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.