Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Primary Care Rehabilitation, Region Västra Götaland, Närhälsan Eriksberg, Gothenburg, Sweden.
BMC Health Serv Res. 2024 Oct 26;24(1):1286. doi: 10.1186/s12913-024-11758-7.
Musculoskeletal disorders are commonly treated in primary healthcare and may, if not treated adequately, entail a risk for long-term disability and sickness absence. A team-based rehabilitation intervention (PREVention of Sickness Absence for Musculoskeletal disorders, PREVSAM) was evaluated in a randomised controlled trial. The purpose of this study was to evaluate the process of implementing the PREVSAM model in primary care rehabilitation.
This process evaluation was conducted alongside the trial, collecting quantitative and qualitative data to evaluate how the PREVSAM model was implemented, mechanisms of impact, and contextual factors. Acceptability, feasibility, appropriateness, adaptations, training and support, resources, recruitment, reach, retention, dose, fidelity, and readiness for change were investigated. Qualitative data were collected from healthcare professionals and patients.
Eight of 22 invited rehabilitation clinics (36%) and 28 of 54 healthcare professionals (52%) were included in the PREVSAM trial and this process evaluation. Of 507 eligible patients, 261 (51%) were included. Of those, 134 were randomised to the intervention and 129 (96%) were retained. Twelve healthcare professionals and 15 patients participated in the qualitative evaluations. The model's essential components; individual assessments and structured, team-based rehabilitation with clear division of responsibilities agreed in a joint health plan; were generally delivered according to protocol. The optional components early access to psychological treatment and workplace contact were delivered to a lesser extent. Perceived acceptability, feasibility, and appropriateness of the PREVSAM model were moderate to high. Several contextual barriers, in the form of missing prerequisites, affected the implementation. Qualitative data showed that the model, with its holistic view, was appreciated by both healthcare professionals and patients.
This process evaluation suggests that PREVSAM is acceptable, feasible and appropriate for patients with MSDs reporting psychological risk factors associated with increased risk for sickness absence. While essential components were implemented with fidelity for most patients, optional components were not. This variability reflects the complexity of the model, its mandatory and optional components, contextual barriers, and the person-centred approach meeting individual patient needs. As all model components were not delivered to all patients, the intervention may have been too similar to treatment as usual to detect differences on a group level. A limitation of the study is that half of the participating rehabilitation clinics withdrew prematurely.
肌肉骨骼疾病在初级保健中较为常见，如果治疗不当，可能会导致长期残疾和病假。一项基于团队的康复干预措施（预防肌肉骨骼疾病的病假，PREVSAM）在一项随机对照试验中进行了评估。本研究的目的是评估在初级保健康复中实施 PREVSAM 模型的过程。
该过程评估与试验同时进行，收集定量和定性数据，以评估 PREVSAM 模型的实施方式、影响机制和背景因素。评估了可接受性、可行性、适当性、适应性、培训和支持、资源、招募、覆盖面、保留率、剂量、保真度和变革准备情况。定性数据来自医疗保健专业人员和患者。
在 22 家受邀康复诊所（36%）和 54 名医疗保健专业人员（52%）中，有 8 家参加了 PREVSAM 试验和本过程评估。在 507 名符合条件的患者中，有 261 名（51%）被纳入。其中，134 名随机分配到干预组，129 名（96%）保留。12 名医疗保健专业人员和 15 名患者参加了定性评估。该模型的基本组成部分，即个人评估和结构化的、基于团队的康复，以及在联合健康计划中明确划分责任，通常按照协议进行。早期获得心理治疗和工作场所联系的可选组成部分则较少得到实施。该模型的可接受性、可行性和适当性被认为是中等至高的。一些以缺失先决条件为形式的背景障碍，对实施产生了影响。定性数据显示，该模型以其整体观点，受到医疗保健专业人员和患者的赞赏。
本过程评估表明，PREVSAM 对报告与病假风险增加相关的心理风险因素的 MSD 患者是可接受的、可行的和适当的。虽然对于大多数患者来说，基本组成部分都得到了忠实的实施，但可选组成部分则没有。这种变异性反映了模型的复杂性，其强制性和可选组成部分、背景障碍以及以个人为中心的方法满足个别患者的需求。由于并非所有模型组成部分都提供给了所有患者，因此该干预措施可能与常规治疗过于相似，以至于无法在群体层面上检测到差异。研究的一个局限性是，一半参与的康复诊所提前退出。
