Predictors for return to work after multimodal rehabilitation in persons with persistent musculoskeletal pain

Abstract: Background Musculoskeletal disorders (MSDs) are one of the most important causes of temporary and permanent disability, causing acute or persistent pain, resulting in reduced and/or lost ability to work. Return to work (RTW) is multidimensional problem including many different factors and aspects. Few recent studies have analyzed factors predicting RTW after multimodal rehabilitation (MMR). Identification of predictors for RTW may help to improve the planning and optimization of the RTW strategy. The REHSAM II project is a randomized controlled trial with the aim to evaluate if MMR together with a web Behavior Change Program for Activity could increase work ability among persons with persistent MSDs as compared to MMR. Therefore the aim of this study was to identify factors explaining RTW 12 month after baseline in the REHSAM II project. Methods The present study is a secondary assessment of the data from the randomized controlled trial REHSAM II. A total of 97 participants with persistent musculoskeletal pain were randomly allocated to MMR + web-based education or only MMR group. The subjects were followed from baseline to 12 months. Information on potential predictors was obtained from self-administered questionnaires. Data were analyzed with univariate and multiple logistic regression models. Results In the final multiple regression model RTW was predicted by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ score) (p=0.003, OR=0.961) and EuroQol (EQ-5D index) (p=0.017, OR=7.283). The univariate regression analyses showed that pain and disability level, the capacity to perform a task in relation to pain and other symptoms, hospital and psychiatric care, medication for insomnia, catastrophizing, self-assessed work ability compared with the lifetime best, satisfaction with life, ability for coping and controlling work situation, ability for coping with life outside work and sense of responsibility for managing health condition were significantly associated with RTW. Conclusion In conclusion, psychosocial pain-related variable and health-related quality of life predicted RTW in the final model. The result confirms the fact that RTW is a multidimensional problem involving a complex interaction of many factors.