High cost-benefit of early team-based biomedical and cognitive-behaviour intervention for long-term pain-related sickness absence

Abstract

Objective: To report the results from a prospective, cognitive-behavioural team-based, individually geared, low-intensity, rehabilitation programme, randomly assigned to care-seekers in primary care physiotherapy with new pain-related sick leave, and to examine a possible reduction in social security expenditure.

Methods: A total of 194 care-seekers were included in a stepwise procedure from November 2000 to February 2002. Control group n = 381.

Results: The median number of days of sick leave in the intervention group was 22 during the first 6-month period. After 180 days 5.2% were still on sick leave and after 360 days 4.2%. The comparable figures in the control group were 30 days, 9.7% and 7.2%, respectively. Reductions in social security expenditure were statistically significant from the fourth month. As predicted, clinically relevant subgroups contributed differently to this reduction, both early and later on. The overall problem for one-third of the subgroups was insufficient co-ordination from the employer and the social security executive.

Conclusion: It was possible to reduce the social security expenditure in this setting. The intervention costs were balanced out during the first year. A large potential for further cost reductions was identified in increased implementation of workplace-based return-to-work interventions.