title: Rehabilitation benefits highly motivated patients: a six-year prospective cost-effectiveness study.
abstract: OBJECTIVE
  To compare the six-year outcome of a multidisciplinary rehabilitation program with continued care within primary care in terms of health-related quality of life and cost-effectiveness. Furthermore, predictors of total costs to society were examined.
  
  
  METHODS
  A prospective, matched, controlled, six-year follow-up was designed. The study included 236 patients (42 men, 194 women) nineteen to sixty-one years of age with prolonged musculoskeletal disorders. The intervention comprised a four-week multidisciplinary rehabilitation and an active one-year follow-up based on a bio-psycho-social approach. The control group received continued care within primary care. The main outcome measures were quality of life measured using the Nottingham Health Profile, motivation identified by an interview and patient-specific total costs to society. Differences in mean costs between groups and cost-effectiveness were evaluated by applying nonparametric bootstrapping techniques.
  
  
  RESULTS
  Total costs per treated patient in the rehabilitation group and the control group were pound 43,464 (SD = 31,093) and pound 44,123 (SD = 33,333), respectively (p = .896). Multidisciplinary rehabilitation improved quality of life somewhat more cost-effectively. Motivation was revealed as a predictor of total costs.
  
  
  CONCLUSIONS
  In the long-run, the evaluated multidisciplinary rehabilitation improved the highly motivated patients' quality of life most cost-effectively. The latently motivated patients may require rehabilitation, which is less intensive and with a longer duration, to improve their health in a whole-person perspective. The burden of prolonged musculoskeletal disorders to society was reaffirmed. Motivation could be a predictor of total costs, a factor which has to be taken into account in the examination procedure.
authors.affiliation: Department of Physical Therapy, Lund University, University Hospital, Kronoberg County Council, Växjö, Sweden.
authors.forename: Birgitta E M
authors.initials: BE
authors.lastname: Grahn
authors.forename: Lars A
authors.initials: LA
authors.lastname: Borgquist
authors.forename: Charlotte S
authors.initials: CS
authors.lastname: Ekdahl
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009140:Musculoskeletal Diseases / Q000191:economics* / Q000534:rehabilitation*; D011788:Quality of Life