Article Details

Research Database: Article Details

Citation:  Abásolo, L., Carmona, L., Hernández-García, C., Lajas, C., Loza, E., Blanco, M., Candelas, G., Fernández-Gutiérrez, B., & Jover, J.A. (2007). Musculoskeletal work disability for clinicians: Time course and effectiveness of a specialized intervention program by diagnosis. Arthritis Care & Research, 57 (2), 335-342.
Title:  Musculoskeletal work disability for clinicians: Time course and effectiveness of a specialized intervention program by diagnosis
Authors:  Abásolo, L., Carmona, L., Hernández-García, C., Lajas, C., Loza, E., Blanco, M., Candelas, G., Fernández-Gutiérrez, B., & Jover, J.A.
Year:  2007
Journal/Publication:  Arthritis Care & Research
Publisher:  Wiley
Full text:  http://proxy.library.vcu.edu/login?url=http://onlinelibrary.wiley.c...   
Peer-reviewed?  Yes
NIDILRR-funded?  No
Research design:  Randomized controlled trial

Structured abstract:

Background:  Musculoskeletal disorders (MSDs) have a large impact on the population in terms of high prevalence, morbidity, and disability potential. MSDs in the workplace have a huge impact, emerging as a growing problem in our modern societies (3); they represent the second largest cause of short-term or temporary work disability after the common cold. In Spain, temporary work disability related to MSDs accounts for 20% of sick leave days.
Purpose:  The purpose of the study was to determine how a specially-designed intervention program influenced the course of work disability in patients with MSDs. This information can be critical both to determine which actions could be implemented in the standard care system
Setting:  The study was conducted in multiple health care facilities in three Health Care Districts in Madrid, Spain.
Study sample:  The study sample consisted of 13,077 MSD patients randomized into intervention and control groups, generating 16,297 temporary work disability episodes All workers from 3 health districts who began sick leave with a diagnosis of an MSD during the study period (1998–2001) were included. Sick leave episodes secondary to trauma, surgery, or work accidents were excluded. The two groups were similar on all sociodemographic variables; however, the intervention group had a lower percentage of muscular pain patients who had previously been self-employed.
Intervention:  Patients in the program were attended by 2 trained rheumatologists in each health district, who were working full time for the program. The rheumatologists acted as principal care providers in regular clinical visits. The visits were structured following specific proceedings for the different diagnoses including education, pharmacologic and nonpharmacologic treatment, and timing of diagnostic tests in a stepwise manner. The program also incorporated administrative duties such as the prescription of medication and the filling out of the corresponding temporary work disability forms by the patients. Patients were seen as often as necessary until the episode of temporary work disability was resolved or recovery was deemed unrealistic.
Control or comparison condition:  The control condition was standard care provided by the primary care physicians, with weekly administrative duties plus basic diagnostic and therapeutic procedures without prespecified protocols. Primary care physicians could send the patients to specialized care at any time.
Data collection and analysis:  The control condition was standard care provided by the primary care physicians, with weekly administrative duties plus basic diagnostic and therapeutic procedures without prespecified protocols. Primary care physicians could send the patients to specialized care at any time.
Findings:  A total of 7,805 patients were allocated to the control group and 5,272 patients were invited to participate in the intervention group, of whom 3,311 (62.8%) attended the program. In both groups, the duration of temporary work disability episodes varied among the different MSD syndrome categories. Temporary work disability episodes were significantly shorter in the intervention group compared with the control group in all syndrome categories except for knee pain. The greatest difference between groups was observed for carpal tunnel syndrome, in which the median duration was 3 times greater in the control group than in the intervention group. After adjusting for sociodemographic variables to account for differences at baseline, all syndrome categories showed a higher rate of return to work in the intervention group compared with the control group, again except for knee pain
Conclusions:  The results of the study demonstrate that the specific care program improves the clinical course of work disability in nonselected patients with almost any MSD diagnosis. The intervention achieved a significant reduction in the total days of temporary work disability for patients in all disease categories except knee pain, as compared with patients included in the control group. The findings suggest that implementing this type of specialist-run, protocol-based early intervention program would be very beneficial in the treatment of most patients with work disability related to MSDs,

Disabilities served:  Arthritis
Chronic pain
Medical impairment
Mobility impairment
Populations served:  Gender: Female and Male
Interventions:  Medication
Training
Outcomes:  Increase in tenure