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Quality of life, Motivation and costs in multidisciplinary occupational rehabilitation

Abstract

Department of Physical Therapy, Lund

Lunds universitet

Birgitta Grahn, Thesis, 1999

Prolonged musculoskeletal disorders (PMSD) are an escalating medical, social and cost problem in the developed countries. The complexity of PMSDs has emphasised the need to develop effective multidisciplinary rehabilitation programmes using a holistic approach.

The aim of the thesis was to evaluate the outcome of a multidisciplinary rehabilitation programme focusing on Body Awareness Therapy and cognitive and relaxation treatment, in terms of health-related quality of life (HRQL), working ability and costs, and to obtain a deeper understanding of the process of motivation for change in PMSD patients. Furthermore, predictors of outcome were investigated.

A prospective, matched, controlled two-year follow-up study was designed. The rehabilitation group and the control group comprised 122 and 114 patients respectively. The main variables that were measured were HRQL (Nottingham Health Profile, NHP), motivation, body awareness, pain, pain-related medicine consumption, psychosomatic symptoms, working environment, working ability and the patient-specific total cost to society. The cost-effectiveness was expressed as a quotient of the total costs/NHP global score difference value.

The results revealed that the following variables were significantly improved in the rehabilitation group as compared with the control group at the two-year follow-up: HRQL (p=0.049), emotional reactions (p=0.043), pain related to movements (p=0.028) and need for pain-related medicines (p=0.009). Multivariate regression analyses including all the patients revealed that motivation was a predictor of change in HRQL (p=0.001), working ability (p<0.001) and costs (p<0.001). Motivation for change followed different processes depending on the level at entry to the study. Central themes of importance to the process of motivation were the utilisation of professional networks, emotional support, use of personal coping resources and social support at work. It was confirmed that PMSD patients contribute substantially to the cost to society. However, multidisciplinary rehabilitation improved HRQL more cost-effectively. The relationship in savings in terms of indirect costs between the highly-motivated and the less-motivated patients was calculated at 4:1.

It is concluded that the multidisciplinary rehabilitation programme focusing on physiotherapeutic methods improved HRQL to a somewhat greater degree and more cost-effectively than ordinary treatment available within primary care. The patient’s motivation could influence outcome and underlines the importance of the interaction between the patient and the health care providers.

Keywords: Multidisciplinary rehabilitation, musculoskeletal disorders, physiotherapy, motivation, health-related quality of life, networks, outcome, predictors, primary health care, cost-effectiveness analysis.