title: A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain.
abstract: 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.
authors.affiliation: Section for Personal Injury Prevention, Karolinska Institutet, Box 127 18, 112 94 Stockholm, Sweden Unit of Statistics and epidemiology, Clinical Research Center, Örebro University Hospital, 701 82 Örebro, Sweden.
authors.forename: Irene B
authors.initials: IB
authors.lastname: Jensen
authors.forename: Gunnar
authors.initials: G
authors.lastname: Bergström
authors.forename: Therese
authors.initials: T
authors.lastname: Ljungquist
authors.forename: Lennart
authors.initials: L
authors.lastname: Bodin
mesh_terms: D000328:Adult; D001416:Back Pain / Q000191:economics / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000191:economics / Q000534:rehabilitation*; D010415:Pensions; D026761:Physical Therapy Specialty / Q000191:economics / Q000458:organization & administration*; D015397:Program Evaluation; D011788:Quality of Life; D012046:Rehabilitation / Q000191:economics / Q000458:organization & administration*; D018582:Sick Leave