Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up.
OBJECTIVE
To determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints.


METHODS
A randomized controlled trial with a 1-year follow-up was carried out. Thirty-eight subjects were allocated to multidisciplinary treatment (intervention, n=23), or to usual care provided by occupational health services (n=15). The intervention consisted of psychological and physical sessions provided by a medical specialist, a psychologist, a physiotherapist and an occupational therapist. It aims at reconditioning, "de-medicalizing", unrestrained moving and return-to-work. The intervention process was evaluated on compliance to the protocol and the effectiveness of its components. The individual outcome variable was the severity of complaints. The societal outcomes included return-to-work and costs. Measurements were performed at baseline and after 2, 6 and 12 months. Mixed model analyses were used for analysis.


RESULTS
The intervention achieves its aims: physical disabilities (P=0.039), kinesiophobia (P<0.001) and physical functioning (P=0.016) improved significantly as compared to usual care. In addition, the intervention was significantly more effective in reducing the severity of complaints than usual care. The intervention was equally effective compared to usual care in terms of return-to-work (86% in the intervention group vs. 73% in the usual care group). The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months.


CONCLUSIONS
Multidisciplinary treatment affects individuals positively, but shows no significant difference in (cost-) effectiveness on the societal level as compared to usual care.
Meijer
Eline M
EM
Academic Medical Center, Universiteit van Amsterdam, Coronel Institute of Occupational Health, Research Institute AmCOGG, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. e.m.meijer@amc.uva.nl
Sluiter
Judith K
JK
Heyma
Arjan
A
Sadiraj
Klarita
K
Frings-Dresen
Monique H W
MH
D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005500:Follow-Up Studies; D006801:Humans; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D009426:Netherlands; D009784:Occupational Diseases / Q000191:economics / Q000523:psychology / Q000628:therapy*; D010353:Patient Education as Topic; D018582:Sick Leave; D016896:Treatment Outcome; D034941:Upper Extremity