Promoting work ability in a structured national rehabilitation program in patients with musculoskeletal disorders: outcomes and predictors in a prospective cohort study

Clinical Application of Rapid Upper Limb Assessment and Nordic Musculoskeletal Questionnaire in Work-Related Musculoskeletal Disorders: A Bibliometric Study

Assessment of work-related musculoskeletal disorders (WMSDs) using the Rapid Upper Limb Assessment (RULA) and the Nordic Musculoskeletal Questionnaire (NMQ) has become widely accepted and reported in the literature. The objectives of this study are to (1) recognize and describe the topmost 50 cited scientific articles in WMSDs using the RULA and NMQ and (2) explore the factors that contribute to making an article influential. In this bibliometric study, we used the Web of Science and MEDLINE databases to identify the top 50 cited articles published from 1993 to 2022. The data collected were the title of the journal, number of citations, year of publication, type of the study, institution where the work was conducted, level of evidence, contribution of primary authors, and country of origin of the work. Our results showed that the top 50 cited articles were published between 1980 and 2010. The 2000s was the most valuable decade. Regarding journals, the Work journal had the highest number of articles concerning the use of RULA and NMQ in healthcare professionals. The maximum number of citations regarding RULA occurred in the Journal of Robotic Surgery (n = 50) and the maximum for NMQ occurred in the Journal of Safety Research (n = 106). Most articles originated from the United States, followed by England and the Netherlands. Eight authors had two publications published in the top 50 list. The majority of the topmost cited research articles were cross-sectional studies. Most of these studies were level III evidence. The bibliometric analysis from this study provides insights to researchers to choose the most appropriate and influential journal for submitting work on WMSDs.

Non-pharmacological interventions to promote work participation in people with rheumatic and musculoskeletal diseases: a systematic review and meta-analysis from the EULAR taskforce on healthy and sustainable work participation

OBJECTIVE

To summarise the evidence on effectiveness of non-pharmacological (ie, non-drug, non-surgical) interventions on work participation (sick leave, work status and presenteeism) in people with rheumatic and musculoskeletal diseases (RMDs).

METHODS

A systematic review of randomised controlled trials (RCTs) and longitudinal observational studies (LOS) was performed. Qualitative (RCTs/LOS) and quantitative (RCTs) evidence syntheses were conducted. Mixed-effects restricted maximum likelihood models were used to combine effect estimates, using standardised mean differences (SMDs) as the summary measure for each outcome domain separately, with a negative SMD favouring the intervention over comparator. Subgroup analyses were performed for type of RMD, risk status at baseline regarding adverse work outcomes and intervention characteristics.

RESULTS

Of 10 153 records, 64 studies (37 RCTs and 27 LOS; corresponding to k=71 treatment comparisons) were included. Interventions were mostly conducted in clinical settings (44 of 71, 62%). Qualitative synthesis suggested clear beneficial effects of 7 of 64 (11%) interventions for sick leave, 1 of 18 (6%) for work status and 1 of 17 (6%) for presenteeism. Quantitative synthesis (37 RCTs; k=43 treatment comparisons) suggested statistically significant but only small clinical effects on each outcome (SMD_{sick leave} (95% CI)=-0.23 (-0.33 to -0.13; k=42); SMD_{work status}=-0.38 (-0.63 to -0.12; k=9); SMD_presenteeism=-0.25 (-0.39 to -0.12; k=13)).

CONCLUSION

In people with RMDs, empirical evidence shows that non-pharmacological interventions have small effects on work participation. Effectiveness depends on contextual factors such as disease, population risk status, intervention characteristics and outcome of interest, highlighting the importance of tailoring interventions.

Components of primary care multimodal rehabilitation and their association with changes in sick leave: An observational study

BACKGROUND: To address the increase in sick leave for nonspecific chronic pain and mental illness, the Swedish government and the Swedish Association of Local Authorities and Regions entered into an agreement on a “Rehabilitation Guarantee” to carry out multimodal rehabilitation (MMR). OBJECTIVE: To investigate whether components of primary care MMR are associated with changes in sick leave. METHODS: A web-based survey was conducted in conjunction with a retrospective cross-sectional observational study of 53 MMR units. Sick leave data for the years before and after MMR completion was collected for 846 individuals. RESULTS: There was great disparity in how MMR was delivered. The average duration of rehabilitation was 4–8 weeks, and 74% of the MMR teams reported having fewer patients than recommended (≥20/year). Only 58% of the teams met the competence requirements. In-depth competence in pain relief and rehabilitation was reported by 45% of the teams and was significantly associated with fewer sick leave days after MMR (26.53, 95% CI: 3.65; 49.42), as were pain duration (17.83, 95% CI: –9.20; 44.87) and geographic proximity (23.75, 95% CI: –5.25; 52.75) of the health care professionals included in the MMR unit. CONCLUSIONS: In-depth competence and knowledge about the complex health care needs of patients seem essential to MMR teams’ success in reducing sickness benefits for patients with nonspecific chronic pain and mental illness. Further research is needed to elucidate the optimal combination of primary care MMR components for increasing the return-to work rate and to determine whether involvement of the Social Insurance Agency or employers could support and further contribute to recuperation and help patients regain their previous work capacity.

Application of the rapid upper limb assessment tool to assess the level of ergonomic risk among health care professionals: A systematic review

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) and ergonomic risk factors are widespread problems in the healthcare sector. OBJECTIVE: The primary objective of this review is to evaluate the application of the Rapid Upper Limb Assessment (RULA) tool in various healthcare professionals and to assess the level of ergonomic risk among them. METHODS: The databases MEDLINE, EMBASE, CINAHL, LILACS, SCIELO, DOAJ, PubMed, and PEDro were searched with terms associated with ergonomics, assessment, health care providers, risk factors, workplace, and RULA. We reviewed the literature from 2000 to 2020, including studies assessing RULA’s effectiveness for evaluating the WMSD’s and ergonomic risk in health care practitioners. We excluded the studies which were not open access and freely available. RESULTS: Overall, 757 records were screened; of these 40 potential studies, 13 different healthcare professionals were identified as eligible for inclusion. In most studies, the RULA tool was established as an effective tool in application and evaluating the level of the ergonomic risk among them. CONCLUSIONS: The RULA tool assessed the high ergonomic risk levels in dental professionals and low ergonomic risk levels in professionals working in the pharmacy department, clearly suggesting potential changes in work postures were necessary to prevent or reduce these risk factors.

Predictive Factors of Short-Term Related Musculoskeletal Pain in the Automotive Industry

To determine the short-term associations between biomechanical risk factors and musculoskeletal symptoms in the upper limbs and low back in an automotive company, a longitudinal study with a follow-up of 4 days was conducted in a sample of 228 workers of the assembly and paint areas. Data were analyzed using generalized estimating equations, calculating the crude and adjusted model for age, sex, seniority, and intensity of pain at baseline. The interactions found were the same for both models. Workers were divided in low-risk and high-risk group for posture, force, exposure, percentage of cycle time with the arm at/above shoulder level, and with the trunk flexed or/and strongly flexed. The predictive factors showed by time × group effect were found between pain intensity on the left shoulder for posture (β = 0.221, p < 0.001), percentage of time with the trunk flexed (β = 0.136, p = 0.030) and overall exposure (β = 0.140, p = 0.013). A time × group interactions were observed, namely between neck pain and posture (β = 0.218, p = 0.005) and right wrist and force (β = 0.107, p = 0.044). Workers in the high-risk group were more prone to report unfavorable effects on their self-reported musculoskeletal pain, across a workweek when exposed to specific risk factor, being posture important to neck, right wrist and left shoulder pain.

Self-Reported Health in Patients on or at Risk of Sick Leave Due to Depression and Anxiety: Validity of the EQ-5D

Objectives: The EQ-5D is a generic, self-report measure of health that is increasingly used in clinical settings, including mental health. The EQ-5D captures health using five dimensions: Mobility, Self-care, Usual activities, Pain/discomfort, and Anxiety/Depression. The validity of the EQ-5D is previously unexplored in patients on or at risk of sick leave due to depression and anxiety. The study’s aim was to examine its validity in this group of patients.

Methods: Baseline data were collected from self-report questionnaires in an observational study (N=890) at a Norwegian outpatient-clinic. Participants were adults on or at risk of sick leave due to depression and anxiety who were referred for treatment by general practitioners. The crosswalk methodology was applied to estimate the EQ-5D value. Validity was assessed by comparing responses on the EQ-5D with the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI), and Subjective Health Complaints (SHC). An ordinal regression model was used to assess known-groups validity. Convergent validity was assessed using Pearson’s correlation coefficient, and a multivariate regression model that included sociodemographic characteristics.

Results: The mean EQ-5D value was 0.631, indicating reduced health status compared to “full health” anchored at 1.0, and patients reported moderate levels of depression and anxiety. Ordinal regression indicated that the EQ-5D could discriminate between different levels of symptom severity for depression and anxiety. The EQ-5D value showed significant correlation with the clinical measures; r=−0.52 for the BDI-II, r=−0.49 for the BAI, and r=−0.44 for SHC. The multivariate regression showed that the clinical variables significantly predicted the EQ-5D value, explaining 40.1% of the variance. Depression and anxiety scores were the largest determinants of EQ-5D value, respectively, whilst sick leave, subjective health complaints, and gender made moderate contributions.

Conclusion: The EQ-5D showed indication of validity in patients on or at risk of sick leave due to depression and anxiety in the present study. The EQ-5D value was sensitive to both symptom severity and functional impairment in the form of sick leave. The findings support the EQ-5D as a feasible and relevant measure of health status in these patients.

Working time and upper limb musculoskeletal symptoms: a longitudinal study among assembly line workers

This study followed assembly line workers during 7 months, comprising a 4-wk season holidays. The main purposes were to determine the potential effect of working time on the presence and intensity of upper limb musculoskeletal symptoms, as to verify the effect of 4 wk of job interruption in the upper limb musculoskeletal symptoms presence and intensity. Data was collected during 6 moments. Generalized estimating equations analyses were used. For the effect estimates, odds ratio with corresponding 95% confidence intervals were reported for each outcome/model. The upper limb musculoskeletal symptoms showed a significant increase (p=0.001), especially after the 4 wk off. In all data collection points there was a significant positive association between the upper limb musculoskeletal symptoms and general health status (p<0.001). Considering symptoms’ intensity, significant relations were found (p<0.001). Work time had a negative effect on the work-related upper limb musculoskeletal symptoms over 7 months (OR 0.909, 95% CI 0.861–0.960, p=0.001). For the intensity of upper limb symptoms, the effect of time was also statistical significant (OR 0.115, 95% CI 1.031–1.220, p=0.008). A 4-wk job interruption did not show an immediately positive effect on upper limb musculoskeletal symptoms presence.

Long-term effects on function, health-related quality of life and work ability after structured physiotherapy including a workplace intervention. A secondary analysis of a randomised controlled trial (WorkUp) in primary care for patients with neck and/or back pain

Objective: To study the long-term effects of a workplace intervention in addition to structured physiotherapy regarding self-reported measures in patients with acute/subacute neck and/or back pain.Design: WorkUp - a cluster-randomised controlled trial in 32 primary care centers in Sweden, from January 2013 through December 2014 (ClinicalTrials.gov ID: NCT02609750).Intervention: Structured physiotherapy with the workplace dialogue 'Convergence Dialogue Meeting' (CDM), conducted by the treating physiotherapist as an add-on. Reference group received structured physiotherapy.Subjects: Adults, 18-67 years (mean 43.7, standard deviation (SD) 12.2), 65.3% women with acute/subacute neck and/or back pain who had worked ≥4 weeks past year, considered at risk of sick leave or were on short-term sick leave (≤60 days) were included (n = 352).Outcome measures: Self-reported function, functional rating index (FRI), health-related quality of life (EQ-5D-3L) and work ability (Work Ability Score, WAS) at 12 months follow-up.Results: The mean differences in outcomes between intervention and reference group were; -0.76 (95% confidence interval (CI): -2.39, 0.88; FRI), 0.02 (95% CI: -0.04, 0.08; EQ-5D-3L) and -0.05 (95% CI: -0.63, 0.53; WAS). From baseline to 12 months, the intervention group improved function from 46.5 (SD 19.7) to 10.5 (SD 7.3) on FRI; health-related quality of life from 0.53 (SD 0.29) to 0.74 (SD 0.20) on EQ-5D and work ability from 5.7 (SD 2.6) to 7.6 (SD 2.1) on WAS.Conclusion: Despite a clinically relevant improvement over time, there were no significant differences in improvement between groups, thus we conclude that CDM had no effect on self-reported measures in this study.Key pointsIn earlier analysis of the primary outcome (work ability measured by absenteeism) in this trial, a positive effect was found when the workplace intervention 'Convergence Dialogue Meeting' (CDM) was added to structured physiotherapy for patients with neck or back pain.By contrast, in this new analysis of secondary outcomes (self-reported function, health and perceived work ability), there was no added effect of CDM above structured physiotherapy alone, although patients in both the intervention and reference group improved over time.The addition of CDM to physiotherapy is therefore justified by its specific effect on behavior (work absence) rather than any effect on clinical outcomes.

Evaluation of a multimodal pain rehabilitation programme in primary care based on clinical register data: a feasibility study

Aim:

Investigate the feasibility of identifying a well-defined treatment group and a comparable reference group in clinical register data.

Background:

There is insufficient knowledge on how to avert neck/back pain from turning chronic or to impair work ability. The Swedish Government implemented a national multimodal rehabilitation (MMR) programme in primary care intending to promote work ability, reduce sick leave and increase return to work. Since randomised control trial data for effect is lacking, it is important to evaluate existing observational data from clinical settings.

Methods:

We identified all unique patients with musculoskeletal pain (MSP) diagnoses undergoing the MMR programme in primary care in the Skåne Health care Register (n = 2140) during 2010–2011. A reference cohort in primary care (n = 56 300) with similar MSP diagnoses, same ages and the same level of sick leave before baseline was identified for the same period. The reference cohort received ordinary care and treatment in primary care. The final study group consisted of 603 eligible MMR patients and 2874 eligible reference patients. Socio-economic and health-related baseline data including sick leave one year before up to two years after baseline were compared between groups.

Findings:

There were significant socio-economic and health differences at baseline between the MMR and the reference patients, with the MMR group having lower income, higher morbidity and more sick leave days. Sick leave days per year decreased significantly in the MMR group (118–102 days, P < 0.001) and in the reference group (50–42 days, P < 0.001) from one year before baseline to two years after.

Conclusions:

It was not feasible to identify a comparable reference group based on clinical register data. Despite an ambitious attempt to limit selection bias, significant baseline differences in socio-economic and health were present. In absence of randomised trials, effects of MMR cannot be sufficiently evaluated in primary care.

Can the STarT Back Tool predict health-related quality of life and work ability after an acute/subacute episode with back or neck pain? A psychometric validation study in primary care

OBJECTIVES

The predictive ability of the STarT Back Tool (SBT) has not yet been examined among acute/subacute back and/or neck pain in a primary care setting in respect to health-related quality of life (HRQoL) and work ability outcomes. The aim of this study was to evaluate the SBT's predictive validity for HRQoL and work ability outcomes at long-term follow-up in a population with acute/subacute back and/or neck pain.

SETTING

Prospective data from 35 primary care centres in south Sweden during 2013.

PARTICIPANTS

Patients (n=329) with acute/subacute back and/or neck pain, aged 18-67 years, not on sick leave or <60 days of sick leave completed the SBT when applying for physiotherapy treatment. Long-term follow-up measures (median 13 months, range 11-27 months) of HRQoL (EQ-5D) and work ability (Work Ability Score) was completed by 238 patients (72%).

OUTCOMES

The predictive ability of the SBT for HRQoL and work ability outcomes was examined using Kruskal-Wallis test, logistic regression and area under the curve (AUC).

RESULTS

Based on SBT risk group stratification, 103 (43%), 107 (45%) and 28 (12%) patients were considered as low, medium and at high risk, respectively. There were statistically significant differences in HRQoL (p<0.001) and work ability (p<0.001) at follow-up between all three SBT risk groups. Patients in the high risk group had a significantly increased risk of having poor HRQoL (OR 6.16, 95% CI 1.50 to 25.26) and poor work ability (OR 5.08, 95% CI 1.75 to 14.71) vs the low risk group at follow-up. The AUC was 0.73 (95% CI 0.61 to 0.84) for HRQoL and 0.68 (95% CI 0.61 to 0.76) for work ability.

CONCLUSIONS

The SBT is an appropriate tool for identifying patients with a poor long-term HRQoL and/or work ability outcome in a population with acute/subacute back and/or neck pain, and maybe a useful adjunct to primary care physiotherapy assessment and practice.

TRIAL REGISTRATION NUMBER

NCT02609750; Results.

Use of pain medication before and after inpatient musculoskeletal rehabilitation: longitudinal analysis of a nationwide cohort

The objective of this study was to identify subgroups among the participants in inpatient multidisciplinary musculoskeletal rehabilitation based on the differences in the shapes of trajectories of pain medication consumption during the 9 years around the time of intervention. A register-based study among 4578 public sector employees was conducted. Group-based trajectory analysis was done on the purchase of prescribed pain medications during the 9 years around the time of rehabilitation. The participants were on an average 50.7 (SD=6.6) years of age, and 2955 (86%) were women. Average yearly purchase of pain medications increased during the follow-up period from 73.4 (SD=193.0) to 163.3 (SD=295.7) defined daily doses. The analysis suggested six-cluster model. The shapes of the trajectories of three clusters did not show any steep slopes, one trajectory demonstrated nonstop rising through the entire follow-up, and one trajectory was closed to the trajectory average of medication use. One trajectory (11% of the sample) demonstrated a steep growth before the intervention and steep drop after it. When comparing this cluster with all other clusters combined, odds ratios were 0.40 [95% confidence interval (CI): 0.19-0.85] for age group (older vs. younger), 0.78 (95% CI: 0.61-1.01) for sex (women vs. men), and 1.44 (95% CI: 1.09-1.90) for occupational status (lower vs. higher). In other words, the participants belonged to this cluster were younger employees with a lower occupational grade. It seems that younger employees in manual jobs benefitted of the studied multidisciplinary musculoskeletal rehabilitation the most, especially when the timing of intervention is bounded to the substantial rise of pain severity.

Fostering needs assessment and access to medical rehabilitation for patients with chronic disease and endangered work ability: protocol of a multilevel evaluation on the effectiveness and efficacy of a CME intervention for general practitioners

BACKGROUND

Studies show that endangered work ability (EWA) can be maintained or restored through medical rehabilitation (MR). For patients, general practitioners (GP) represent an important point of access to MR in outpatient care. However, many different barriers and shortcomings hinder GPs in both timely detection of the need for MR and the recognition of its potentials for their EWA-patients. These are necessary if GPs are to adequately inform patients about MR options and successfully support applications for MR. This study describes the evaluation of a continuing medical education (CME) module designed to improve rehabilitation-related practical performance of GPs regarding a) subjective satisfaction of GPs with the CME module, b) stability of attitudes and knowledge over time regarding rehabilitation, and c) subjective and objective changes in MR-related competencies needed to support MR applications.

METHODS

This study is an open, non-randomised, pre-post-intervention study. The intervention involves a CME module for GPs (n = 1365) in the German state of Saxony-Anhalt on the topic of medical rehabilitation in connection with the federal German pension fund (Deutsche Rentenversicherung). The module will be initially held as regularly scheduled meetings in moderated GP quality circles (QC), and then offered as a written self-study unit. At the end it will be evaluated by the GPs. The study's primary focus is on the organizational practice as measured by the number of approved MR applications supported by medical reports submitted by the participating GPs in the 6 months before and 6 months after the CME module. Other study aims involve measuring self-perceived competencies of GPs, as well as their attitudes towards and knowledge of rehabilitation (both upon completing the CME and 6 months later). In addition, the level of satisfaction with the CME module will be analysed among participating GPs and QC moderators (as CME facilitators).

DISCUSSION

Implementing targeted CME on complex topics such as those involving barriers is possible, even promising, when using QCs and their moderators. Of particular importance is how aware moderating physicians are of the relevance of MR need detection and access.

ETHICS AND DISSEMINATION

The ethics committee of the Martin-Luther-Universität Halle-Wittenberg has registered this study under the number 2014-13. The study will be reported on in peer-reviewed journals and at national and international conferences. The results will be available to current and future initiatives aiming to improve detection of MR need and making MR accessible to EWEC patients needing such support to minimize the effects of chronic disease on their livess.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register (ID number DRKS00006188) and WHO International Clinical Trials Registry Platform, Universal Trial Number (UTN) U1111-1158-8334.

Referring to multimodal rehabilitation for patients with musculoskeletal disorders - a register study in primary health care

Background

In 2008, the Swedish government introduced a National Rehabilitation Program, in which the government financially reimburses the county councils for evidence-based multimodal rehabilitation (MMR) interventions. The target group is patients of working age with musculoskeletal disorders (MSD), expected to return to work or remain at work after rehabilitation. Much attention in the evaluations has been on patient outcomes and on processes. We lack knowledge about how factors related to health care providers and community can have an impact on how patients have access to MMR. The aim of this study was therefore to study the impact of health care provider and community related factors on referrals to MMR in patients with MSD applying for health care in primary health care.

Methods

This was a primary health care-based cohort study based on prospectively ascertained register data. All primary health care centres (PHCC) contracted in Region Skåne in 2010-2012, referring to MMR were included (n = 153). The health care provider factors studied were: community size, PHCC size, public or private PHCC, whether or not the PHCCs provided their own MMR, burden of illness and the community socioeconomic status among the registered population at the PHCCs. The results are presented with descriptive statistics and for the analysis, non-parametric and multiple linear regression analyses were applied.

Results

PHCCs located in larger communities sent more referrals/1000 registered population (p = 0.020). Private PHCCs sent more referrals/1000 registered population compared to public units (p = 0.035). Factors related to more MMR referrals/1000 registered population in the multiple regression analyses were PHCCs located in medium and large communities and with above average socioeconomic status among the registered population at the PHCCs, private PHCC and PHCCs providing their own MMR. The explanation degree for the final model was 24.5%.

Conclusions

We found that referral rates to MMR were positively associated with PHCCs located in medium and large sized communities with higher socioeconomic status among the registered population, private PHCCs and PHCCs providing their own MMR. Patients with MSD are thus facing significant inequities and were thus not offered the same opportunities for referrals to rehabilitation regardless of which PHCC they visited.

Work-related musculoskeletal disorders in Australian dentists and orthodontists: Risk assessment and prevention

BACKGROUND

As professionals work longer hours and live longer there have been concerns regarding the Work related Musculoskeletal Disorders (WMSD) affecting both professional and personal lives. Moreover, past decade has seen a surge in interest in all allied health sciences personnel with self reporting cross sectional studies.

OBJECTIVE

Health professionals often suffer WMSD due to occupational stress. It is important to assess the problem in order to find ways to prevent it. Hence, the focus of this cross-sectional survey. The aim was to investigate the prevalence and risk factors of WMSD between Australian dentists and orthodontists.

MATERIALS AND METHOD

A postal survey was sent to 447 Australian orthodontists and 450 Queensland dentists using the universal Nordic scale previously piloted at UQ and refined for this cross-sectional study. Questions were directed towards individuals, workplace and psychosocial variables and were designed to gather information regarding health, lifestyle, education, awareness of musculoskeletal problems and current preventative strategies.

RESULTS

A high prevalence of musculoskeletal problems was found for both dentists (88.9%) and orthodontists (83.6%) reported in the last 12 months. The main predictor in both groups was increased work stress. Less than a third of those professionals surveyed had received education regarding dental practice ergonomics during their tertiary education.

CONCLUSION

Dentists and orthodontists experienced a high rate of musculoskeletal problems which were associated with increased levels of stress at work. Further research should be directed toward interventions aimed at reducing stress in the work environment as well as improving work posture.

Back pain: Prevention and management in the workplace

Despite all the efforts in studying work-related risk factors for low back pain (LBP), interventions targeting these risk factors to prevent LBP have no proven cost-effectiveness. Even with adequate implementation strategies for these interventions on group level, these did not result in the reduction of incident LBP. Physical exercise, however, does have a primary preventive effect on LBP. For secondary prevention, it seems that there are more opportunities to cost-effectively intervene in reducing the risk of long-term sickness absence due to LBP. Starting at the earliest moment possible with proper assessment of risk factors for long-term sickness absence related to the individual, the underlying mechanisms of the LBP, and also factors related to the workplace by a well-trained clinician, may increase the potential of effective return to work (RTW) management. More research on how to overcome barriers in the uptake of these effective interventions in relation to policy-specific environments, and with regard to proper financing of RTW management is necessary.

Productivity at work and quality of life in patients with rheumatoid arthritis

Background

The aim of this study was to determine which combination of personal, disease-related and environmental factors is best associated with at-work productivity loss in patients with rheumatoid arthritis (RA), and to determine whether at-work productivity loss is associated with the quality of life for these patients.

Methods

This study is based on cross-sectional data. Patients completed a questionnaire with personal, disease-related and environmental factors (related to the work environment), and clinical characteristics were obtained from patient medical records. At-work productivity loss was measured with the Work Limitations Questionnaire, and quality of life with the RAND 36. Using linear regression analyses, a multivariate model was built containing the combination of factors best associated with at-work productivity loss. This model was cross-validated internally. We furthermore determined whether at-work productivity loss was associated with quality of life using linear regression analyses.

Results

We found that at-work productivity loss was associated with workers who had poorer mental health, more physical role limitations, were ever treated with a biological therapeutic medication, were not satisfied with their work, and had more work instability (R² = 0.50 and R² following cross-validation was 0.32). We found that at-work productivity loss was negatively associated with health-related quality of life, especially with dimensions of mental health, physical role limitations, and pain.

Conclusions

We found that at-work productivity loss was associated with personal, work-related, and clinical factors. Although our study results should be interpreted with caution, they provide insight into patients with RA who are at risk for at-work productivity loss.

Predictors of multidisciplinary treatment outcome in patients with chronic musculoskeletal pain

PURPOSE

The present study aimed to identify predictors of rehabilitation outcome for patients with chronic musculoskeletal pain (CMP) and psychological problems.

METHODS

A retrospective cohort study including 230 adult patients with CMP admitted for multidisciplinary pain rehabilitation. Potential predictors were patient characteristics, duration of complaints, baseline functioning, pain, personality, coping style, fear of movement, psychological distress and type of treatment. Outcome measures were physical functioning, mental health, pain and patient-reported effect. Multiple (logistic) regression models were used to identify predictors.

RESULTS

Patients who were more disabled and patients with more pain benefitted more from the rehabilitation treatment than less disabled patients or those with less pain. Age, work status, vitality, depression and coping style also predicted outcomes significantly. The models explained between 27 and 80% of the outcomes. There was an interaction between type of treatment, work status and the baseline pain score as regards the outcome in terms of pain.

CONCLUSIONS

No strong predictors of treatment outcome were found other than the baseline scores of the respective outcome variables. More disabled patients and patients with more pain benefitted more from the rehabilitation program. Other predictors improved the prediction models slightly. Implications for Rehabilitation It remains challenging to correctly predict the outcome of treatment from patients' baseline sociodemographic and psychological characteristics; predictors other than baseline scores of the outcome variables are only slightly associated with treatment outcome. Patients with chronic musculoskeletal pain and poor physical functioning or mental health benefit most from pain rehabilitation. Older patients benefit less from a pain rehabilitation program than younger patients in terms of physical functioning. Pain reduction during a pain rehabilitation program is greatest in patients with high pain intensity who are not at work at the start of the rehabilitation program. Coping style influences the outcome of rehabilitation of patients with chronic musculoskeletal pain.