Back to work: evaluation of a multidisciplinary rehabilitation program with emphasis on mental symptoms; A two-year follow up

Abstract

Background: The aim of this investigation was to analyze temporal changes in anxiety, depression, and stress in patients with musculoskeletal pain for a period of up to 2 years after a multidisciplinary rehabilitation program, in relation to sick-listing (registered with The Swedish Social Insurance Agency [Forsakringskassan] for sickness benefit).

Methods: Ten persons with full-time sick leave (absence from work for medical reasons) (group 1) and 49 with part-time or no sick leave (group 2) at the end of the 2-year study period participated. It was shown in a previous study that group 1 had higher pain rating and higher subjective physical disability than group 2, with little or no improvement during and after rehabilitation. In the present study, all participants were evaluated with the Hospital Anxiety and Depression scale and a self-rated stress test.

Results: Participants with full-time sick leave during the study period (group 1) showed improved stress levels but no change in anxiety and depression levels. Anxiety, depression, and stress changed more favorably in participants with part-time or no sick leave than in those with full-time sick leave.

Conclusion: The results of this study indicate that investigation and appropriate treatment of psychological symptoms, including anxiety and depression, are important in multidisciplinary rehabilitation of patients with musculoskeletal disorders.

Keywords: anxiety; depression; musculoskeletal; rehabilitation; sick leave; stress.

Figure 1

Development of the anxiety (HAD) score (y axis) in participants with a full-time sickness benefit (group 1, thick line, filled squares) and with part-time or no sickness benefit (group 2, hatched line, filled squares, P < 0.0005, Friedman’s one-way analysis of variance) before and after the rehabilitation program and 6, 12, and 24 months after completion (x axis). Abbreviation: HAD, Hospital Anxiety and Depression.

Figure 2

Development of the depression (HAD) score (y axis) in participants with a full-time sickness benefit (group 1, thick line, filled squares) and with a part-time or no sickness benefit (group 2, hatched line, filled squares, P < 0.01, Friedman’s one-way analysis of variance) before and after the rehabilitation program and 6, 12, and 24 months after completion (x axis). Abbreviation: HAD, Hospital Anxiety and Depression.

Figure 3

Development of the stress test score (y axis) in participants with full-time sickness benefit (group 1, thick line, filled squares) and with part-time or no sickness benefit (group 2, hatched line, filled squares, P < 0.0005, Friedman’s one-way analysis of variance) before and after rehabilitation program and at months 6, 12, and 24 after completion (x axis).