Severinsson Yvonne, Grimby-Ekman Anna, Nordeman Lena, Holmgren Kristina, Käll Lina Bunketorp, Dottori Maria, Larsson Maria Eh
Department of Orofacial Pain, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Work. 2023;74(3):907-917. doi: 10.3233/WOR-210836.
To address the increase in sick leave for nonspecific chronic pain and mental illness, the Swedish government and the Swedish Association of Local Authorities and Regions entered into an agreement on a "Rehabilitation Guarantee" to carry out multimodal rehabilitation (MMR).
To investigate whether components of primary care MMR are associated with changes in sick leave.
A web-based survey was conducted in conjunction with a retrospective cross-sectional observational study of 53 MMR units. Sick leave data for the years before and after MMR completion was collected for 846 individuals.
There was great disparity in how MMR was delivered. The average duration of rehabilitation was 4-8 weeks, and 74% of the MMR teams reported having fewer patients than recommended (≥20/year). Only 58% of the teams met the competence requirements. In-depth competence in pain relief and rehabilitation was reported by 45% of the teams and was significantly associated with fewer sick leave days after MMR (26.53, 95% CI: 3.65; 49.42), as were pain duration (17.83, 95% CI: -9.20; 44.87) and geographic proximity (23.75, 95% CI: -5.25; 52.75) of the health care professionals included in the MMR unit.
In-depth competence and knowledge about the complex health care needs of patients seem essential to MMR teams' success in reducing sickness benefits for patients with nonspecific chronic pain and mental illness. Further research is needed to elucidate the optimal combination of primary care MMR components for increasing the return-to work rate and to determine whether involvement of the Social Insurance Agency or employers could support and further contribute to recuperation and help patients regain their previous work capacity.
为应对非特异性慢性疼痛和精神疾病导致的病假增加问题，瑞典政府与瑞典地方当局和地区协会达成了一项关于“康复保障”的协议，以开展多模式康复（MMR）。
调查初级保健MMR的组成部分是否与病假变化相关。
结合对53个MMR单位的回顾性横断面观察研究进行了一项基于网络的调查。收集了846名个体在MMR完成前后几年的病假数据。
MMR的实施方式存在很大差异。康复的平均时长为4 - 8周，74%的MMR团队报告患者数量少于推荐数量（≥20例/年）。只有58%的团队符合能力要求。45%的团队报告具备疼痛缓解和康复方面的深入能力，这与MMR后病假天数减少显著相关（26.53，95%置信区间：3.65；49.42），MMR单位中医疗保健专业人员的疼痛持续时间（17.83，95%置信区间：-9.20；44.87）和地理位置接近程度（23.75，95%置信区间：-5.25；52.75）也与之相关。
对于MMR团队成功减少非特异性慢性疼痛和精神疾病患者的病假福利而言，深入了解患者复杂的医疗保健需求的能力和知识似乎至关重要。需要进一步研究以阐明初级保健MMR组成部分的最佳组合，以提高重返工作率，并确定社会保险机构或雇主的参与是否能够支持并进一步促进康复，帮助患者恢复以前的工作能力。
