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Reneman MF, Beemster TT, Welling SJ, Mierau JO, Dijk HH. Vocational Rehabilitation for Patients with Chronic Musculoskeletal Pain With or Without a Work Module: An Economic Evaluation. J Occup Rehabil 2021; 31:84-91. [PMID: 32816203 PMCID: PMC7954755 DOI: 10.1007/s10926-020-09921-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Vocational rehabilitation (VR) is a widely used intervention aimed to optimize work participation for patients on sick leave due to chronic musculoskeletal pain (CMP). Economic evaluations of care as usual VR are scarce, and may provide relevant information to guide clinical, reimbursement and policy decisions. The aim of this study was to evaluate the short-term cost-effectiveness and return on investment (ROI) of VR for patients on sick leave due to CMP with an additional work module (VR+) compared to VR without work module, from a societal and employers' perspective. Methods A retrospective longitudinal cohort study within a Dutch care as usual context was applied. Participants with CMP and decreased work participation originating from seven Dutch rehabilitation centers were included in this study. Participants underwent VR or VR+. Main data sources at baseline and discharge: Quality-adjusted life year (QALY) based on EQ-5D, intervention costs, self-reported productivity and health care utilization. Main analyses cost-effectiveness, including incremental cost-effectiveness ratio (ICER) and a cost-effectiveness acceptability curve (CEAC); and ROI analyses with use of the human capital method. Results N = 324 participants were analyzed. The results show that VR+ was cost-effective compared to VR: mean cost savings of €820 per 0.012 QALY gained. CEAC suggests probability of VR+ being cost-effective is > 0.91 for thresholds of €20.000 and higher. The mean ROI of VR+ for employers was 38%. Conclusion It was concluded that at discharge, VR+ was cost-effective compared to VR. ROI was positive for employers.
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Affiliation(s)
- Michiel F Reneman
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Haren, P.O. Box 30.002, 9750 RA, Groningen, The Netherlands.
| | - Timo T Beemster
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
- Department Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sybren J Welling
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Jochen O Mierau
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Aletta Jacobs School of Public Health, University of Groningen, Groningen, The Netherlands
| | - Hermien H Dijk
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
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Beemster TT, van Bennekom CAM, van Velzen JM, Frings-Dresen MHW, Reneman MF. Vocational Rehabilitation with or without Work Module for Patients with Chronic Musculoskeletal Pain and Sick Leave from Work: Longitudinal Impact on Work Participation. J Occup Rehabil 2021; 31:72-83. [PMID: 32378023 PMCID: PMC7954725 DOI: 10.1007/s10926-020-09893-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Purpose To study the longitudinal relationship between interdisciplinary vocational rehabilitation (VR) with and without additional work module on work participation of patients with chronic musculoskeletal pain and sick leave from work. Methods Retrospective longitudinal data retrieved from care as usual in seven VR centers in the Netherlands was used. The VR program without work module consisted of multi-component healthcare (physical exercise, cognitive behavioral therapy, education, relaxation). The other program with additional work module (VR+) included case management and a workplace visit. Generalized estimating equations using binary logistic was applied. The dependent variable was work participation (achieved/not achieved) on discharge and 6-months follow-up. Independent variables were type of intervention, return to work expectation, sick leave duration, working status, job strain, and job dissatisfaction. Results Data from N = 470 patients were analyzed, of which 26% received VR and 74% VR+. Both programs increased work participation at 6-months follow-up (VR 86%, VR+ 87%). The crude model showed a significant longitudinal relationship between type of intervention and work participation in favor of VR+ (OR 1.8, p = 0.01). The final model showed a non-significant relationship on discharge (OR 1.3, p = 0.51) and a significant relationship on 6-months follow-up in favor of VR+ (OR 1.7, p = 0.04). RTW expectation was a significant confounder in the final model on discharge and 6-months follow up (OR 3.1, p = 0.00). Conclusions Both programs led to increased work participation. The addition of a work module to the VR program lead to a significant increase in odds of work participation at 6-months follow-up.
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Affiliation(s)
- Timo T Beemster
- University Medical Center Groningen, Department of Rehabilitation Medicine, University of Groningen, Haren, P.O. Box 30.002, 9750 RA, Groningen, The Netherlands
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
- Amsterdam UMC, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Coen A M van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
- Amsterdam UMC, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith M van Velzen
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
- Amsterdam UMC, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Amsterdam UMC, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel F Reneman
- University Medical Center Groningen, Department of Rehabilitation Medicine, University of Groningen, Haren, P.O. Box 30.002, 9750 RA, Groningen, The Netherlands.
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Beemster TT, van Velzen JM, van Bennekom CAM, Reneman MF, Frings-Dresen MHW. Usefulness and feasibility of comprehensive and less comprehensive vocational rehabilitation for patients with chronic musculoskeletal pain: perspectives from patients, professionals, and managers. Disabil Rehabil 2020; 44:754-767. [PMID: 32588666 DOI: 10.1080/09638288.2020.1780481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To explore the usefulness and feasibility of a comprehensive vocational rehabilitation (C-VR) program and less comprehensive (LC-VR) program for workers on sick leave due to chronic musculoskeletal pain, from the perspective of patients, professionals, and managers. MATERIALS AND METHODS Semi-structured interviews were held with patients, professionals, and managers. Using topic lists, participants were questioned about barriers to and facilitators of the usefulness and feasibility of C-VR and LC-VR. Thirty interviews were conducted with thirteen patients (n = 6 C-VR, n = 7 LC-VR), eight professionals, and nine managers. All interviews were transcribed verbatim. Data were analyzed by systematic text condensation using inductive thematic analysis. RESULTS Three themes emerged for usefulness ("patient factors," "content," "dosage") and six themes emerged for feasibility ("satisfaction," "intention to continue use," "perceived appropriateness," "positive/negative effects on target participants," "factors affecting implementation ease or difficulty," "adaptations"). The patients reported that both programs were feasible and generally useful. The professionals preferred working with the C-VR, although they disliked the fixed and uniform character of the program. They also mentioned that this program is too extensive for some patients, and that the latter would probably benefit from the LC-VR program. Despite their positive intentions, the managers stated that due to the Dutch healthcare system, implementation of the LC-VR program would be financially unfeasible. CONCLUSIONS The main conclusion of this study is that it is not useful to have one VR program for all patients with CMP and reduced work participation, and that flexible and tailored-based VR are warranted.Implications for rehabilitationBoth comprehensive and less comprehensive vocational rehabilitation are deemed useful for patients with chronic musculoskeletal pain and reduced work participation. Particular patient factors, for instance information uptake, discipline, willingness to change, duration of complaints, movement anxiety, obstructing thoughts, and willingness to return to work might guide the right program for the right patient.Both comprehensive and less comprehensive vocational rehabilitation are deemed feasible in practice. However, factors such as center logistic (schemes, rooms, professionals available) and country-specific healthcare insurance and sickness compensation systems should foster the implementation of less comprehensive programs.
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Affiliation(s)
- Timo T Beemster
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.,Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Judith M van Velzen
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.,Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Coen A M van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.,Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Monique H W Frings-Dresen
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Beemster TT, van Velzen JM, van Bennekom CAM, Reneman MF, Frings-Dresen MHW. Test-Retest Reliability, Agreement and Responsiveness of Productivity Loss (iPCQ-VR) and Healthcare Utilization (TiCP-VR) Questionnaires for Sick Workers with Chronic Musculoskeletal Pain. J Occup Rehabil 2019; 29:91-103. [PMID: 29549605 DOI: 10.1007/s10926-018-9767-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The purpose of this study was to assess test-retest reliability, agreement, and responsiveness of questionnaires on productivity loss (iPCQ-VR) and healthcare utilization (TiCP-VR) for sick-listed workers with chronic musculoskeletal pain who were referred to vocational rehabilitation. Methods Test-retest reliability and agreement was assessed with a 2-week interval. Responsiveness was assessed at discharge after a 15-week vocational rehabilitation (VR) program. Data was obtained from six Dutch VR centers. Test-retest reliability was determined with intraclass correlation coefficient (ICC) and Cohen's kappa. Agreement was determined by Standard Error of Measurement (SEM), smallest detectable changes (on group and individual level), and percentage observed, positive and negative agreement. Responsiveness was determined with area under the curve (AUC) obtained from receiver operation characteristic (ROC). Results A sample of 52 participants on test-retest reliability and agreement, and a sample of 223 on responsiveness were included in the analysis. Productivity loss (iPCQ-VR): ICCs ranged from 0.52 to 0.90, kappa ranged from 0.42 to 0.96, and AUC ranged from 0.55 to 0.86. Healthcare utilization (TiCP-VR): ICC was 0.81, and kappa values of the single healthcare utilization items ranged from 0.11 to 1.00. Conclusions The iPCQ-VR showed good measurement properties on working status, number of hours working per week and long-term sick leave, and low measurement properties on short-term sick leave and presenteeism. The TiCP-VR showed adequate reliability on all healthcare utilization items together and medication use, but showed low measurement properties on the single healthcare utilization items.
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Affiliation(s)
- Timo T Beemster
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.
- Academic Medical Center, Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Judith M van Velzen
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
- Academic Medical Center, Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Coen A M van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
- Academic Medical Center, Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Monique H W Frings-Dresen
- Academic Medical Center, Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Beemster TT, van Velzen JM, van Bennekom CAM, Frings-Dresen MHW, Reneman MF. Cost-effectiveness of 40-hour versus 100-hour vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain: study protocol for a randomized controlled trial. Trials 2015. [PMID: 26215748 PMCID: PMC4518875 DOI: 10.1186/s13063-015-0861-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although vocational rehabilitation is a widely advocated intervention for workers on sick leave due to subacute or chronic nonspecific musculoskeletal pain, the optimal dosage of effective and cost-effective vocational rehabilitation remains unknown. The objective of this paper is to describe the design of a non-inferiority trial evaluating the effectiveness and cost-effectiveness of 40-h multidisciplinary vocational rehabilitation compared with 100-h multidisciplinary vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain. METHODS/DESIGN A non-inferiority study design will be applied. The study population consists of workers who are on part-time or full-time sick leave due to subacute or chronic nonspecific musculoskeletal pain. Two multidisciplinary vocational rehabilitation programs following the bio-psychosocial approach will be evaluated in this study: 40-h vocational rehabilitation and 100-h vocational rehabilitation, both delivered over a maximum of 15 weeks. The 100-h vocational rehabilitation comprises five modules: work participation coordination, graded activity, cognitive behavioral therapy, group education, and relaxation. The 40-h vocational rehabilitation comprises work participation coordination and a well-reasoned choice from the other four modules. Four rehabilitation centers will participate in this study, each delivering both interventions. Patients will be randomized into one of the interventions, stratified for the duration of sick leave (<6 weeks or ≥ 6 weeks) and type of sick leave (part-time or full-time). The primary outcome is work participation, measured by self-reported sick leave days, and will be assessed at baseline, mid-term, discharge, and at 2, 4, 6, 8, 10, and 12 months follow-up. Secondary outcomes are work ability, disability, quality of life, and physical functioning and will be assessed at baseline, discharge, and at 6 and 12 months follow-up. Cost outcomes are absenteeism, presenteeism, healthcare usage, and travelling costs. Cost-effectiveness will be evaluated from the societal and employer perspectives. DISCUSSION The results obtained from this study will be useful for vocational rehabilitation practice and will provide stakeholders with relevant insights into two versions of vocational rehabilitation. TRIAL REGISTRATION Dutch Trial Register identifier: NTR4362 (registered 17 March 2014).
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Affiliation(s)
- Timo T Beemster
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands. .,Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Judith M van Velzen
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands. .,Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Coen A M van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands. .,Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Monique H W Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Reneman MF, Beemster TT, Edelaar MJA, van Velzen JM, van Bennekom C, Escorpizo R. Towards an ICF- and IMMPACT-based pain vocational rehabilitation core set in the Netherlands. J Occup Rehabil 2013; 23:576-584. [PMID: 23377824 DOI: 10.1007/s10926-013-9423-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND For clinical use and research of pain within the context of vocational rehabilitation, a specific core set of measurements is needed. The recommendations of the International Classification of Functioning, Disability and Health (ICF) brief Core Set for Vocational Rehabilitation (VR) and those of Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) cover two broad areas. These two sources can be integrated when made applicable to vocational rehabilitation and pain. Objective To develop a core set of diagnostic and evaluative measures specifically for vocational rehabilitation of patients with subacute and chronic musculoskeletal pain, while using the brief ICF core set for VR as the reference framework in VR, and the IMMPACT recommendations in the outcome measurements around pain. METHODS Three main steps were taken. The first step was to remove irrelevant and duplicate domains of the brief ICF Core Set for Vocational Rehabilitation and the IMMPACT recommendations around pain. The second step was to match the remaining domains with existing instruments or measures. Instruments were proposed based on availability and its proven use in Dutch practice and based on proof of sufficient clinimetric properties. In step 3, the preliminary VR-Pain core set was presented to 3 expert panels: proposed users, Dutch pain rehabilitation experts, and international VR experts. RESULTS Experts agreed with the majority of the proposed domains and instruments. The final VR-Pain Core Set consists of 18 domains measured with 12 instruments. All instruments possessed basic clinimetric properties. CONCLUSION An agreed-upon VR-Pain Core Set with content that covers relevant domains for pain and VR and validated instruments measuring these domains has been developed. The VR-Pain Core Set may be used for regular clinical purposes and research in the field of vocational rehabilitation and pain, but adaptations should be considered for use outside the Netherlands.
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Affiliation(s)
- M F Reneman
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, 9750 RA Haren, P.O. Box 30.002, Groningen, The Netherlands,
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