Return to Work in Employees on Sick Leave due to Neck or Shoulder Pain: A Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention with One-Year Register-Based Follow-Up

Line Thorndal Moll,Berit Schiøttz-Christensen,Ole Kudsk Jensen,Merete Labriola,David Høyrup Christiansen,Claus Vinther Nielsen,Christina Malmose Stapelfeldt

doi:10.1007/s10926-017-9727-9

Abstract

Purpose The aim of this study was to evaluate the effect of a multidisciplinary intervention (MDI) compared to a brief intervention (BI) with respect to return to work (RTW), pain and disability in workers on sick leave because of neck or shoulder pain. Methods 168 study participants with sickness absence for 4–16 weeks due to neck or shoulder pain were enrolled in a hospital-based clinical study and randomized to either MDI or BI. The primary outcome was RTW obtained by a national registry on public transfer payments. Secondary outcomes were self-reported pain and disability levels. One-year follow-up RTW rates were estimated by Cox proportional hazard regression adjusted for gender, age, sick leave prior to inclusion, part-time sick leave and clinical diagnosis. Secondary outcomes were analysed using logistic and linear regression analysis for pain and disability, respectively. Results In the MDI group, 50 participants (59%) experienced four or more continuous weeks of RTW while 48 (58%) returned to work in the BI group during the 1 year of follow-up. Results showed a statistically non significant tendency towards a lower rate of RTW in the MDI group than in the BI group (adjusted HR = 0.84, 95% CI 0.54, 1.31). There were no statistically significant differences in secondary outcomes between the MDI and BI groups. Conclusion The brief and the multidisciplinary interventions performed equally with respect to both primary and secondary outcomes. The added focus on RTW in the multidisciplinary group did not improve RTW rates in this group.

Highlights

Musculoskeletal disorders are widely recognized as common causes of disability and sick leave [1,2,3]
For chronic low back pain (LBP), it is suggested based on moderate evidence that multidisciplinary rehabilitation is superior to physiotherapy with respect to return to work (RTW), pain and disability and superior to usual care with respect to pain and disability [12]
The access to register data on the primary outcome allowed for 100% follow-up, whereas a considerable dropout rate (n = 89) was seen on the secondary outcomes gathered by questionnaires

Summary

Introduction

Musculoskeletal disorders are widely recognized as common causes of disability and sick leave [1,2,3]. J Occup Rehabil (2018) 28:346–356 though prevalence estimates tend to differ across studies, primarily due to differences in case definitions. Estimates of the 12-month prevalence are 2–11% for activity-limiting neck pain [3] and 5–47% for shoulder pain [4]. 11–14% report activity limitation due to neck pain [5]. Neck pain is the fourth most common reason for years lived with disability [1] and in Denmark, 16% of days on sick leave in 2015 were caused by neck pain [6]. In accordance with the above, sickness absence as a focus of political concern is well established [7]

Methods

Results

Conclusion