| dc.description.abstract | This thesis examines the effect of a work-focused intervention in specialist care for sick-listed
patients with neck or low back pain on return to work (RTW), pain and disability.
Neck and back pain is the leading cause of years lived with disability. A high proportion of
patients with a chronic course of pain and disability are referred to specialist care. In the
search for an effective treatment for pain-related work disability, multidisciplinary
rehabilitation programs that focus on reducing the obstacles to return to work (RTW) have
been developed. The effect of these interventions in countries with different financial
compensation systems and labour markets is unknown. Most studies have been conducted in
primary care or occupational settings, and whether these interventions are as effective in
specialist care is unknown. Therefore, the main objective of this thesis is to evaluate whether
work-focused interventions could reduce the time until RTW compared with multidisciplinary
interventions in specialist care. Secondly, we wanted to explore the effect of work-focused
interventions on fear-avoidance beliefs regarding work, pain and disability. Thirdly, to
evaluate the associations among pain, disability, anxiety, depression and the perception of
psychological and social factors at work.
We found a median time until RTW of approximately 160 days. Nearly three-quarters of the
patients returned to work after 12 months, without any differences between the intervention
and control groups. The improvement in pain and disability was similar in the two
intervention groups. The work-focused intervention group focused specifically on reducing
the barriers to RTW, including fear, but fear avoidance of work decreased similarly in both
the work-focused and control groups after the intervention. A clinically relevant change in the
fear avoidance of work after the intervention significantly increased the probability of RTW (OR 3.60), and a change in fear avoidance of physical activity increased the likelihood of a
clinically important improvement in disability scores (OR 3.65).
Of the assessed medical factors, anxiety and depression showed the most association with
psychological and social factors at work. The degree of pain and disability at baseline Showed
surprisingly low associations with the perceived psychological and social factors at work.
Our results support similar effect of multidisciplinary interventions and work-focused
intervention in specialist care on RTW, pain and disability outcomes. A reduction in fear
avoidance after treatment predicted better outcomes, and may be one of the mechanisms
behind improvement in both interventions. | nb_NO |
