Behavioral Medicine Physiotherapy in the Context of Return to Work for Chronic Pain: A Single-Case Experimental Design Study

Abstract

Effective interventions are needed for return-to-work (RTW) for individuals with chronic pain on long-term sick leave. In this study, a behavioral medicine physiotherapy protocol was systematically replicated and added to workplace components. The intervention was evaluated for fidelity and effects on target activities and work ability. A single-case experimental design was used with five participants. Daily and weekly ratings of personalized target activities at work as well as work ability were carried out throughout the study period of 26-28 weeks. Effects of the behavioral medicine physiotherapy intervention were evaluated for each individual using visual analysis of displayed graphs and quantitative non-overlap methods. Goal achievement for target activities was reviewed. Three participants completed the intervention. The results indicated an effect from the behavioral medicine physiotherapy intervention on task-specific self-efficacy for target activities, but no consistent effect on experience of target activities or work ability. All three participants had increased function in target activities in line with pre-defined goals. Fidelity to the intervention manual was good. Behavioral medicine physiotherapy can be successfully adapted to work disability and was here replicated in an RTW context for individuals with chronic pain. The intervention protocol should be further evaluated in large-scale studies.

Keywords: behavioral medicine; chronic pain; exercise; rehabilitation; return to work.

Figure 1

Target activity and work ability ratings for participant 1. Experience of and self-efficacy for the target activity “Handwriting or computer work”, as well as general work ability, rated on numerical rating scales 0–10, where higher score indicates better outcome. Median score per week are displayed for full study period, including baseline (A), return-to-work coordination (B), effective communication within the organization (C), behavioral medicine physiotherapy (D), post-intervention, 1-month follow-up and 2-month follow-up. During the physiotherapy intervention, on-set of applies skills training was week 18, generalization week 20, and maintenance and relapse prevention week 26.

Figure 2

Target activity and work ability ratings for participant 3. Experience of and self-efficacy for the target activities “Seated work” and “Lifting”, as well as general work ability, rated on numerical rating scales 0–10, where higher score indicates better outcome. Median score per week are displayed for full study period, including baseline (A), return-to-work coordination (B), effective communication within the organization (C), behavioral medicine physiotherapy (D), post-intervention, 1-month follow-up and 2-month follow-up. During the physiotherapy intervention, on-set of applies skills training was week 17, generalization week 19 and maintenance and relapse prevention week 25. Change of sick leave and work context were at the following time points: week 10, week 26 and F1.

Figure 2

Target activity and work ability ratings for participant 3. Experience of and self-efficacy for the target activities “Seated work” and “Lifting”, as well as general work ability, rated on numerical rating scales 0–10, where higher score indicates better outcome. Median score per week are displayed for full study period, including baseline (A), return-to-work coordination (B), effective communication within the organization (C), behavioral medicine physiotherapy (D), post-intervention, 1-month follow-up and 2-month follow-up. During the physiotherapy intervention, on-set of applies skills training was week 17, generalization week 19 and maintenance and relapse prevention week 25. Change of sick leave and work context were at the following time points: week 10, week 26 and F1.

Figure 3

Target activity and work ability ratings for participant 5. Experience of and self-efficacy for the target activity “Work task in the afternoon”, as well as general work ability, rated on numerical rating scales 0–10, where higher score indicates better outcome. Median score per week are displayed for full study period, including baseline (A), return-to-work coordination (B), effective communication within the organization (C), behavioral medicine physiotherapy (D), post-intervention, 1-month follow-up and 2-month follow-up. During the physiotherapy intervention, on-set of applied skills training was week 20, generalization week 23 and maintenance and relapse prevention week 25.