Center for Clinical Research Dalarna, Uppsala University, Falun, Region Dalarna, Sweden.
Department of Statistics, Uppsala University, Uppsala, Region Uppsala, Sweden; Yau Mathematical Science Center, Tsinghua University, Beijing, China.
J Pain. 2023 Nov;24(11):2003-2013. doi: 10.1016/j.jpain.2023.06.009. Epub 2023 Jun 20.
Interdisciplinary treatment is a widely implemented strategy for the rehabilitation of patients with chronic pain. A primary treatment objective is to decrease the load on the social insurance system; however, it is questionable whether interdisciplinary treatment reduces sickness absence and disability pension (SA/DP). This register-based observational study compared SA and DP between patients in interdisciplinary treatment and unspecified interventions. With data from 7,752 Swedish specialist health care patients in their prime working age, we analyzed total net SA/DP days over 3 years from the first visit to a pain rehabilitation center. A zero-one-inflated beta model, adjusted for theoretically substantiated confounders, was used to estimate the mean differences in total days and the proportions of patients with both zero and maximum days. Compared with unspecified interventions, interdisciplinary treatment resulted in a mean (95% confidence interval) absolute increase of 50 (37, 62) total days, a 13.0% (11.3%, 14.6%) decrease in patients with zero days, and a 1.5% (.2%, 2.8%) decrease in patients with the maximum days. These findings support that interdisciplinary treatment increases SA/DP compared to less intensive interventions but reduces the risk of maximum days, implying that it is advantageous for patients with the highest absence. This highlights the need for improved patient selection procedures and the adaptation of interdisciplinary treatment programs to more adequately target SA/DP reduction. PERSPECTIVES: This study provides an accessible overview of SA/DP among working-age patients with chronic pain in Swedish specialist health care. It also shows that interdisciplinary treatment does not decrease SA/DP more than alternative treatments in most patients but is advantageous for the patients with the longest absence.
跨学科治疗是一种广泛实施的慢性疼痛患者康复策略。主要治疗目标是减轻社会保险系统的负担；然而，跨学科治疗是否能减少病假和残疾抚恤金（SA/DP）仍存在争议。这项基于登记的观察性研究比较了接受跨学科治疗和未指定干预措施的患者的 SA 和 DP。我们使用了来自瑞典专家医疗保健的 7752 名处于工作年龄的患者的数据，分析了从第一次就诊到疼痛康复中心的 3 年内的总净 SA/DP 天数。采用零一膨胀贝塔模型，根据理论上有充分根据的混杂因素进行调整，以估计总天数和零天和最大天数患者的比例的平均差异。与未指定的干预措施相比，跨学科治疗导致总天数平均（95%置信区间）绝对增加 50 天（37，62），零天患者比例降低 13.0%（11.3%，14.6%），最大天患者比例降低 1.5%（0.2%，2.8%）。这些发现支持跨学科治疗与低强度干预相比会增加 SA/DP，但会降低最大天数的风险，这意味着它对缺勤时间最长的患者有利。这突出表明需要改进患者选择程序，并调整跨学科治疗方案，以更有针对性地减少 SA/DP。观点：本研究提供了瑞典专家医疗保健中慢性疼痛的工作年龄患者的 SA/DP 的易访问概述。它还表明，在大多数患者中，跨学科治疗并没有比替代治疗更能减少 SA/DP，但对缺勤时间最长的患者有利。
