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Abstract
Background Musculoskeletal disorders (MSKD) are among the leading causes of work disability and sick leave in the Western world. Programs in persons who are already work disabled lack efficacy and therefore a shift is made towards interventions early in the period of sick leave aiming at the prevention of long term sick leave or work disability. Earlier research showed that multidisciplinary interventions with behavioral components as well as spa-exercise therapy are effective in the facilitation of work resumption and reduction of sick leave in MSKD-patients (1,2).
Objectives To explore whether a 4 weeks multidisciplinary intervention including hydrotherapy and combined spa-exercise therapy in patients with recent sick-leave due to MSKD improved work outcome at acceptable costs in a period of up to 6 months compared to persons receiving usual care.
Methods Patients in the program-group were compared with a usual care group (UC-group) of subjects matched from an occupational health service database based on age, gender and type of MSKD. Days of sick leave and hazard of work resumption were compared by a bootstrapped independent sample t-test and Cox regression, respectively. The program costs per working day gained in the program group were calculated assuming no changes in healthcare utilization. Within the program-group, healthcare costs and EuroQol (EQ) for the 6 months before and after the program were compared.
Results One hundred eleven program-participants provided data 6 months after the program with a mean age of 47 (±9.9) and of which 77 (69.4%) women. Days absent from work during follow-up since the first sick leave-day were 58.21 (±34.43) and 75.54 (39.78) in the program and UC- group (p=0.002). The Kaplan-Meier curve showed a median time until work resumption of 60 working days in the program-group and 85 working days in the UC-group (Fig.1) The hazard of work resumption in program-participants was not significantly lower than in the UC-group during the first 20 days of observation [hazard ratio (HR) 0.54 (95% CI 0.25-1.15)] but significantly higher thereafter [HR 1.60 (95% CI 1.22-2.11)]. Average productivity costs were € 11,457 (±9,265/median 8,549) in the program-group and € 15,680 (±10,864/ median 12,848) in the UC-group (p=0.001). Program costs were € 6172 and costs per working day gained were € 356. Costs of healthcare utilization in program-participants decreased from € 1887 (±3755)/6 months/patient to € 1112 (±1470)/6 months/patient.EQ-5D/EQ-VAS improved significantly from 0.57 (±0.26) to 0.70 (±0.22) and from 56.07 (±15.06) to 69.44 (±13.56) 6 months after the program.
Conclusions In MSKD-patients on recent sick leave, the multidisciplinary program reduces the total length of sick leave compared to usual care. Costs of the treatment program are partially offset by improvement in health and healthcare costs.
References
Waddell et al. Report for the Vocational Rehabilitation Task Group; TSO; 2008.
van Tubergen et al. Arthritisand Rheumatism; 2001.
Disclosure of Interest None declared