The aim of the present study was to evaluate the long-term outcome of a behavioural medicine rehabilitation programme and the outcome of its two main components, compared to a 'treatment-as-usual' control group. The study employed a 4 x 5 repeated-measures design with four groups and five assessment periods during a 3-year follow-up. The group studied consisted of blue-collar and service/care workers on sick leave, identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomised to one of the four conditions: behaviour-oriented physiotherapy (PT), cognitive behavioural therapy (CBT), behavioural medicine rehabilitation consisting of PT+CBT (BM) and a 'treatment-as-usual' control group (CG). Outcome variables were sick leave, early retirement and health-related quality of life. A cost-effectiveness analysis, comparing the programmes, was made. The results showed, consistently, the full-time behavioural medicine programme being superior to the three other conditions. The strongest effect was found on females. Regarding sick leave, the mean difference in the per-protocol analysis between the BM programme and the control group was 201 days, thus reducing sick leave by about two-thirds of a working year. Rehabilitating women has a substantial impact on costs for production losses, whereas rehabilitating men seem to be effortless with no significant effect on either health or costs. In conclusion, a full-time behavioural medicine programme is a cost-effective method for improving health and increasing return to work in women working in blue-collar or service/care occupations and suffering from back/neck pain.
The aim of the study was to evaluate the outcome 6 years after completing a multiprofessional 8-week rehabilitation programme regarding the following objectives: (1) return to work, (2) level of activity and (3) pain intensity. Of 149 patients attending a rehabilitation programme, 122 were followed up after 6 years, through a structured telephone interview, and their present work situation, level of activity, sleeping habits, their estimated pain intensity and consumption of analgesics were recorded. The questions presented were the same as they had answered before entering the programme. The return-to-work rate was compared to 79 patients in a control group. At the 6-year follow-up, compared to before entering the programme, 52% had returned to work (P
A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients. Is sick leave outcome dependent on psychologically derived patient groups?
A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.
Mental disorders are a key cause of sickness absence (SA) and challenge prolonging working careers. Thus, evidence on the development of SA trends is needed. In this study, educational differences in long SAs due to mental disorders were examined in two age groups among employees of the City of Helsinki from 2004 to 2013.
All permanently and temporarily employed staff aged 18-34 and 35-49 were included in the analyses (n=~27800 per year). SA spells of =14 days due to mental disorders were examined annually. Education was classified to higher and lower levels. Joinpoint regression was used to identify major turning points in SA trends.
Joinpoint regression models showed that lower educated groups had more long SAs spells due to mental disorders than those groups with higher education. SA trends decreased during the study period in all studied age and educational groups. Lower educated age groups had similar SA trends. Younger employees with higher education had the fewest SAs.
A clear educational gradient was found in long SAs due to mental disorders during the study period. SA trends decreased from 2004 to 2013.
BACKGROUND AND PURPOSE: Neck/shoulder and low back pain are common in the Western world and can cause great personal and economic consequences, but so far there are few long term follow-up studies of the consequences of back pain, especially studies that separate the location of back pain. More knowledge is needed about different patterns of risk factors and prognoses for neck/shoulder and low back pain, respectively, and they should not be treated as similar conditions. The aim of the present study was to investigate possible long-term differences in neck/shoulder and low back symptoms, experienced over a 12-year period, with regard to work status, present health, discomfort and influence on daily activities. METHOD: A retrospective cohort study of individuals sicklisted with neck/shoulder or low back diagnoses 12 years ago was undertaken. Included were all 213 people who, in 1985, lived in the municipality of Linköping, Sweden, were aged 25-34 years and who had taken at least one new period of sickleave lasting > 28 days with a neck/shoulder or low back diagnosis. In 1996, a questionnaire was mailed to the 204 people who were still resident in Sweden (response rate 73%). RESULTS: Those initially absent with neck/shoulder diagnoses rated their present state of discomfort as worse than those sicklisted with low back diagnoses. Only 4% of the neck/shoulder group reported no present discomfort compared with 25% of the low back group. Notably, both groups reported the same duration of low back discomfort during the last year, which may indicate a higher risk for symptoms in more than one location for subjects with neck/shoulder problems. CONCLUSIONS: Individuals with sickness absence of more than 28 days with neck/shoulder or low back diagnoses appear to be at high risk of developing long-standing symptoms significantly more so for those initially having neck/shoulder diagnoses.
Socioeconomic differences in sickness absence are well established among middle-aged employees but poorly known among younger employees, in particular for shorter spells. We examined trends in occupational class differences in short sickness absence among young women.
The data were obtained from the registers of the City of Helsinki, Finland, and included female employees aged 18-34 years from 2002 to 2013. Self-certified (1-3 days) sickness absence spells were examined. Occupational class was classified into four hierarchical categories. Joinpoint regression models were used to identify major changes in sickness absence trends.
Short sickness absence increased until 2008, after which it decreased in all occupational classes except manual workers. Differences in sickness absence between occupational classes remained over time. Routine non-manuals had the highest amount of short sickness absence, while managers and professionals had the smallest amount. Manual workers had somewhat less short sickness absence than routine non-manuals and semi-professionals.
The socioeconomic differences in short sickness absence were clear among young women but not fully consistent as routine non-manuals tended to have more sickness absence than manual workers. Preventive measures are needed to narrow socioeconomic differences in young women's sickness absence especially among routine non-manuals.
Sick-leave between 1984 and 1989 was higher among both female (n = 515) and male (n = 304) fish-processing workers [observed/expected (O/E) 2.24 and 1.69, respectively] than among non-exposed groups (0.62 and 0.89). Diagnoses in the musculoskeletal system dominated (i.e., neck/upper limbs; females, exposed vs. non-exposed workers: 30 vs. 12%; males: 11 vs. 5.8%). In subjects who left employment, the O/E-ratio decreased (females: 3.02 vs. 1.55; males: 2.40 vs. 1.55). Among those women hired before the start of the observation period, exposed subjects had higher frequencies of sick-leave than non-exposed, for both total illness and musculoskeletal diagnoses. In the men, there were corresponding differences, though not fully statistically significant. Reported occupational diseases [O/E: females: 4.5; (95% confidence interval) CI = 3.2-6.1; males: 2.3; CI = 1.3-3.9] and accidents (females: 4.3; CI = 3.0-5.9; males: 1.8; CI = 1.2-2.7) were also higher in female than in male fish-processing workers, and much higher than in non-exposed workers. In conclusion, work in the fish-processing industry was associated with increased frequencies of sick-leave, especially because of diagnoses of the musculoskeletal system, and occupational disorders and accidents, in particular among female workers.
This is a study of the relationship between occupational exposure to magnetic fields in pot rooms and occurrence of sick leave caused by musculoskeletal disorders. The average exposure to static magnetic fields was 8 mT in the pot rooms. Ripple fields were recorded as well. A cohort of 342 exposed workers and 222 unexposed workers from the same electrolysis plant was retrospectively followed for 5 years. The reference group had a type of work similar to the exposed group except for the exposure to magnetic fields. The occurrence of sick leave and the diagnoses causing the sick leave were obtained from the Occupational Health Care Unit: these data were stored in their computer files. The data were complete. No relationship between the occurrence of sick leave caused by musculoskeletal disorders and exposure to magnetic fields was found. This was the case for both the annual number of periods of sick leave and the total number of days with sick leave. The results must be interpreted with caution due to limitations in the design and available data. Also, static magnetic fields constituted the major exposure, and the results may be different when related to work in other types of magnetic-field exposure.
