Quality improvement of vocational rehabilitation in patients with chronic musculoskeletal pain and reduced work participation

Abstract

Research has shown that multi-domain vocational rehabilitation (VR) is beneficial in achieving sustainable levels of work participation in sick-listed workers with chronic musculoskeletal pain (CMP). There are however some research gaps regarding “clinimetrics” and “dose-content” of VR. Some of these parts are studied in this thesis, with the aim to contribute to the quality improvement of VR for patients with chronic musculoskeletal pain and reduced work participation. The most important findings of the thesis are: - The development of a core set consisting of diagnostic and evaluative questionnaires. The core set was implemented in 2014 and since then used by seven Dutch VR centers. - Insights into the clinimetric properties of relevant questionnaires on the constructs of “work participation”, “healthcare usage”, and “pain-related disability.” This provided information detailing which questionnaires, and/or cut-off scores can be used for diagnostic, process-related, and evaluative purposes in VR. - Experiences from patients, professionals, and managers with comprehensive and less-comprehensive VR were collected. The overall conclusion is that it is not useful to deliver one VR program for all patients and that treatment should be personalized through the use of quasi-flexible and tailored VR. - The relationship between multicomponent VR both with and without an additional work module on work participation showed to be non-significant. It should therefore be recommended to not include a work module to VR as part of standardized care, but the decision to include or not should be determined on a patient by patient basis.