Patterns of sickness absence a decade after pain-related multidisciplinary rehabilitation Hillevi Busch ⇑ , Lennart Bodin, Gunnar Bergström, Irene B. Jensen Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden Sponsorships or completing interests that may be relevant to content are disclosed at the end of this article. article info Article history: Received 23 February 2010 Received in revised form 28 December 2010 Accepted 1 February 2011 Keywords: Multidisciplinary rehabilitation Neck pain Back pain Sickness absence RCT Cost effectiveness Intervention study abstract Multidisciplinary programmes using a vocational approach can enhance work return in chronic pain patients, but little is known about the long-term effects of rehabilitation. The current study examined the patterns of sickness absence 10 years after participation in 3 treatment groups (physiotherapy, cog- nitive behavioural therapy, and vocational multidisciplinary rehabilitation) in comparison to a control group receiving treatment-as-usual. Cost-effectiveness was also assessed. Two hundred fourteen patients participated in a randomized controlled trial and were followed-up via register data 10 years after the interventions. On average, persons in multidisciplinary rehabilitation had 42.98 fewer days on sickness absence per year compared to those treated-as-usual (95% confidence interval À82.45 to À3.52, P = 0.03). The corresponding reduction of sickness absence after physiotherapy and cognitive behavioural therapy was not significantly different from the control group. The effect of rehabilitation seems to be more pronounced for disability pension than for sick leave. The economic analyses showed substantial cost savings for individuals in the multidisciplinary group compared to the control group. Ó 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. 1. Introduction Systematic reviews have shown the efficacy of intensive multi- disciplinary treatment for persistent back pain [8,9,19]. Multidisci- plinary programmes are known to reduce pain-related disability and emotional distress, and to enhance the quality of life in patients with chronic pain [21]. A combination of multidisciplinary and voca- tional rehabilitation may also enhance work ability in these patients [16,26]. The treatment involves different professionals (medical doctor, physiotherapist, and psychologist), is time-consuming and demanding for the patients involved, hence its cost-effectiveness has been questioned [15]. For a work-oriented rehabilitation pro- gramme to be cost-effective, the patient has to return to work and the expenses for rehabilitation must be less than those for continued sickness benefits. The number of studies evaluating the cost-effec- tiveness of multidisciplinary treatment starts to increase and, thus far, most published data indicate that multidisciplinary rehabilita- tion pays off by reducing costs for sickness absence and disability pension [5]. Some studies indicate that the expenses for multidisci- plinary rehabilitation are outweighed within a few years [20,23]. Optimally, though, the effects of rehabilitation should last longer than a couple of years, and to investigate whether the effects of an intervention persist or diminish in time, extended follow-up periods are essential. Further, some treatment outcomes may appear gradu- ally over time. For example, in previous reports from the current pro- ject we found perceived disability and quality of life to be the first aspects to improve after multidisciplinary rehabilitation [13], but it was not until a couple of years after the intervention that reliable differences in total sickness absence emerged [12]. However, it should be noted that the effects of rehabilitation were found for fe- male participants only. The current study is the third follow-up of a randomized controlled trial in which the effect of multidisciplinary rehabilitation and its single treatment components (physiotherapy and cognitive behavioural therapy) were examined and compared to a control group receiving treatment-as-usual. The intervention has been evaluated at 18 months [13] and 36 months [12] postinter- vention. The aim of the current study was to analyze how the patterns of all-cause sickness absence developed during 10 consec- utive years after completion of the intervention, and to analyze the cost-effectiveness of the rehabilitation. The hypothesis was that par- ticipants in multidisciplinary treatment would have lower sickness absence during the follow-up period in comparison to persons receiving treatment-as-usual. 2. Methods A brief summary of the methods is given here. For a more de- tailed description of the methods, see earlier publications [13]. 0304-3959/$36.00 Ó 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2011.02.004 ⇑ Corresponding author. Address: Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm S-171 77, Sweden. Tel.: +46 8 524 832 06. E-mail address: hillevi.busch@ki.se (H. Busch). PAIN Ò 152 (2011) 1727–1733 www.elsevier.com/locate/pain