title: The effects of multimodal rehabilitation on pain-related sickness absence - an observational study.
abstract: The aim of the current study was to examine the effects on sickness absence of multimodal rehabilitation delivered within the framework of a national implementation of evidence based rehabilitation, the rehabilitation guarantee for nonspecific musculoskeletal pain.
  
  
  
  This was an observational matched controlled study of all persons receiving multimodal rehabilitation from the last quarter of 2009 until the end of 2010. The matching was based on age, sex, sickness absence the quarter before intervention start and pain-related diagnosis. The participants were followed by register data for 6 or 12 months. The matched controls received rehabilitation in accordance with treatment-as-usual.
  
  
  
  Of the participants, 54% (N = 3636) were on registered sickness absence at baseline and the quarter before rehabilitation. The average difference in number of days of sickness absence between the participants who received multimodal rehabilitation and the matched controls was to the advantage of the matched controls, 14.7 days (CI 11.7; 17.7, p ≤ 0.001) at 6-month follow-up and 9.5 days (CI 6.7; 12.3, p ≤ 0.001) at 12-month follow-up. A significant difference in newly granted disability pensions was found in favor of the intervention.
  
  
  
  When implemented nationwide, multimodal rehabilitation appears not to reduce sickness absence compared to treatment-as-usual. Implications for Rehabilitation A nationwide implementation of multimodal rehabilitation was not effective in reducing sickness absence compared to treatment-as-usual for persons with nonspecific musculoskeletal pain. Multimodal rehabilitation was effective in reducing the risk of future disability pension for persons with nonspecific musculoskeletal pain compared to treatment-as-usual. To be effective in reducing sick leave multimodal rehabilitation must be started within 60 days of sick leave. The evidence for positive effect of multimodal rehabilitation is mainly for sick listed patients. Prevention of sick leave for persons not being on sick leave should not be extrapolated from evidence for multimodal rehabilitation.
authors.affiliation: a Public Health Agency of Sweden , Stockholm , Sweden.
authors.forename: Hillevi
authors.initials: H
authors.lastname: Busch
authors.affiliation: b Unit of Intervention and Implementation Research for Worker Health , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Björk Brämberg
authors.affiliation: b Unit of Intervention and Implementation Research for Worker Health , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Hagberg
authors.affiliation: b Unit of Intervention and Implementation Research for Worker Health , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Bodin
authors.affiliation: b Unit of Intervention and Implementation Research for Worker Health , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.
authors.forename: Irene
authors.initials: I
authors.lastname: Jensen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D059352:Musculoskeletal Pain / Q000534:rehabilitation*; D009788:Occupational Therapy; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D062707:Return to Work; D018582:Sick Leave / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology
keywords: Multimodal rehabilitation; observational study; sick leave