Journal of Rehabilitation Medicine 51-4inkOmslag | Page 47
J Rehabil Med 2019; 51: 281–289
ORIGINAL REPORT
RETURN TO WORK AFTER INTERDISCIPLINARY PAIN REHABILITATION: ONE-
AND TWO-YEAR FOLLOW-UP STUDY BASED ON THE SWEDISH QUALITY
REGISTRY FOR PAIN REHABILITATION
Marcelo RIVANO FISCHER, RPych, PhD 1,2 , Elisabeth B. PERSSON, ROT, PhD 1,2 , Britt-Marie STÅLNACKE, MD, PhD 3,4 ,
Marie-Louise SCHULT, ROT, PhD 4,5,6 and Monika LÖFGREN, RPT, PhD 4,5
From the 1 Lund University, Department of Health Sciences, Research Group Rehabilitation Medicine, Lund, 2 Skane University Hospital,
Department of Pain Rehabilitation, Lund, 3 Umeå University, Department of Community Medicine and Rehabilitation, Rehabilitation
Medicine, Umeå, 4 Karolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital,
5
Danderyd University Hospital, Department of Rehabilitation Medicine and 6 Karolinska Institute, Department of Neurobiology, Care
Sciences and Society, Stockholm, Sweden
Objectives: To investigate: (i) changes in sick-leave
benefits from 1 year prior to multimodal rehabilita-
tion to 1 and 2 years after rehabilitation; (ii) sex dif-
ferences in sick leave; and (iii) the impact of policy
changes on sick leave.
Methods: All patients undergoing multimodal reha-
bilitation registered in a national pain database for
2007–11 (n = 7,297) were linked to the Swedish So-
cial Insurance Agency database. Sick leave was ana-
lysed in 3-month periods: T0: 1 year before rehabi-
litation; T1: before start; T2: 1 year after; and T3: 2
years after rehabilitation. Four sick-leave benefit ca-
tegories were constructed: no sick leave, part-time
sick leave, full-time sick leave, and full-time perma-
nent sick leave. The individual change in sick-leave
category at each time-period was analysed.
Results: Sick-leave benefits increased from T0 to T1
(p <0.001) and decreased from T1 to T3 (p < 0.001).
Reductions were significant for both men and wo-
men from T1 to T3, but men had less sick-leave be-
nefits at T2 and T3. Positive changes in sick-leave
benefits at T2 and T3 were found both prior to and
after policy changes, with less sick-leave benefits af-
ter policy changes at all time-points.
Conclusion: Multimodal rehabilitation may positively
influence sick-leave benefits for patients with chro-
nic pain, regardless of their sick-leave situation, sex
or policy changes.
Key words: chronic pain; rehabilitation; registries; return to
work; sick leave.
Accepted Feb 26, 2019; Epub ahead of print Mar 8, 2019
J Rehabil Med 2019; 51: 281–289
Correspondence address: Marcelo Rivano Fischer, Lasarettsgatan 13,
221 85 Lund, Sweden. E-mail: [email protected]
C
hronic pain, a major health and socioeconomic
problem, often causes long-term work absen-
teeism. In a European survey 19% of the population
reported chronic pain. Of those, 34% reported severe
pain, 21% were diagnosed with depression due to
pain, 61% were unable to work outside home, and
20% lost their work due to pain (1). In Sweden, it
has been reported that people with musculoskeletal
LAY ABSTRACT
This study investigated changes in sick-leave benefits
from 1 year before multimodal rehabilitation to 1 and 2
years after rehabiliation. The study also examined dif-
ferences in sick leave between men and women, and
whether sick-leave policy changes influence patterns
of sick leave. All patients receiving pain rehabilitation
in 2007–11, who were registered in both the national
pain database and the Swedish Social Insurance Agency
database, were included in the study. Sick leave was
analysed 1 year before rehabilitation, before the start, 1
year after, and 2 years after rehabilitation. It was shown
that sick-leave benefits increased during the year before
rehabilitation and decreased after rehabilitation. These
reductions in benefits were significant for both men
and women. Positive changes in sick-leave benefits at
follow-up were found both before and after policy chan-
ges, with less sick-leave benefits after policy changes at
all time-points. In conclusion, multimodal rehabilitation
has a positive impact on sick-leave patterns for patients
with chronic pain, regardless of their sick-leave situa-
tion, sex, or policy changes.
chronic pain have a mean of 46 days’ sick leave per
year (2). In Europe, large differences in return to work
(RTW) after sick leave due to back pain are associated
with differences in the countries’ regulations on work
interventions and sick-leave benefits (3). Major policy
changes were effected in Sweden in July 2008, aimed at
speeding up rehabilitation processes, reducing benefit
levels, and establishing an upper time-limit for sick
leave. The changes were fully implemented in 2009.
Risk factors for disability pension were investigated
in a population-based cohort study in Sweden. Higher
age, low income, previous sick-leave history and not
being born in Sweden increased the risk of disability
pension. For women, the highest risk factor was mus-
culoskeletal pain (4).
Multimodal rehabilitation (MMR) is the gold standard
for managing the consequences of chronic pain (5);
studies indicate better outcomes on RTW than unimodal
interventions. A Swedish study (6) showed the strongest
effects of MMR on RTW in female participants, with
substantial impact on costs for production losses, while
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977
doi: 10.2340/16501977-2544