Usefulness and feasibility of comprehensive and less comprehensive vocational rehabilitation for patients with chronic musculoskeletal pain: perspectives from patients, professionals, and managers

Abstract

Purpose

To explore the usefulness and feasibility of a comprehensive vocational rehabilitation (C-VR) program and less comprehensive (LC-VR) program for workers on sick leave due to chronic musculoskeletal pain, from the perspective of patients, professionals, and managers.

Materials and methods

Semi-structured interviews were held with patients, professionals, and managers. Using topic lists, participants were questioned about barriers to and facilitators of the usefulness and feasibility of C-VR and LC-VR. Thirty interviews were conducted with thirteen patients (n = 6 C-VR, n = 7 LC-VR), eight professionals, and nine managers. All interviews were transcribed verbatim. Data were analyzed by systematic text condensation using inductive thematic analysis.

Results

Three themes emerged for usefulness (“patient factors,” “content,” “dosage”) and six themes emerged for feasibility (“satisfaction,” “intention to continue use,” “perceived appropriateness,” “positive/negative effects on target participants,” “factors affecting implementation ease or difficulty,” “adaptations”). The patients reported that both programs were feasible and generally useful. The professionals preferred working with the C-VR, although they disliked the fixed and uniform character of the program. They also mentioned that this program is too extensive for some patients, and that the latter would probably benefit from the LC-VR program. Despite their positive intentions, the managers stated that due to the Dutch healthcare system, implementation of the LC-VR program would be financially unfeasible.

Conclusions

The main conclusion of this study is that it is not useful to have one VR program for all patients with CMP and reduced work participation, and that flexible and tailored-based VR are warranted.

Implications for rehabilitation

• Both comprehensive and less comprehensive vocational rehabilitation are deemed useful for patients with chronic musculoskeletal pain and reduced work participation. Particular patient factors, for instance information uptake, discipline, willingness to change, duration of complaints, movement anxiety, obstructing thoughts, and willingness to return to work might guide the right program for the right patient.

• Both comprehensive and less comprehensive vocational rehabilitation are deemed feasible in practice. However, factors such as center logistic (schemes, rooms, professionals available) and country-specific healthcare insurance and sickness compensation systems should foster the implementation of less comprehensive programs.

Keywords:

• Qualitative research
• tailored intervention
• workplace intervention
• return to work
• implementation research

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Medical Ethical Committee of the Academic Medical Center, Amsterdam, the Netherlands, authorized this study and decided that a full application was not required.

Disclosure statement

The authors report no conflicts of interest.

Data availability

The data that support the findings of this study are available from the corresponding author, MFR, upon reasonable request.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Table

Table

Notes

1 See also Online Resource 2.

Additional information

Funding

This work was financially supported by Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.