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Quality of life, Motivation and Costs in Multidisciplinary Rehabilitation. A prospective controlled two-year study in patients with prolonged musculoskeletal disorders

Grahn, Birgitta LU (1999)
Abstract (Swedish)
Popular Abstract in Swedish

Livskvalitet, motivation och kostnader vid rehabilitering av patienter med långvariga muskuloskeletala besvär



Långvariga muskuloskeletala besvär är ett omfattande medicinskt, socialt och ekonomiskt problem i utvecklade länder.



Syftet med avhandlingen var att utvärdera ett multidisciplinärt rehabiliteringsprogram som fokuserade på Basal Kroppskännedom och kognitiv och avspänningsbehandling med tanke på hälso-relaterad livskvalitet, arbetsförmåga och kostnader för samhället, och att uppnå en djupare förståelse för motivation till förändring hos patienter med långvariga muskuloskeletala besvär. Slutligen undersöktes faktorer som skulle kunna predicera... (More)
Popular Abstract in Swedish

Livskvalitet, motivation och kostnader vid rehabilitering av patienter med långvariga muskuloskeletala besvär



Långvariga muskuloskeletala besvär är ett omfattande medicinskt, socialt och ekonomiskt problem i utvecklade länder.



Syftet med avhandlingen var att utvärdera ett multidisciplinärt rehabiliteringsprogram som fokuserade på Basal Kroppskännedom och kognitiv och avspänningsbehandling med tanke på hälso-relaterad livskvalitet, arbetsförmåga och kostnader för samhället, och att uppnå en djupare förståelse för motivation till förändring hos patienter med långvariga muskuloskeletala besvär. Slutligen undersöktes faktorer som skulle kunna predicera rehabiliteringsresultat.



En prospektiv, matchad, kontrollerad 2-års studie genomfördes. Rehabiliteringsgruppen och kontrollgruppen omfattade 122 respektive 114 patienter. Patienterna undersöktes med tanke på: hälso-relaterad livskvalitet, motivation, kroppskännedom, smärta, smärt-relaterad medicinförbrukning, psykosomatiska symtom, arbetsmiljö, arbetsförmåga och patientspecifika direkta och indirekta kostnader.



Faktorer som förbättrades signifikant för rehabiliteringsgruppen jämfört med kontrollgruppen var hälso-relaterad livskvalitet (p=0.049), känslomässiga reaktioner (p=0.043), smärta relaterad till aktivitet (p=0.028) och behovet av smärt-relaterad medicin (p=0.009). Patientgruppens stora kostnad för samhället bekräftades. Den multidisciplinära rehabiliteringen förbättrade dock patienternas livskvalitet kostnadseffektivare än primärvården. Motivation till förändring visade sig vara en prediktor för förändringar i hälso-relaterad livskvalitet (p=0.001), arbetsförmåga (p<0.001) och totalkostnader (p<0.001). Centrala theman för motivation till förändring visade sig vara: utnyttjandet av de professionella nätverken, känslomässigt stöd, användning av coping strategier och socialt stöd på arbetsplatsen. Minskningen av indirekta kostnader bland de hög-motiverade jämfört med de latent-motiverade patienterna hade relationen 4:1.



Avhandlingen visar att det utvärderade multidisciplinära rehabiliteringsprogrammet med en accentuering på sjukgymnastiska metoder förbättrade den hälso-relaterade livskvaliteten i större utsträckning och mera kostnadseffektivt än den konventionella behandlingen inom primärvården. Patienternas motivation kan i stor utsträckning påverka resultaten och pekar på betydelsen av interaktionen mellan patienten och sjukvården. (Less)
Abstract
Prolonged musculoskeletal disorders (PMSD) is an escalating medical, social and cost problem in developed countries. The complexity of PMSDs has emphasised the need of developing effective multidisciplinary rehabilitation programme with a holistic approach.



The aim of the thesis was to evaluate the outcome of a multidisciplinary rehabilitation programme focusing on Body Awareness Therapy and cognitive and relaxation treatment in terms of health-related quality of life (HRQL), working ability and costs, and to obtain a deeper understanding of the process of motivation for change in PMSD patients. Furthermore, predictors of outcome were investigated.



A prospective, matched, controlled two-year follow-up... (More)
Prolonged musculoskeletal disorders (PMSD) is an escalating medical, social and cost problem in developed countries. The complexity of PMSDs has emphasised the need of developing effective multidisciplinary rehabilitation programme with a holistic approach.



The aim of the thesis was to evaluate the outcome of a multidisciplinary rehabilitation programme focusing on Body Awareness Therapy and cognitive and relaxation treatment in terms of health-related quality of life (HRQL), working ability and costs, and to obtain a deeper understanding of the process of motivation for change in PMSD patients. Furthermore, predictors of outcome were investigated.



A prospective, matched, controlled two-year follow-up study was designed. The rehabilitation group and the control group comprised 122 and 114 patients respectively. The main variables that were measured were: HRQL (Nottingham Health Profile, NHP), motivation, body awareness, pain, pain-related medicine consumption, psychosomatic symptoms, working environment, working ability and patient-specific total costs due to society. The cost-effectiveness was expressed as a quotient of the total costs/NHP global score difference value.



Results revealed the following variables to be significantly improved for the rehabilitation group as compared with the control group at the two-year follow-up: HRQL (p=0.049), emotional reactions (p=0.043), pain related to movements (p=0.028) and need for pain-related medicines (p=0.009). Multivariate regression analyses including all the patients revealed that motivation was a predictor of change in HRQL (p=0.001), working ability (p<0.001) and costs (p<0.001). Motivation for change followed different processes depending on the level at entry to the study. Central themes of importance to the process of motivation were: the utilisation of professional networks, emotional support, use of personal coping resources and social support at work. It was confirmed that PMSD patients contribute substantially to the costs to society. However, multidisciplinary rehabilitation improved HRQL more cost-effectively. The relationship in savings in terms of indirect costs between the highly-motivated and the less-motivated patients was calculated at 4:1.



It is concluded that the multidisciplinary rehabilitation programme focusing on physiotherapeutic methods improved HRQL ta a somewhat greater extent and more cost-effectively than ordinary treatment available within primary care. The patient's motivation could influence outcome and underlines the importance of the interaction between the patient and the health care providers. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Professor Ekberg, Kerstin, Centre for Work and Rehabilitation, Department of Health and Environment, Linköping University, Sweden
organization
publishing date
type
Thesis
publication status
published
subject
keywords
cost-effectiveness analysis, primary health care, predictors, outcome, networks, health-related quality of life, motivation, physiotherapy, Multidisciplinary rehabilitation, musculoskeletal disorders, Skeleton, muscle system, rheumatology locomotion, Skelett, muskelsystem, reumatologi
pages
154 pages
publisher
Inst för Sjukgymnastik, Lunds Universitet, Box 5134, SE-220 05 Lund
defense location
Assembly Hall, University Hospital, Lund
defense date
1999-12-08 10:15
external identifiers
  • other:ISRN: LUMEDW/MEPT--1016--SE
ISBN
91-628-3866-0
language
English
LU publication?
yes
id
8ae1f148-c406-4742-bd96-338dca4801d6 (old id 40034)
date added to LUP
2007-06-20 16:39:22
date last changed
2016-09-19 08:45:06
@phdthesis{8ae1f148-c406-4742-bd96-338dca4801d6,
  abstract     = {Prolonged musculoskeletal disorders (PMSD) is an escalating medical, social and cost problem in developed countries. The complexity of PMSDs has emphasised the need of developing effective multidisciplinary rehabilitation programme with a holistic approach.<br/><br>
<br/><br>
The aim of the thesis was to evaluate the outcome of a multidisciplinary rehabilitation programme focusing on Body Awareness Therapy and cognitive and relaxation treatment in terms of health-related quality of life (HRQL), working ability and costs, and to obtain a deeper understanding of the process of motivation for change in PMSD patients. Furthermore, predictors of outcome were investigated.<br/><br>
<br/><br>
A prospective, matched, controlled two-year follow-up study was designed. The rehabilitation group and the control group comprised 122 and 114 patients respectively. The main variables that were measured were: HRQL (Nottingham Health Profile, NHP), motivation, body awareness, pain, pain-related medicine consumption, psychosomatic symptoms, working environment, working ability and patient-specific total costs due to society. The cost-effectiveness was expressed as a quotient of the total costs/NHP global score difference value.<br/><br>
<br/><br>
Results revealed the following variables to be significantly improved for the rehabilitation group as compared with the control group at the two-year follow-up: HRQL (p=0.049), emotional reactions (p=0.043), pain related to movements (p=0.028) and need for pain-related medicines (p=0.009). Multivariate regression analyses including all the patients revealed that motivation was a predictor of change in HRQL (p=0.001), working ability (p&lt;0.001) and costs (p&lt;0.001). Motivation for change followed different processes depending on the level at entry to the study. Central themes of importance to the process of motivation were: the utilisation of professional networks, emotional support, use of personal coping resources and social support at work. It was confirmed that PMSD patients contribute substantially to the costs to society. However, multidisciplinary rehabilitation improved HRQL more cost-effectively. The relationship in savings in terms of indirect costs between the highly-motivated and the less-motivated patients was calculated at 4:1.<br/><br>
<br/><br>
It is concluded that the multidisciplinary rehabilitation programme focusing on physiotherapeutic methods improved HRQL ta a somewhat greater extent and more cost-effectively than ordinary treatment available within primary care. The patient's motivation could influence outcome and underlines the importance of the interaction between the patient and the health care providers.},
  author       = {Grahn, Birgitta},
  isbn         = {91-628-3866-0},
  keyword      = {cost-effectiveness analysis,primary health care,predictors,outcome,networks,health-related quality of life,motivation,physiotherapy,Multidisciplinary rehabilitation,musculoskeletal disorders,Skeleton,muscle system,rheumatology locomotion,Skelett,muskelsystem,reumatologi},
  language     = {eng},
  pages        = {154},
  publisher    = {Inst för Sjukgymnastik, Lunds Universitet, Box 5134, SE-220 05 Lund},
  school       = {Lund University},
  title        = {Quality of life, Motivation and Costs in Multidisciplinary Rehabilitation. A prospective controlled two-year study in patients with prolonged musculoskeletal disorders},
  year         = {1999},
}