Multidisciplinary rehabilitation in musculoskeletal disorders : Quantitative and qualitative follow-up studies

Sammanfattning: The primary aim of this investigation was to evaluate a seven-weekmultidisciplinary rehabilitation programme, with emphasis onmusculoskeletal disorders, for working-age people, by assessments at thestart and end of the rehabilitation programme, and at follow-upexaminations 6, 12 and 24 months after completion of the programme. Afurther aim was to explore the experiences of people not returning to workduring a period of six years after participation in an extensivemultidisciplinary rehabilitation programme.Sixty participants, 40 women and 20 men (mean age 46.8 ± SD 7.9), withmusculoskeletal disorders, mainly neck and back pain, participated in a 7-week rehabilitation programme which was based on a combination oftheoretical and practical education, physical activities, relaxation andindividual guidance. Before and after the programme and at the follow-upoccasions all participants were evaluated with the Global Self-EfficacyIndex (GSI), Hospital Anxiety and Depression Scale (HAD), and Stress test(Study I). A group of participants who were still full-time sick-listed (GroupI) at the end of the study period were compared with participants who werepart-time or not sick-listed (Group II) at the end of the study period (II, III,IV). They were evaluated with the Disability Rating Index (DRI), with thePain Intensity Rating Index on a visual analogue scale (VAS) (II, III)),mobility tests (III), GSI (III), HAD, and a stress test (IV). Seven women(median age 48 years) and three men (53 years) (Group I) were interviewedand the interviews were analysed by manifest content analysis (V).At the 2-year follow-up full-time sick leave, anxiety, depression and selfexperiencedstress had decreased in both sexes. They also showed increasedquality of life (QoL) (I). In participants with full-time sick leave (Group I),self-experienced physical disability and pain ratings were high and showedno decrease up until the 2-year follow-up. In participants with part-time orno sick leave (Group II), physical disability and pain ratings decreasedgradually throughout the 2-year follow-up period (II). Cervical andthoracolumbar spine range of motion (ROM) was lower in Group I than inGroup II from the start of rehabilitation to a 2-year follow-up. Only GroupII showed a temporal improvement in ROM. No changes in DRI, VAS orGSI were found in parallel with corresponding temporal changes in any ofthe ROM (III). Group I experienced no change in anxiety or depressionduring the study period, in contrast to Group II, in which this decreased.Decreased stress was found in both groups (IV). Group I describedperceived barriers to and possibilities of returning to work, and also gaveinformation on what strategies they used, to cope with everyday life (V).The majority of the participants improved and they continued to bephysically active, their QoL improved, and most participants returned towork. Ten of the participants, however, were on full-time sick leavethroughout the whole study period, with high self-experienced physicaldisability, high pain rating and no improvement in anxiety and depression.They experienced barriers to re-entering the labour market as consequencesof physical symptoms and fatigue. But they also believed in possibilities ofreturning to work if they could get a modified job adapted to their owncapacity.Thus, persons with severe disability and pain did not improve byrehabilitation in this project. New methods of treatment have to bedeveloped for improvement of symptoms resulting in reduction offunctional impairment and a consequent need for sick leave.