title: Motivated patients are more cost-effectively rehabilitated. A two-year prospective controlled study of patients with prolonged musculoskeletal disorders diagnosed in primary care.
abstract: OBJECTIVE
  To compare the cost-effectiveness of a multidisciplinary rehabilitation program with traditional treatment within primary care in terms of the health-related quality of life (HRQOL) in patients with prolonged musculoskeletal disorders (MSD) on the one hand and the costs to society on the other. Predictors of total costs, such as motivation, socio-economic level, age, pain, and working environment, were investigated.
  
  
  METHODS
  A prospective, matched, controlled 2-year follow-up study was designed. The main outcome measures were HRQOL using the Nottingham Health Profile (NHP) and patient-specific total costs due to society. The cost-effectiveness was expressed as a quotient of the total costs to society/NHP global score difference value.
  
  
  RESULTS
  Patients with prolonged MSD generate substantial total costs to society, chiefly in the area of indirect costs. Multidisciplinary rehabilitation improved HRQOL more cost-effectively. Motivation was revealed as a predictor of total costs. The relationship in savings in terms of indirect costs between the highly-motivated and the less-motivated patients was calculated at 4:1.
  
  
  CONCLUSIONS
  The large group of patients with prolonged MSD generate substantial total costs, and even small reductions in direct and indirect costs could be of importance to society. The multidisciplinary rehabilitation program applied here was more cost-effective as compared with conventional treatment within primary care when it came to improving the patients' perceived HRQOL. Motivation could be a predictor of total costs, which has to be addressed in the process of identifying the patient as a partner in the rehabilitation process.
authors.affiliation: Lund University.
authors.forename: B E
authors.initials: BE
authors.lastname: Grahn
authors.forename: L A
authors.initials: LA
authors.lastname: Borgquist
authors.forename: C S
authors.initials: CS
authors.lastname: Ekdahl
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D009140:Musculoskeletal Diseases / Q000191:economics* / Q000523:psychology / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D013548:Sweden