Multimodal rehabilitation (MMR) in primary care - are the team's organization, content and measures associated to outcome in health and workstatus?

Problem

The Ministry of Social Affairs and the Swedish Association of Local Authorities and Regions (SKL), decided in 2008 to introduce a rehabilitation guarantee using evidence-based medical rehabilitation such as cognitive behavioral therapy for mild and moderate mental disorders (anxiety, depression and stress-related illness) and multimodal rehabilitation (MMR) for chronic pain (pain in the neck, shoulder and back and generalized pain). The primary goal of the rehabilitation guarantee was to increase return to work, or to prevent sick leave. Despite previous studies that have found evidence for the effect of MMR, there is a lack of knowledge about the importance of how the teams are organized and whether the content and measures, given the MMR, are associated to the outcome in health and work status after rehabilitation. In addition, there is a demand for long-term follow-ups.

Approach

To examine and describe the association between the MMR team’s organization, content and measures to outcome in health and work status at the completion of the rehabilitation and up to 12 months afterwards, a cross-sectional study was performed based on data from questionnaires and medical records patient data.

Findings

Unfortunately outcomes in health were only reported systematically in the same way in about 20% of the patients. Work status was reported in about 75% of the patients. Preliminary findings show that improved work status mainly seemed to be associated to whether the MMR teams had had contact with the workplace.

Consequences

Despite several years of rehabilitation guarantee and treatment with MMR, it is still unclear how the teams should be organized, what content they should have and what measures should be included. However, a higher degree of work place involvement seems to be necessary to improve work status.