Evaluation of a guidelines implementation intervention to reduce work disability and sick leaves related to chronic musculoskeletal pain: a theory-informed qualitative study in occupational health care

Abstract

Background: Guidelines for pain management and sick leave prescription were formulated and implemented in an occupational health services (OHS) in Finland to reduce work disability and sick leaves related to musculoskeletal pain. We investigated how the guidelines implementation intervention may have produced its effects, how the number of prescribed sick leave days varied before and after the launch of the guidelines, and which factors beyond physician behaviour were seen to influence sick leaves.

Methods: Seventeen physicians, two occupational physiotherapists and one occupational health care nurse were interviewed. Qualitative content analysis using both inductive and deductive approaches was performed, informed by Behaviour Change Wheel and Theoretical Domains Framework. Employees' sick leave days related to musculoskeletal disorders in 2015-2019 were drawn from the employer's register.

Results: Physicians' guidelines adherence was facilitated by psychological capability (e.g., having relevant knowledge, remembering to engage in recommended behaviours), reflective motivation (e.g., guidelines-related behaviours regarded as central part of one's professional role; beliefs in the positive consequences of recommended behaviours to employees and employers), and physical and social opportunities (e.g., adequate physical resources, culture of social support). Some physicians also described barriers to recommended behaviours (e.g., lack of knowledge or non-pharmacological pain treatment tools). The guidelines had served as sources of new knowledge, reminders of recommended practices and means of self-assessment. Considerable declining trend of prescribed sick leave days was detected, especially during the first years after the intervention, levelling off somewhat thereafter. OHS policies and structures were seen to enable professionals' focusing on preventing pain-related disability and prolonged sick leaves. The decline of sickness absences was also attributed to the municipal client organization's commitment and the employees' positive attitudes towards the alternatives to full-time sick leave.

Conclusions: The guidelines implementation intervention was found successful. The study showed the importance of social and organizational environment supporting physicians' engagement in recommended practices.

Keywords: Guideline implementation; Intervention evaluation; Musculoskeletal pain; Occupational health care; Sick leave.

Fig. 1

Total number of sick leave days prescribed at the OHS per month

Fig. 2

Total number of sick leave days prescribed at the OHS in three diagnostic categories (ICD10 M54, ICD10 M75, ICD10 M77.1)