Interdisciplinary Intervention Versus Brief Intervention for Patients With Musculoskeletal Pain
Is Interdisciplinary Intervention for Patients Sicklisted With Musculoskeletal Pain More Effective in Helping Patients Back to Work Than Than The Less Resource Demanding Brief Intervention Method?
Musculoskeletal pain is very common in the normal population, and the reason for about 50 % of the long term sickness absence in Norway. Most of these patients have common, but troublesome subjective health complaints where pathological findings are absent or substantially less than expected compared to the reported intensity of the complaints. Psychosocial factors are important in the development of chronic complaints. In a large meta-analysis job satisfaction was found to be associated with mental health and subjective physical health. Individual factors are also important. Uncertainty related to the understanding of pain mechanisms, treatment strategies and management contribute to the problem.
Among patients sicklisted for musculoskeletal complaints, low back pain is the largest diagnose group. Most of these patients also have many other complaints. Previous studies have shown that for low back pain patients a brief intervention at a spine clinic with examination, information, reassurance, and encouragement to engage in physical activity as normal as possible, had significant effect in reducing sick leave. Other studies have shown that multidisciplinary rehabilitation for chronic low back pain has effect on sick leave. A Danish study from Arbeidsmiljøinstituttet report that interdisciplinary treatment for patients sicklisted for musculoskeletal complaints, had effect on socio-economic costs, pain, and function.
A treatment team consisting of various professionals is expensive, and in this study we will compare the simple, standardized brief intervention model with the more resource demanding interdisciplinary treatment for patients sicklisted for musculoskeletal complaints.
Research question / hypothesis: An interdisciplinary treatment model for musculoskeletal complaints - is it beneficial for reducing sickness absence?
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
In 2007 The Government in Norway raised a fund to support efforts to reduce sickness absence, called "Raskere tilbake prosjekt". Helse Sør-Øst was invited to establish projects within their health care system, and the department of physical medicine and rehabilitation at Sykehuset Innlandet HF was assigned the task to constitute an outpatient-clinic for musculoskeletal diseases.
This initiative opened possibilities to explore new strategies based on science and own clinical experience to help these patients back to work without being confined to the traditional diagnose related examination and treatment offered in most clinics. In this project the main focus is directed towards work and barriers for working life. Because sickness absence often is multicausal and needs a bio-psycho-social approach, this should be reflected in the composition of the treatment team.
There is a great demand to make out how complex bio-psycho-social problems can be solved, organized, implemented, and have economic gains for the society. To answer these questions we need randomized controlled clinical studies, and we need documentation when new treatment models are offered to this group of patients.
Type d'étude
Inscription (Réel)
Phase
- N'est pas applicable
Contacts et emplacements
Lieux d'étude
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Ottestad, Norvège, 2312
- Dep. of Physica. Medicin and Rehabilitation, Innlandet Hospital Trust
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Musculoskeletal diagnosis
- Minimum 50% sick leave from work for not more than one year
- Minimum 50 % employed
Exclusion Criteria:
- Not sicklisted
- Sicklisted less than 50%
- Sicklisted > 1 year
- Less than 50% employed
- Pregnancy
- Does not speak Norwegian
- Psychiatric disease
- Osteoporosis
- Cancer disease
- Rheumatic disease
- Ongoing Insurance Compensation Case
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Expérimental: Intervention group
Treatment team with a physician, a physiotherapist, a social service worker.
The main goal for the team is to make a survey of the patient's situation, in which the biomedical tradition to make a diagnosis is replaced by a disability diagnosis, with systematically identification of barriers for return to work.
The patient meets at the outpatient clinic three times; at baseline, after 2 weeks and after 3 months.
One year after baseline the patient has a telephone-follow-up.
At baseline, the patient and the team works out a rehabilitation plan and in this process a new visual, educational tool is central.
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Interdisciplinary collaboration deals with tasks often complex which require different skills to make a wide assessment.In this study the treatment team consists of a physician, a physiotherapist and a social service worker.
The main goal for the team is to make a survey of the patient's situation, in which the biomedical tradition to make a diagnosis is replaced by a disability diagnosis, with systematically identification of barriers for return to work.
The conclusion of the team will be followed by a targeted rehabilitation plan.
Factors assessed to be the major cause of the reduced function at work will have priority in the following rehabilitation process.
One of the team members will be responsible for the further process to follow the plan to help the patient back to work, in cooperation with the patient, the workplace, the general practitioner, and NAV.
Autres noms:
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Comparateur actif: Controll group
The brief intervention is a standardized intervention based on the studies by Indahl and Hagen.
Therapist treatment manuals will be written for the intervention.
The essential features are interview and examination by a specialist in physical medicine and rehabilitation.
Patients will be given time to express their concerns and problems in daily activities.
Unless symptoms and clinical findings indicate some serious disease, the patients will be informed about the good prognosis, and the importance of staying active to avoid development of muscle dysfunction.
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The brief intervention is a standardized intervention and the essential features are interview and examination by a specialist in physical medicine and rehabilitation.
Patients will be given time to express their concerns and problems in daily activities.
The examination is thorough with detailed feedback on findings and normal functions, and clear and consistent explanations on pain and defense mechanisms.
Somatic findings will be explained.Unless pathological findings, the patient will be encouraged to physical activity.
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
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Change in Sickness leave 1 year after inclusion
Délai: At 12 months after baseline
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In addition to the main outcome we will also evaluate job satisfaction, social support, coping, defense mechanisms, illness perception, function level, activity of daily living, psychological distress, and health complaints/pain as recorded by the questionnaires at baseline.
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At 12 months after baseline
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Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Les enquêteurs
- Chaise d'étude: Eli M. Hagen, MD, PhD, Sykehuset Innlandet HF
Publications et liens utiles
Liens utiles
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 150160
Plan pour les données individuelles des participants (IPD)
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