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Back to work: evaluation of a multidisciplinary rehabilitation program with emphasis on mental symptoms; A two-year follow up
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
The Research and Development Unit, Jämtland County Council, Östersund, Sweden.
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.ORCID iD: 0000-0001-6653-3414
2012 (English)In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 5, 145-151 p.Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this investigation was to analyze temporal changes in anxiety, depression, and stress in patients with musculoskeletal pain for a period of up to 2 years after a multidisciplinary rehabilitation program, in relation to sick-listing (registered with The Swedish Social Insurance Agency [Forsakringskassan] for sickness benefit). Methods: Ten persons with full-time sick leave (absence from work for medical reasons) (group 1) and 49 with part-time or no sick leave (group 2) at the end of the 2-year study period participated. It was shown in a previous study that group 1 had higher pain rating and higher subjective physical disability than group 2, with little or no improvement during and after rehabilitation. In the present study, all participants were evaluated with the Hospital Anxiety and Depression scale and a self-rated stress test. Results: Participants with full-time sick leave during the study period (group 1) showed improved stress levels but no change in anxiety and depression levels. Anxiety, depression, and stress changed more favorably in participants with part-time or no sick leave than in those with full-time sick leave. Conclusion: The results of this study indicate that investigation and appropriate treatment of psychological symptoms, including anxiety and depression, are important in multidisciplinary rehabilitation of patients with musculoskeletal disorders

Place, publisher, year, edition, pages
Dove Press , 2012. Vol. 5, 145-151 p.
Keyword [en]
anxiety, depression, musculoskeletal, rehabilitation, sick leave, stress
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:miun:diva-10637DOI: 10.2147/JMDH.S32372Scopus ID: 2-s2.0-84874783471OAI: oai:DiVA.org:miun-10637DiVA: diva2:280771
Available from: 2013-04-04 Created: 2009-12-11 Last updated: 2016-10-27Bibliographically approved
In thesis
1. Multidisciplinary rehabilitation in musculoskeletal disorders: Quantitative and qualitative follow-up studies
Open this publication in new window or tab >>Multidisciplinary rehabilitation in musculoskeletal disorders: Quantitative and qualitative follow-up studies
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The primary aim of this investigation was to evaluate a seven-week

multidisciplinary rehabilitation programme, with emphasis on

musculoskeletal disorders, for working-age people, by assessments at the

start and end of the rehabilitation programme, and at follow-up

examinations 6, 12 and 24 months after completion of the programme. A

further aim was to explore the experiences of people not returning to work

during a period of six years after participation in an extensive

multidisciplinary rehabilitation programme.

Sixty participants, 40 women and 20 men (mean age 46.8 ± SD 7.9), with

musculoskeletal disorders, mainly neck and back pain, participated in a 7-

week rehabilitation programme which was based on a combination of

theoretical and practical education, physical activities, relaxation and

individual guidance. Before and after the programme and at the follow-up

occasions all participants were evaluated with the Global Self-Efficacy

Index (GSI), Hospital Anxiety and Depression Scale (HAD), and Stress test

(Study I). A group of participants who were still full-time sick-listed (Group

I) at the end of the study period were compared with participants who were

part-time or not sick-listed (Group II) at the end of the study period (II, III,

IV). They were evaluated with the Disability Rating Index (DRI), with the

Pain Intensity Rating Index on a visual analogue scale (VAS) (II, III)),

mobility tests (III), GSI (III), HAD, and a stress test (IV). Seven women

(median age 48 years) and three men (53 years) (Group I) were interviewed

and the interviews were analysed by manifest content analysis (V).

At the 2-year follow-up full-time sick leave, anxiety, depression and selfexperienced

stress had decreased in both sexes. They also showed increased

quality of life (QoL) (I). In participants with full-time sick leave (Group I),

self-experienced physical disability and pain ratings were high and showed

no decrease up until the 2-year follow-up. In participants with part-time or

no sick leave (Group II), physical disability and pain ratings decreased

gradually throughout the 2-year follow-up period (II). Cervical and

thoracolumbar spine range of motion (ROM) was lower in Group I than in

Group II from the start of rehabilitation to a 2-year follow-up. Only Group

II showed a temporal improvement in ROM. No changes in DRI, VAS or

GSI were found in parallel with corresponding temporal changes in any of

the ROM (III). Group I experienced no change in anxiety or depression

during the study period, in contrast to Group II, in which this decreased.

Decreased stress was found in both groups (IV). Group I described

perceived barriers to and possibilities of returning to work, and also gave

information on what strategies they used, to cope with everyday life (V).

The majority of the participants improved and they continued to be

physically active, their QoL improved, and most participants returned to

work. Ten of the participants, however, were on full-time sick leave

throughout the whole study period, with high self-experienced physical

disability, high pain rating and no improvement in anxiety and depression.

They experienced barriers to re-entering the labour market as consequences

of physical symptoms and fatigue. But they also believed in possibilities of

returning to work if they could get a modified job adapted to their own

capacity.

Thus, persons with severe disability and pain did not improve by

rehabilitation in this project. New methods of treatment have to be

developed for improvement of symptoms resulting in reduction of

functional impairment and a consequent need for sick leave.

Abstract [en]

Huvudsyftet med undersökningen var att utvärdera ett 7-veckors

multidisciplinärt rehabiliteringsprogram inriktat på muskuloskeletala besvär,

för arbetsföra kvinnor och män, vid start och efter

rehabiliteringsprogrammets slut samt vid 6, 12 och 24 månader. Vidare var

syftet att undersöka deltagares upplevelse av att inte återgå i någon form av

arbete sex år efter deltagande i rehabiliteringsprogrammet.

Sextio deltagare, 40 kvinnor och 20 män (medelålder 46.8 ±7.9), med

muskuloskeletala besvär, framför allt nack- och ryggbesvär, deltog i ett 7-

veckors rehabiliteringsprogram som innehöll en kombination av teoretisk

och praktisk undervisning, fysisk aktivitet, avslappning och individuell

vägledning. Deltagarna testades före och efter rehabiliteringsprogrammet

samt vid uppföljningstillfällena med Globalt Självskattnings Index (GSI),

Hospital Anxitey and Depression Scale (HAD) och stress test (Studie I). En

grupp deltagare som fortfarande var helt sjukskriven (Grupp I) i slutet av

studieperioden, jämfördes med deltagare som var delvis eller inte alls

sjukskriven (Grupp II) vid studieperiodens slut (II, III, IV). De utvärderades

med Disability Rating Index (DRI), smärtskattning med visuell analog skala

(VAS) (II,III), rörlighetsmätning (III), GSI (III), HAD, och stress test (IV).

Sju kvinnor (median ålder 48 år) och tre män (53 år) (Grupp I) intervjuades

och intervjuerna analyserades med manifest innehållsanalys (V).

Vid två års uppföljning hade heltidssjukskrivning, ångest/oro, depression

och självupplevd stress minskat hos båda könen. De visade också ökad

livskvalitet (I). Deltagarna som var helt sjukskrivna (Grupp I) hade hög

självskattad funktionsnedsättning samt smärtskattning och visade ingen

förändring vid två års uppföljning. Deltagarna som var delvis eller inte alls

sjukskrivna (Grupp II) visade en gradvis förbättring av fysisk funktion och

smärtskattning under studieperioden (II). Cervical och thoracolumbar

rörlighet var mindre i Grupp I jämfört med i Grupp II från start till två års

uppföljning. Endast Grupp II visade en temporär förbättring av den aktiva

rörligheten. DRI, VAS och GSI förändrades inte parallellt med

förändringarna i den aktiva rörligheten (III). Grupp I upplevde ingen

förändring i ångest/oro eller depression under studie perioden jämfört med

Grupp II, som minskade ångest/oro och depression. Båda grupperna

skattade mindre stress (IV). I studie V beskrevs deltagarnas upplevelser av

hinder och möjligheter för att återgå i arbete. De beskrev vidare vilka

strategier som användes för att hantera vardagslivet.

Majoriteten av deltagarna förbättrades och de fortsatte att vara fysiskt

aktiva, livskvaliteten förbättrades och de flesta deltagarna återgick i arbete.

Tio av deltagarna var helt sjukskrivna under hela studieperioden, med hög

självskattad fysisk funktionsnedsättning, hög smärtskattning och ingen

förbättring i ångest/oro eller depression. De upplevde hinder för återgång i

arbete, en konsekvens av de fysiska symtomen och trötthet. De trodde också

på möjlighet till återgång i arbete om de kunde få ett arbete anpassat till

deras egen arbetsförmåga.

Alltså, personer med stor funktionsnedsättning och hög smärta

förbättrades inte av rehabilitering i det här projektet. Nya metoder av

behandling behöver utvecklas för att förbättra symtomen och därmed

minska funktionell försämring och behovet av sjukskrivning.

Place, publisher, year, edition, pages
Östersund: Mittuniversitetet, 2009. 55 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 75
Keyword
disability, mental health, mobility, musculoskeletal, pain, quality of life, rehabilitation, return to work, sick leave, nedsatt förmåga, mental hälsa, rörlighet, muskuloskeletal, smärta, livskvalitet, rehabilitering, återgång i arbete, sjukskrivning, rehabiliteringsvetenskap
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-10636 (URN)978-91-86073-55-8 (ISBN)
Public defence
2009-12-18, F 229, Campus Östersund, Östersund, 10:30 (English)
Opponent
Supervisors
Available from: 2009-12-11 Created: 2009-12-11 Last updated: 2012-08-02Bibliographically approved

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