An Intervention Program To Decrease the Duration and Cost of Work Disability Related to Musculoskeletal Disorders

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The summary below is from the full report titled "A Health System Program To Reduce Work Disability Related to Musculoskeletal Disorders." It is in the 20 September 2005 issue of Annals of Internal Medicine (volume 143, pages 404-414). The authors are L. Abásolo, M. Blanco, J. Bachiller, G. Candelas, P. Collado, C. Lajas, M. Revenga, P. Ricci, P. Lázaro, M.D. Aguilar, E. Vargas, B. Fernández-Gutiérrez, C. Hernández-García, L. Carmona, and J.A. Jover.

What is the problem and what is known about it so far?

Painful conditions of the muscles, bones, tendons, and joints are known as musculoskeletal disorders (MSDs). These ailments are common causes of inability to work and represent high-cost illnesses because of the expense of medical treatment and the loss of productivity when people are removed from the work force. The health system has yet to produce an effective method of returning these workers to their jobs promptly.

Why did the researchers do this particular study?

To find out if an intervention program integrated into the health system could return workers to their jobs more quickly and reduce the cost of temporary disability due to MSD.

Who was studied?

13,077 patients in Madrid who had received a certificate of temporary work disability from the national Social Security agency because of MSD. Patients were excluded if the cause of MSD was a workplace accident, trauma, or surgery.

How did the researchers do the study?

Patients in the study were randomly assigned to receive the intervention or standard care. Patients in the intervention group (5272 individuals) were seen periodically by a specialist in MSD illnesses (a rheumatologist) as often as necessary. Visits included education, clinical management, and management of prescriptions for free medications as well as filling out all necessary forms. Patients in the standard care group (7805 individuals) received usual medical management by the primary care physician, with referral to specialized care if needed. Return to work was negotiated with the patient and was never forced. Duration of temporary disability and the cost of MSD care were observed for each group. A random sample of 500 patients in the study were sent a questionnaire that asked how satisfied they were with the care they received and their opinion of the manner in which it was delivered.

What did the researchers find?

Duration of temporary disability was significantly shorter in the intervention group than in the control group (average of 26 days vs. 41 days). Fewer intervention patients went on permanent disability than control patients (38 vs. 99). By the end of the second year, every dollar invested in the program saved between $8 and $20. Net financial benefit of the program was a savings of more than $5 million. Patients in the intervention group were significantly more satisfied with their care and had a higher opinion of the way care was delivered than control patients.

What were the limitations of the study?

Both the patients and the doctors knew who was assigned to each group, so the analysis of results may have been affected by a desire to find a good effect from the intervention.

What are the implications of the study?

Investment in a relatively expensive intervention system of individualized specialist and generalist care for patients with MSD has the potential to return people to work more quickly and save money.