Return to Work in Patients with Chronic Musculoskeletal Pain: Multidisciplinary Intervention Versus Brief Intervention: A Randomized Clinical Trial.
Randi Brendbekken, Hege R Eriksen, Astrid Grasdal and 3 others
PMID 26910406WHAT IT FOUND
A comprehensive multidisciplinary intervention did not increase full return to work at 12 or 24 months compared to a brief intervention.
However, patients in the multidisciplinary group returned to partial work significantly faster during the first seven months.
Key findings
01There were no significant differences between the multidisciplinary and brief intervention groups in the proportion of patients fully returned to work at either the 12-month or 24-month follow-up.
02Patients in the multidisciplinary group were significantly more likely to be on partial return to work than the brief group during months two, three and seven.
03The multidisciplinary intervention involved more therapist time and a broader assessment of psychosocial factors, but did not result in higher rates of full return to work.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The two interventions were quite similar in their core philosophy, as both were based on a non-injury model and included patient education, which may have diluted the observable difference between them. Both interventions focused solely on the individual patient; neither involved direct workplace interventions or collaboration with employers, which the authors suggest might be necessary for better outcomes. The participants were referred by general practitioners as difficult cases, and many had physically demanding jobs with fewer opportunities for alternative work, which may have limited the potential for return to work regardless of treatment. The generous sickness compensation system in Norway may have reduced the economic incentive for patients to return to work quickly, affecting outcomes in both groups. There was no blinding of patients or therapists, which could have influenced patient engagement and reporting of partial work status.
Declared interests
The study was funded by Innlandet Hospital Trust, Norway. No other conflicts of interest were reported.
The easy way to misread this
Do not interpret the faster reduction in full sick leave in the MI group as evidence that it is superior for achieving full return to work. The primary outcome of full return to work was null at both 12 and 24 months, and the significant findings were limited to partial return to work in the first seven months.