Early Identification of Risk for and Prevention of Sickness Absence Due to Musculoskeletal Pain - an RCT

Study Overview
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Brief Summary
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Background: Musculoskeletal pain is a leading cause of disability in the world. Although the majority of musculoskeletal-related pain conditions, such as low back pain, often resolves spontaneously, pain may recur or persist over a long time, potentially leading to disability and subsequent reduced work capacity and long-term sickness absence. There is a need for early identification of individuals in which this may occur, to prevent or reduce the risk of long-term musculoskeletal pain and long-term sickness absence. The aim of the trial described in this protocol is to evaluate a primary care rehabilitation model, PREVSAM, including early identification of patients at risk for long-term musculoskeletal pain and related sickness absence and a coordinated interdisciplinary rehabilitation programme based on individual and organizational resources. Methods: Eligible individuals will be recruited from primary care rehabilitation centres, health care centres, and include those who seek care for musculoskeletal pain and who are at risk of developing persistent pain, disability and sickness absence. Participants will be randomized to either treatment according to the PREVSAM model (intervention group) or treatment as usual (TAU) within primary care (control group). The PREVSAM model will comprise a person-centred rehabilitation plan, including coordinated measures within primary health care as well as in collaboration with participants' employers, and when relevant the Swedish Public Employment Agency. The primary outcome sickness absence will be measured at 3 and12 months from the Swedish Social Insurance Agency regarding: the number and proportion of individuals who remain in full- or part-time work, the number of gross and net days of sickness during the follow-up period, and time to first sickness absence spell. Secondary outcomes are patient-reported work ability, pain, health-related quality of life, risk for sickness absence, anxiety/depression, general and pain self-efficacy and disability at 3 months after inclusion (short-term follow-up), and at 6 and 12 months (long-term follow-up). Follow-up of drug consumption and cost-effectiveness analyes will be performed at 12 months. Discussion: This study is expected to provide new knowledge on how to best identify individuals at risk for long-term disability and sick leave due to musculoskeletal pain, and whether rehabilitation according to the PREVSAM model is effective. The study findings may contribute to more effective primary care rehabilitation processes of this large patient population, and potentially reduce sick leave and costs for healthcare and society.

Official Title
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Early Identification of Risk for and Prevention of Sickness Absence Due to Musculoskeletal Pain (PREVSAM) - a Randomized Controlled Trial

Conditions
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Musculoskeletal Disorder

Intervention / Treatment
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* Other: PREVSAM model
* Other: Treatment as usual (standard treatment)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged over 18 Musculoskeletal pain, preferably less than 3 months Risk for development of persistent musculoskeletal pain and disability ≥ 40 p on ÖMPSQ-SF Independently mobile (with or without aids), to be capable of participating in intervention Exclusion Criteria: Pain not primarily generated from the musculoskeletal system Sickness cash benefit more than 30 days during the last 12 months due to pain from the musculoskeletal system Full disability pension Pregnancy Red flag disorders such as malignancy/cancer, acute traumas such as fracture (less than 6 months ago) or infection, spinal cord compression/cauda equina Severe mental illness

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PREVSAM model<br> | Other: PREVSAM model<br>* A person-centred rehabilitation plan, including coordinated measures within primary health care as well as in collaboration with participants' employers, and when relevant the Swedish Public Employment Agency<br>|
| Active Comparator: Treatment as usual<br> | Other: Treatment as usual (standard treatment)<br>* Treatment as usual (ordinary/standard) treatment. Can include unimodal or multimodal treatment of physiotherapy solely and/or occupational therapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Registered sickness absence | Registered sickness absence at Swedish Social Insurance Agency | During 12 months from baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short time sickness absence | Self reported sickness absence by text messages | Weekly for 12 months following baseline | 
| Patient reported work ability | Self reported work ability using single question of Work Ability Index (WAI) (NRS 0-10) | At 1, 3, 6 and 12 months following baseline | 
| Risk of sickness absence assessed by Örebro Musculoskeletal Pain Screening Questionnaire Short Form (ÖMPSQ-SF) | Self reported risk of sickness absence using ÖMPSQ (NRS 0-10) | At 1, 3, 6 and 12 months following baseline | 
| Patient reported pain duration | Self reported pain duration | At 1, 3, 6 and 12 months following baseline | 
| Patient reported pain intensity | Self reported pain intensity | At 1, 3, 6 and 12 months following baseline | 
| Patient reported pain widespread | Self reported pain widespread | At 1, 3, 6 and 12 months following baseline | 
| Health Related Quality of Life (HRQL) assessed by EuroQol 5 dimensions | Self reported HRQL using EQ5D (5 dimensions with 3 answering options which form an index) | At 1, 3, 6 and 12 months following baseline | 
| Health Related Quality of Life (HRQL) assessed by EuroQol VAS (0-100) | Self reported HRQL using EQVAS | At 1, 3, 6 and 12 months following baseline | 
| Anxiety and Depression assessed by Hospital Anxiety and Depression Scale (HADS) | Self reported anxiety and depression using HADS (NRS 0-21 per Anxiety and depression respectively) | At 1, 3, 6 and 12 months following baseline | 
| Function/Disability assessed by Disability Rating Index (DRI) | Self reported function/disability assessed by Disability Rating Index (DRI) (10 VAS summed range 0-100) | At 1, 3, 6 and 12 months following baseline | 
| Drug use | Use of drugs/medication collected from Läkemedelsregistret | 3 months before to 12 months after baseline | 
| General self-efficacy | Self reported general self efficacy assessed by General self-efficacy scale; the total score ranges between 10 and 40, with a higher score indicating more self-efficacy. | At 1, 3, 6 and 12 months following baseline | 
| Pain Self-efficacy scale 2 items | Self reported pain self efficacy assessed by PSEQ-2SV; the total score ranges between 0 and 12, with a higher score indicating more pain self-efficacy. | At 1, 3, 6 and 12 months following baseline |