A health system program to reduce work disability related to musculoskeletal disorders.
BACKGROUND
Musculoskeletal disorders (MSDs) are a frequent cause of work disability, accounting for productivity losses in industrialized societies equivalent to 1.3% of the U.S. gross national product.


OBJECTIVE
To evaluate whether a population-based clinical program offered to patients with recent-onset work disability caused by MSDs is cost-effective.


METHODS
Randomized, controlled intervention study. The inclusion and follow-up periods each lasted 12 months.


METHODS
Three health districts in Madrid, Spain.


METHODS
All patients with MSD-related temporary work disability in 1998 and 1999.


METHODS
The control group received standard primary care management, with referral to specialized care if needed. The intervention group received a specific program, administered by rheumatologists, in which care was delivered during regular visits and included 3 main elements: education, protocol-based clinical management, and administrative duties.


METHODS
Efficacy variables were 1) days of temporary work disability and 2) number of patients with permanent work disability. All analyses were done on an intention-to-treat basis.


RESULTS
1,077 patients were included in the study, 7805 in the control group and 5272 in the intervention group, generating 16,297 episodes of MSD-related temporary work disability. These episodes were shorter in the intervention group than in the control group (mean, 26 days compared with 41 days; P < 0.001), and the groups had similar numbers of episodes per patient. Fewer patients received long-term disability compensation in the intervention group (n = 38 [0.7%]) than in the control group (n = 99 [1.3%]) (P < 0.005). Direct and indirect costs were lower in the intervention group than in the control group. To save 1 day of temporary work disability, 6.00 dollars had to be invested in the program. Each dollar invested generated a benefit of 11.00 dollars. The program's net benefit was in excess of 5 million dollars.


CONCLUSIONS
The study was unblinded.


CONCLUSIONS
Implementation of the program, offered to the general population, improves short- and long-term work disability outcomes and is cost-effective.
Abásolo
Lydia
L
Hospital Clinico San Carlos, Hospital Ramón y Cajal, Madrid, Spain.
Blanco
Margarita
M
Bachiller
Javier
J
Candelas
Gloria
G
Collado
Paz
P
Lajas
Cristina
C
Revenga
Marcelino
M
Ricci
Patricia
P
Lázaro
Pablo
P
Aguilar
Maria Dolores
MD
Vargas
Emilio
E
Fernández-Gutiérrez
Benjamín
B
Hernández-García
César
C
Carmona
Loreto
L
Jover
Juan A
JA
D000041:Absenteeism; D000328:Adult; D006233:Persons with Disabilities; D004434:Early Ambulation; D004651:Employment; D006804:Ergonomics; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000534:rehabilitation*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D015397:Program Evaluation / Q000191:economics; D013030:Spain; D017211:Treatment Failure; D016896:Treatment Outcome