EUMASS Congress 2018 Maastricht

Transcription

1 From evidence to practice: improving work participation outcomes by work-related medical rehabilitation in patients with chronic musculoskeletal diseases Matthias Bethge

2 1. Background 2. Methods 3. Results 4. Discussion 2

3 From evidence to practice Strong evidence in favor of work-related medical rehabilitation Implementation possible though not finally completed Patients with a high risk of failing return to work Similar effects in routine care only if patients and dose are alike Reduction of the effects in real care very likely: Is there any effect at all in favor of work-related medical rehabilitation in routine care? Bethge M. Rehabilitation 217;56:14-21; Bethge M. Bundesgesundheitsblatt 217;6:

4 Methods Sample: approved rehabilitation due to musculoskeletal disorders Time of measurement: before rehabilitation, 3 and 1 months after completing the rehabilitation Intervention: work-related medical rehabilitation () Controls: medical rehabilitation () Propensity score matching: similar controls and unbiased estimation of the treatment effect Neuderth S et al. BMC Public Health 216;16:84 4

5 Sample characteristics n mean (SD) or % n mean (SD) or % Age in years, mean (SD) (7.8) (7.6) Sex: % female Diagnosis: % M4-M54 (ICD-1) Comorbidity: % F-F99 (ICD-1) SIMBO (-1), mean (SD) (25.) (25.4) Work Ability Score (-1), mean (SD) (2.4) (2.5) Sickness absence in weeks, mean (SD) (13.9) (14.5) Employment: % unemployed SD = standard deviation; SIMBO = German abbreviation of a risk score to identify need for work-related medical rehabilitation; = work-related medical rehabilitation; = medical rehabilitation; Samples were balanced by propensity score matching. 5

6 Dose delivered FCE in min Social counseling in min WRPG in min FCT in min n = 1282; all p <.1 FCE = functional capacity evaluation; WRPG = work-related psychological groups; FCT = functional capacity training 6

7 Dose delivered II 25 Dose of work-related treatment components in h departments for work-related medical rehabilitation (n = 641) 7

8 Dose received Work-related contents (12 items; binary; to 12 points) Example: Did you discuss your return to work in your rehabilitation program? Consistency (6 items; 5-point; to 24 points) Example: The team as a whole dealt very intensively with my health-related problems that were related to my working life. Achievement (8 items; 5-point scaled; to 32 points) Example: I am well prepared for returning to work. Wienert J, Bethge M. Rehabilitation; doi:1.155/a (epub ahead of print) 8

9 Dose received II Content 6 6. Consistency Achievement n = 1274; p <.1 n = 1236; p <.1 n = 1187; p <.1 9

10 Return to work Return to work Time to return to work 1 3 Stable return to work in % Time to return to work (median) n = 126; p =.35 n = 1251; p =.33 1

11 Other outcomes n Average predicted scores (SE) Average predicted scores (SE) Difference or Odds Ratio 95% CI p Work Ability Score (.12) 5.43 (.12).38.5; Unemployment # (.1).18 (.2).54.35;.83.5 Pain disability (.94) (.9) ; Pain intensity (.78) (.77) ;.1.51 Depression (.6) 2.12 (.6) ; Fear-avoidance beliefs (.1) 4.53 (.1) ; Self-management (.7) 5.34 (.7).21.1; = work-related medical rehabilitation; = medical rehabilitation; SE = standard error; CI = confidence interval; # Probabilities and odds ratios are reported for binary outcomes, means and unstandardized mean differences are reported otherwise. 11

12 Why was the effect of reduced in routine care? Poor implementation of (low consistency, < 17 out of 24 points) Stable return to work in % Stable return to work in % Low SIMBO High SIMBO Good implementation of (high consistency, at least 17 out of 24 points) Stable return to work in % Stable return to work in % n = 1215 Low SIMBO High SIMBO 12

13 Conclusion improved work participation outcomes also in routine care. Consistent but reduced effects in favor of Reduced effect as half of the patients reached had low risks of failing to return to work and high heterogeneity of program implementation Similar effects as in randomized controlled trial only if patients reached as intended and good implementation (about 2 points) 13

14 Thank you. Prof. Dr. Matthias Bethge Tel.: ;