Musculoskeletal Disorder
Conditions
Brief summary
Background: Musculoskeletal pain is a leading cause of disability in the world. Although the majority of musculoskeletal-related pain conditions, such as low back pain, often resolves spontaneously, pain may recur or persist over a long time, potentially leading to disability and subsequent reduced work capacity and long-term sickness absence. There is a need for early identification of individuals in which this may occur, to prevent or reduce the risk of long-term musculoskeletal pain and long-term sickness absence. The aim of the trial described in this protocol is to evaluate a primary care rehabilitation model, PREVSAM, including early identification of patients at risk for long-term musculoskeletal pain and related sickness absence and a coordinated interdisciplinary rehabilitation programme based on individual and organizational resources. Methods: Eligible individuals will be recruited from primary care rehabilitation centres, health care centres, and include those who seek care for musculoskeletal pain and who are at risk of developing persistent pain, disability and sickness absence. Participants will be randomized to either treatment according to the PREVSAM model (intervention group) or treatment as usual (TAU) within primary care (control group). The PREVSAM model will comprise a person-centred rehabilitation plan, including coordinated measures within primary health care as well as in collaboration with participants' employers, and when relevant the Swedish Public Employment Agency. The primary outcome sickness absence will be measured at 3 and12 months from the Swedish Social Insurance Agency regarding: the number and proportion of individuals who remain in full- or part-time work, the number of gross and net days of sickness during the follow-up period, and time to first sickness absence spell. Secondary outcomes are patient-reported work ability, pain, health-related quality of life, risk for sickness absence, anxiety/depression, general and pain self-efficacy and disability at 3 months after inclusion (short-term follow-up), and at 6 and 12 months (long-term follow-up). Follow-up of drug consumption and cost-effectiveness analyes will be performed at 12 months. Discussion: This study is expected to provide new knowledge on how to best identify individuals at risk for long-term disability and sick leave due to musculoskeletal pain, and whether rehabilitation according to the PREVSAM model is effective. The study findings may contribute to more effective primary care rehabilitation processes of this large patient population, and potentially reduce sick leave and costs for healthcare and society.
Interventions
OTHERPREVSAM model
A person-centred rehabilitation plan, including coordinated measures within primary health care as well as in collaboration with participants' employers, and when relevant the Swedish Public Employment Agency
OTHERTreatment as usual (standard treatment)
Treatment as usual (ordinary/standard) treatment. Can include unimodal or multimodal treatment of physiotherapy solely and/or occupational therapy
Sponsors
Swedish Council for Working Life and Social Research
Vastra Gotaland Region
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Aged over 18 * Musculoskeletal pain, preferably less than 3 months * Risk for development of persistent musculoskeletal pain and disability ≥ 40 p on ÖMPSQ-SF * Independently mobile (with or without aids), to be capable of participating in intervention
Exclusion criteria
* Pain not primarily generated from the musculoskeletal system * Sickness cash benefit more than 30 days during the last 12 months due to pain from the musculoskeletal system * Full disability pension * Pregnancy * Red flag disorders such as malignancy/cancer, acute traumas such as fracture (less than 6 months ago) or infection, spinal cord compression/cauda equina * Severe mental illness
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Registered sickness absence | During 12 months from baseline | Registered sickness absence at Swedish Social Insurance Agency |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient reported work ability | At 1, 3, 6 and 12 months following baseline | Self reported work ability using single question of Work Ability Index (WAI) (NRS 0-10) |
| Risk of sickness absence assessed by Örebro Musculoskeletal Pain Screening Questionnaire Short Form (ÖMPSQ-SF) | At 1, 3, 6 and 12 months following baseline | Self reported risk of sickness absence using ÖMPSQ (NRS 0-10) |
| Patient reported pain duration | At 1, 3, 6 and 12 months following baseline | Self reported pain duration |
| Patient reported pain intensity | At 1, 3, 6 and 12 months following baseline | Self reported pain intensity |
| Patient reported pain widespread | At 1, 3, 6 and 12 months following baseline | Self reported pain widespread |
| Health Related Quality of Life (HRQL) assessed by EuroQol 5 dimensions | At 1, 3, 6 and 12 months following baseline | Self reported HRQL using EQ5D (5 dimensions with 3 answering options which form an index) |
| Short time sickness absence | Weekly for 12 months following baseline | Self reported sickness absence by text messages |
| Anxiety and Depression assessed by Hospital Anxiety and Depression Scale (HADS) | At 1, 3, 6 and 12 months following baseline | Self reported anxiety and depression using HADS (NRS 0-21 per Anxiety and depression respectively) |
| Function/Disability assessed by Disability Rating Index (DRI) | At 1, 3, 6 and 12 months following baseline | Self reported function/disability assessed by Disability Rating Index (DRI) (10 VAS summed range 0-100) |
| Drug use | 3 months before to 12 months after baseline | Use of drugs/medication collected from Läkemedelsregistret |
| General self-efficacy | At 1, 3, 6 and 12 months following baseline | Self reported general self efficacy assessed by General self-efficacy scale; the total score ranges between 10 and 40, with a higher score indicating more self-efficacy. |
| Pain Self-efficacy scale 2 items | At 1, 3, 6 and 12 months following baseline | Self reported pain self efficacy assessed by PSEQ-2SV; the total score ranges between 0 and 12, with a higher score indicating more pain self-efficacy. |
| Health Related Quality of Life (HRQL) assessed by EuroQol VAS (0-100) | At 1, 3, 6 and 12 months following baseline | Self reported HRQL using EQVAS |
Countries
Sweden
Outcome results
None listed