A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain.
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.
Jensen
Irene B
IB
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.
Bergström
Gunnar
G
Ljungquist
Therese
T
Bodin
Lennart
L
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