Abstract
BackgroundMusculoskeletal pain is a major cause of work disability. Many patients with musculoskeletal pain seek care from health care providers other than their general practitioners, including a range of musculoskeletal practitioners. Therefore, these musculoskeletal practitioners may play a key role by engaging in sickness absence management and work disability prevention. This study aimed to determine the prevalence of musculoskeletal practitioners’ practice behaviours, and their perceptions and beliefs about sickness absence management by using Scandinavian chiropractors as an example, as well as to examine the association between these characteristics and two different practice behaviours.MethodsAs part of a mixed-methods study, we surveyed members of the national chiropractic associations in Denmark, Norway, and Sweden in 2016. Descriptive statistics were used to describe prevalence. Multilevel logistic regression with backwards stepping was used to estimate odds ratios with 95% confidence intervals between each of the two practice behaviours and the characteristics.ResultsOut of the 802 respondents (response rate 56%), 372 were Danish, 349 Norwegian, and 81 Swedish. In Denmark and Norway, 38.7 and 37.8% always/often considered if sick leave was appropriate for their patient compared to 21.0% in Sweden (p = 0.007); and 86.5% of the Norwegian chiropractors always/often recommended to return-to-work versus 64.5 and 66.7% in Denmark and Sweden respectively (p < 0.001). In the final models, factors associated with the two practice behaviours were age, level of clinical experience, working as a teacher, the tendency to be updated on current legislations and policies using social services, contact with general practitioners, relevance of engagement in SAM, consideration of workplace factors, SAM as part of the clinical tool box, patient out-of-pocket fee, and recommending fast return-to-work.ConclusionsWhilst not always engaged in sickness absence management with regards to musculoskeletal pain, chiropractors favour a ‘return-to-work’ rather than a ‘stay-at-home’ approach. Several practice behaviours and perceptions and beliefs are associated with these outcomes; however, system or organisational barriers are linked to clinician non-engagement.
Highlights
Musculoskeletal pain is a major cause of work disability with socioeconomic consequences
Our data indicated that not all Scandinavian chiropractors engage in sickness absence management (SAM), with less than 40% who would always/ often consider if sick leave were appropriate for their patients, and 65–87% who always/often recommended their patients to return-to-work rather than to stay at home
In the model of the outcome, “How often do you consider if sick leave is appropriate for your patient?” the strongest associations were found for strongly disagreeing with the statements, “Usually, it is not relevant to engage in my patients’ sick leave” and “Recommendations regarding sick leave is a part of the clinical tool box”
Summary
Many patients with musculoskeletal pain seek care from health care providers other than their general practitioners, including a range of musculoskeletal practitioners These musculoskeletal practitioners may play a key role by engaging in sickness absence management and work disability prevention. Private sector musculoskeletal practitioners cater to approximately 25% of the healthcare seekers for back pain in the UK [8], and at least one third of back pain patients in Denmark choose to see a chiropractor [7]. Many of these patients may not see another health practitioner about their back pain [9]. Data from previous studies have indicated a potential for cost-effectiveness by including musculoskeletal practitioners in occupational health services [11,12,13]
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