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