Gir tidlig vurdering og behandling hos spesialist i fysikalsk medisin og rehabilitering reduksjon i langtidsfravær hos sykmeldte med muskel- og skjelettsykdommer?
DOI:
https://doi.org/10.5324/nje.v19i2.593Sammendrag
Bakgrunn: De fleste langtidssykmeldte med muskel- og skjelettsykdommer blir utredet, behandlet og fulgt opp av fastlege. Ved lengre tids sykmelding henvises mange fra sin fastlege til spesialist i fysikalsk medisin og rehabilitering for å optimalisere behandlingsopplegget.
Formålet med denne studien var å undersøke om henvisning direkte fra NAV til spesialist uten å gå veien om fastlege, medførte redusert antall sykmeldingsdager og mindre bruk av andre trygdeytelser som rehabiliteringspenger, yrkesrettet attføring og uførepensjon.
Materiale og metode: I samarbeid med 14 NAV-kontor i Vestfold ble 829 sykmeldte i alder 25-50 år med 8-12 ukers sykmelding for muskel- og skjelettsykdommer randomisert til en intervensjonsgruppe (n=409) og en kontrollgruppe (n=420). Eksklusjonskriterier var manglende arbeidsforhold, revmatiske sykdommer, brudd og leddsykdommer. Intervensjonsgruppen ble undersøkt og behandlet av spesialist i fysikalsk medisin og rehabilitering, Spesialsykehuset for rehabilitering, avd. Stavern. Kontrollgruppen fortsatte behandling hos sin fastlege. Noen av disse pasientene ble henvist til samme poliklinikk eller til annen spesialist på initiativ fra sin fastlege. Data for sykmeldingsdager, uførepensjon, rehabiliteringspenger og attføringspenger ble samlet inn fra NAV-kontorene. De samme parametre ble brukt som endepunkter. Etter to år ble endepunktene analysert. Data ble analysert etter "intention to treat"- prinsippet.
Resultater: I intervensjonsgruppen var gjennomsnittlig antall sykmeldingsdager 138 dager (SD 86,2) mot 147 dager (SD 88,0) i kontrollgruppen, en forskjell på ni sykmeldingsdager. Forskjellen er ikke statistisk signifikant (p=0,163). Det var heller ikke statistisk signifikant forskjell i forbruket av yrkesrettet attføring og rehabiliteringspenger mellom intervensjonsgruppen og behandlingsgruppen.
Konklusjon: Henvisning til spesialist i fysikalsk medisin og rehabilitering direkte fra NAV etter 8-12 ukers sykmelding, det vil si uten behovsvurdering hos egen fastlege, førte ikke til en statistisk signifikant reduksjon i varigheten av sykmeldingsperioden i denne studien. Heller ikke andre trygdeytelser som rehabiliteringspenger og yrkesrettet attføring ble redusert etter en observasjonsperiode på to år etter at pasientene ble inkludert i undersøkelsen.
Elvsåshagen H, Tellnes G, Abdelnoor MH. Does early intervention by a specialist in physical medicine and rehabilitation reduce the duration of long term sick leave among persons with musculoskeletal diseases? Nor J Epidemiol 2009; 19 (2): 219-222.
ENGLISH SUMMARY
Background: Most patients with long term sick leave due to musculoskeletal diseases are treated by general practitioners.
The aim of this study was to test the hypothesis that early intervention by a specialist in physical medicine and rehabilitation will reduce the duration of long term sick leave due to musculoskeletal diseases.
Material and methods: In collaboration with 14 National Insurance Offices in the Norwegian county of Vestfold, 829 patients aged 25-50 years with 8-12 weeks of sick leave for musculoskeletal diseases were included and randomized into an intervention group (n=409) and a control group (n=420). Exclusion criteria were no job, rheumatic diseases, fractures and joint diseases. The intervention group was examined by a specialist in Physical Medicine and Rehabilitation at the Hospital of Rehabilitation in Stavern, Norway, where they were examined and treated. The patients in the control group were treated by general practitioners as usual. Some of these patients were also referred to the same hospital or other specialists for examination as part of the general practitioner's own initiative. Data on sick leave, disability pension, and other social benefits were collected from the National Insurance Offices. Number of days of sick leave, rehabilitation benefits and vocational rehabilitation were used as end points. After two years of follow-up the end points were examined. The data were analyzed according to the "intention to treat" principle.
Results: In the intervention group the average number of sick days was 138 as compared to 147 days in the control group. The difference of nine days of sick leave was not statistically significant (p=0,163). Regarding rehabilitation benefits and vocational rehabilitation, the two groups did not differ.
Conclusion: Early intervention by a specialist in physical medicine and rehabilitation did not reduce the duration of long term sick leave for patients with musculoskeletal diseases in this study. After two years of observation no difference was found between the two groups in rehabilitation benefits and vocational rehabilitation.
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