A Health System Program To Reduce Work Disability Related to Musculoskeletal Disorders

  1. Lydia Abásolo, MD;
  2. Margarita Blanco, MD, PhD;
  3. Javier Bachiller, MD;
  4. Gloria Candelas, MD, PhD;
  5. Paz Collado, MD, PhD;
  6. Cristina Lajas, MD, PhD;
  7. Marcelino Revenga, MD;
  8. Patricia Ricci, MD;
  9. Pablo Lázaro, MD, PhD;
  10. Maria Dolores Aguilar, MD, PhD;
  11. Emilio Vargas, MD, PhD;
  12. Benjamín Fernández-Gutiérrez, MD, PhD;
  13. César Hernández-García, MD, PhD;
  14. Loreto Carmona, MD, PhD; and
  15. Juan A. Jover, MD, PhD
  1. From Hospital Clinico San Carlos, Hospital Ramón y Cajal, and Hospital Severo Ochoa, Madrid, Spain.

    Abstract

    Background: Musculoskeletal disorders (MSDs) are a frequent cause of work disability, accounting for productivity losses in industrialized societies equivalent to 1.3% of the U.S. gross national product.

    Objective: To evaluate whether a population-based clinical program offered to patients with recent-onset work disability caused by MSDs is cost-effective.

    Design: Randomized, controlled intervention study. The inclusion and follow-up periods each lasted 12 months.

    Setting: Three health districts in Madrid, Spain.

    Patients: All patients with MSD-related temporary work disability in 1998 and 1999.

    Intervention: The control group received standard primary care management, with referral to specialized care if needed. The intervention group received a specific program, administered by rheumatologists, in which care was delivered during regular visits and included 3 main elements: education, protocol-based clinical management, and administrative duties.

    Measurements: Efficacy variables were 1) days of temporary work disability and 2) number of patients with permanent work disability. All analyses were done on an intention-to-treat basis.

    Results: 13 077 patients were included in the study, 7805 in the control group and 5272 in the intervention group, generating 16 297 episodes of MSD-related temporary work disability. These episodes were shorter in the intervention group than in the control group (mean, 26 days compared with 41 days; P < 0.001), and the groups had similar numbers of episodes per patient. Fewer patients received long-term disability compensation in the intervention group (n = 38 [0.7%]) than in the control group (n = 99 [1.3%]) (P < 0.005). Direct and indirect costs were lower in the intervention group than in the control group. To save 1 day of temporary work disability, $6.00 had to be invested in the program. Each dollar invested generated a benefit of $11.00. The program's net benefit was in excess of $5 million.

    Limitations: The study was unblinded.

    Conclusions: Implementation of the program, offered to the general population, improves short- and long-term work disability outcomes and is cost-effective.

    Article and Author Information

    • Grant Support: In part by grants from the Fondo de Investigaciones Sanitarias of the Spanish Ministry of Health numbers FIS 98/1050 and 00/0201.

    • Potential Financial Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Juan A. Jover, MD, PhD, Servicio de Reumatología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; e-mail, jjover.hcsc{at}salud.madrid.org.

    • Current Author Addresses: Drs. Abásolo, Blanco, Candelas, Lajas, Vargas, Fernández-Gutiérrez, Hernández-García, Carmona, and Jover: Servicio de Reumatología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain.

    • Drs. Bachiller and Revenga: Servicio de Reumatología, Hospital Ramón y Cajal, Carretera de Colmenar, Km 9.1, 28034 Madrid, Spain.

    • Drs. Collado and Ricci: Servicio de Reumatología, Hospital Severo Ochoa, Avenida Orellana s/n 28911, Madrid, Spain.

    • Drs. Lázaro and Aguilar: TAISS (Técnicas Avanzadas de Investigación en Servicios de Salud), C/ Cambrils 41, 28034 Madrid, Spain.

    • Author Contributions: Conception and design: C. Hernández-García, J.A. Jover, E. Vargas.

    • Analysis and interpretation of the data: L. Abásolo, L. Carmona, C. Hernández-García, J.A. Jover, C. Lajas, P. Lázaro, E. Vargas.

    • Drafting of the article: L. Abásolo, L. Carmona, B. Fernández-Gutiérrez, C. Hernández-García, J.A. Jover.

    • Critical revision of the article for important intellectual content: L. Abásolo, M.D. Aguilar, L. Carmona, B. Fernández-Gutiérrez, C. Hernández-García, J.A. Jover, C. Lajas, P. Lázaro.

    • Final approval of the article: L. Abásolo, L. Carmona, B. Fernández-Gutiérrez, C. Hernández-García, J.A. Jover.

    • Provision of study materials or patients: M. Blanco, J. Bachiller, G. Candelas, P. Collado, C. Lajas, M. Revenga, P. Ricci.

    • Statistical expertise: L. Abásolo, M.D. Aguilar, L. Carmona, C. Hernández-García, E. Vargas.

    • Obtaining of funding: J.A. Jover.

    • Administrative, technical, or logistic support: J. Bachiller, M. Blanco, G. Candelas, P. Collado, C. Lajas, M. Revenga, P. Ricci.

    • Collection and assembly of data: L. Abásolo, J. Bachiller, M. Blanco, G. Candelas, P. Collado, C. Lajas, M. Revenga, P. Ricci.

    Summary for Patients

    • Summaries for Patients:An Intervention Program To Decrease the Duration and Cost of Work Disability Related to Musculoskeletal Disorders Ann Intern Med September 20, 2005 143:I-30
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    1. Ann Intern Med September 20, 2005 vol. 143 no. 6 404-414
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