Interdisciplinary Intervention Versus Brief Intervention for Patients With Musculoskeletal Pain
Condition: Musculoskeletal Diseases
MeSH terms: Musculoskeletal Pain; Musculoskeletal Diseases
Study type: Interventional

Summary: 
      Musculoskeletal pain is very common in the normal population, and the reason for about 50 %
      of the long term sickness absence in Norway. Most of these patients have common, but
      troublesome subjective health complaints where pathological findings are absent or
      substantially less than expected compared to the reported intensity of the complaints.
      Psychosocial factors are important in the development of chronic complaints. In a large
      meta-analysis job satisfaction was found to be associated with mental health and subjective
      physical health. Individual factors are also important. Uncertainty related to the
      understanding of pain mechanisms, treatment strategies and management contribute to the
      problem.

      Among patients sicklisted for musculoskeletal complaints, low back pain is the largest
      diagnose group. Most of these patients also have many other complaints. Previous studies have
      shown that for low back pain patients a brief intervention at a spine clinic with
      examination, information, reassurance, and encouragement to engage in physical activity as
      normal as possible, had significant effect in reducing sick leave. Other studies have shown
      that multidisciplinary rehabilitation for chronic low back pain has effect on sick leave. A
      Danish study from Arbeidsmiljøinstituttet report that interdisciplinary treatment for
      patients sicklisted for musculoskeletal complaints, had effect on socio-economic costs, pain,
      and function.

      A treatment team consisting of various professionals is expensive, and in this study we will
      compare the simple, standardized brief intervention model with the more resource demanding
      interdisciplinary treatment for patients sicklisted for musculoskeletal complaints.

      Research question / hypothesis: An interdisciplinary treatment model for musculoskeletal
      complaints - is it beneficial for reducing sickness absence?
    

Detailed description: 
      In 2007 The Government in Norway raised a fund to support efforts to reduce sickness absence,
      called "Raskere tilbake prosjekt". Helse Sør-Øst was invited to establish projects within
      their health care system, and the department of physical medicine and rehabilitation at
      Sykehuset Innlandet HF was assigned the task to constitute an outpatient-clinic for
      musculoskeletal diseases.

      This initiative opened possibilities to explore new strategies based on science and own
      clinical experience to help these patients back to work without being confined to the
      traditional diagnose related examination and treatment offered in most clinics. In this
      project the main focus is directed towards work and barriers for working life. Because
      sickness absence often is multicausal and needs a bio-psycho-social approach, this should be
      reflected in the composition of the treatment team.

      There is a great demand to make out how complex bio-psycho-social problems can be solved,
      organized, implemented, and have economic gains for the society. To answer these questions we
      need randomized controlled clinical studies, and we need documentation when new treatment
      models are offered to this group of patients.
    

Intervention name(s): Interdisciplinary intervention; Control Group, Brief Intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Interdisciplinary collaboration deals with tasks often complex which require different skills to make a wide assessment.In this study the treatment team consists of a physician, a physiotherapist and a social service worker. The main goal for the team is to make a survey of the patient's situation, in which the biomedical tradition to make a diagnosis is replaced by a disability diagnosis, with systematically identification of barriers for return to work. The conclusion of the team will be followed by a targeted rehabilitation plan. Factors assessed to be the major cause of the reduced function at work will have priority in the following rehabilitation process. One of the team members will be responsible for the further process to follow the plan to help the patient back to work, in cooperation with the patient, the workplace, the general practitioner, and NAV.; The brief intervention is a standardized intervention and the essential features are interview and examination by a specialist in physical medicine and rehabilitation. Patients will be given time to express their concerns and problems in daily activities. The examination is thorough with detailed feedback on findings and normal functions, and clear and consistent explanations on pain and defense mechanisms. Somatic findings will be explained.Unless pathological findings, the patient will be encouraged to physical activity.
Other intervention name(s): ISIVET; visual educational tool; interdisciplinary structured interview; multidisciplinary intervention; multidisciplinary treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Sick leave; musculoskeletal pain; return to work; multidisciplinary intervention; randomised controlled trial