotherapy practice for patients with pain in ordinary primary care. We conducted a prospective pairwise cluster randomised controlled trial (ClinicalTrials.gov ID: NCT02609750) in primary care involving 20 primary care rehabilitation units with 1-year follow-up. Adult patients with acute/subacute neck and back pain, worked ≥4 weeks past year and not currently on sick leave or no more than 60 days of sick leave and considered at-risk of sick leave were included (n = 352). All patients received structured physiotherapy and the intervention was the addition of CDM, delivered by the treating physiotherapist. The main confirmatory outcome, work ability (defined as working at least 4 consecutive weeks at follow-up), was assessed by a weekly short text message question on number of sick leave days past week. Work ability was reached by significantly more patients in the intervention group (108/127, 85%) compared with the reference group (127/171, 74%) (P = 0.02). The intervention increased the odds of having work ability at 1-year follow-up, also after adjustment for baseline health-related quality of life (odds ratio 1.85, confidence interval 1.01-3.38). We conclude that an early workplace dialogue in addition to structured physiotherapy improved work ability significantly.
工作场所参与肌肉骨骼疼痛患者的康复治疗可能会提高工作能力。融合对话会议（CDM）是一种旨在帮助患者、护理人员和雇主支持工作能力和重返工作岗位的模式。我们的目的是研究在普通初级保健中，根据 CDM 在物理治疗实践中为疼痛患者增加工作场所对话对工作能力的影响。我们在初级保健中进行了一项前瞻性配对集群随机对照试验（ClinicalTrials.gov ID：NCT02609750），涉及 20 个初级保健康复单位，随访时间为 1 年。纳入了急性/亚急性颈痛和腰痛、工作≥4 周且过去一年未请病假或病假不超过 60 天且被认为有休病假风险的成年患者（n=352）。所有患者均接受结构化物理治疗，干预措施是由治疗物理治疗师提供的 CDM。主要确认结局是工作能力（定义为在随访时至少连续工作 4 周），通过每周一次的简短短信问题评估过去一周的病假天数来评估。与对照组（n=171）相比，干预组（n=127）中有更多的患者达到工作能力（85%比 74%）（P=0.02）。即使调整了基线健康相关生活质量，干预也增加了 1 年随访时具有工作能力的可能性（优势比 1.85，95%置信区间 1.01-3.38）。我们的结论是，除了结构化物理治疗外，早期的工作场所对话显著提高了工作能力。
