Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): short term effects of a randomised controlled trial in primary care

Figures & data

Table 1. The PREVSAM model’s components and differences towards treatment as usual within primary care rehabilitation.

PREVSAM model	Treatment as usual
Early identification of psychological risk factors
A person-centred approach with a biopsychosocial understanding including a medical history with a broad mapping of the patient’s situation	May include a person-centred approach. Medical history focusing on the MSD
Physiotherapy assessment	Physiotherapy assessment
Occupational therapy assessment	May occur in small numbers
A team meeting to establish a joint health plan with SMART goals	May include an individualised rehabilitation plan
Identification and clarification of the patient’s attitudes towards responsibility for the management of musculoskeletal pain and a clear division of the team members’ responsibilities
Possibility of early access to psychological treatment (optional)	May have psychological treatment elsewhere, however no formal collaboration with the rehabilitation clinic
Possibility to address work-related factors and contact with the workplace (optional)

Figure 1. Flow chart of participants’ enrolment and allocation.

A flow chart showing the process from enrolment to final cases in the analyses.

Table 2. Baseline demographics regarding sex, place of birth, marital status/living situation, and age.

Characteristics baseline	PREVSAM group n = 129		TAU n = 125		Between groups analysis
					p Value (χ2-test)
Sex	n	%	n	%	0.924
Women	87	67.4	85	68
Men	42	32.6	40	32
Place of birth	Missing = 2		Missing = 5
Within or outside Sweden					0.582
Born in Sweden	112	88.2	103	85.8
Born outside Sweden	15	11.8	17	14.2
Living situation	Missing = 2		Missing = 4
Living alone or with others					0.625
Single	24	18.9	20	16.5
Cohabitating (with partner, children, friend and/or parents)	103	81.1	101	83.5
Age at start					(Independent t-test)
Mean, median (min–max)	47.8, 49 (20–67)		47.0, 49 (21–66)		0.669

Note: Variable numbers of participants are owing to internal missing data.

Table 3. Baseline demographics regarding education level, occupation, and income.

Characteristics baseline	PREVSAM group n =129 n    %		TAU n = 125 n    %		Between groups analysis
					p Value (χ2-test)
Highest completed education	Missing = 2		Missing = 5		0.791
Primary school or equivalent	11	8.7	7	5.8
Secondary school	57	44.9	56	46.7
College, university including higher academic degree	59	46.5	57	47.5
Occupation according to The Swedish Standard Classification of Occupations 2012 (SSYK 2012)	Missing = 2		Missing = 5		0.008
Managers	11	8.5	3	2.4
Occupations requiring advanced level of higher education	35	27.1	19	15.2
Occupations requiring higher education qualifications or equivalent	7	5.4	21	16.8
Administration and customer service clerks	15	11.6	11	8.8
Service, care, and shop sales workers	30	23.3	36	28.8
Agricultural, horticultural, forestry and fishery workers	1	0.8	0	0.0
Building and manufacturing workers	8	6.2	13	10.4
Mechanical manufacturing and transport workers, etc.	6	4.7	8	6.4
Elementary occupations	11	8.5	9	7.2
Students	3	2.3	0	0.0
Approximate household income before tax	Missing = 2		Missing = 6		0.125
0–14 999 Swedish crowns	6	4.7	1	0.8
15 000–29 999 Swedish crowns	14	11.0	22	18.5
30 000–44 999 Swedish crowns	33	26.0	31	26.1
≥45 000 Swedish crowns	74	58.3	65	54.6

Note: Variable numbers of participants are owing to internal missing data. Boldface indicates statistical significance at p < 0.05.

Table 4. ICD-10 diagnoses reported by the team members in the PREVSAM group and in TAU.

ICD-10	PREVSAM group n = 129%	TAU n = 125%
A00-B99 Certain infectious diseases and parasitic diseases	0.0	0.8
F00-F99 Mental and behavioural disorders	3.1	3.2
G00-G99 Diseases of the nervous system	0.8	1.6
H60-H95 Diseases of the ear and the mastoid process	0.0	1.6
M00-M99 Diseases of the musculoskeletal system and connective tissue	87.6	84.8
R00-R99 Symptoms, signs of disease and abnormal clinical and laboratory findings not elsewhere classified	11.6	16.0
S00-T98 Injuries, poisonings, and certain other consequences of external causes	12.4	8.0
Z00-Z99 Factors of importance for the state of health and for contacts with health care	10.9	3.2

Table 5. Comparison of proportions of patients remaining in full- and part time work (no registered sickness benefit days) between the PREVSAM group and TAU.

	PREVSAM group, n = 128		TAU, n = 122
Time period	Proportion  95% CI		Proportion  95% CI		Proportion difference	p Value
Three months following baseline, M and S-diagnoses	0.859	0.788; 0.909	0.779	0.697; 0.843	0.080	0.097
Three months following baseline, M, S, F and R-diagnoses	0.828	0.753; 0.884	0.738	0.653; 0.808	0.090	0.082
Three months following baseline, all diagnoses	0.789	0.711; 0.851	0.705	0.619; 0.779	0.084	0.126

Notes: M “Diseases of the musculoskeletal system and connective tissue.” S “Injuries, poisonings, and certain other consequences of external causes.” F “Mental and behavioural disorders.” R “Symptoms, signs of disease and abnormal clinical and laboratory findings not elsewhere classified.”

Table 6. Comparisons of registered sickness benefit days between the PREVSAM group and TAU.

Time period	PREVSAM group, n = 128				TAU, n = 122
	Mean      SD     Median   Q1;Q3				Mean      SD     Median   Q1;Q3				p Value
Three months following baseline, M and S-diagnoses gross days	7.13	20.9	0	0;0	10.81	25.3	0	0;0	0.106
Three months following baseline, M and S-diagnoses net days	6.15	19.2	0	0;0	10.18	24.4	0	0;0	0.097
Three months following baseline, M, S, F and R-diagnoses gross days	7.69	21.2	0	0;0	11.79	25.6	0	0;4	0.087
Three months following baseline, M, S, F and R diagnoses net days	6.66	19.4	0	0;0	10.93	24.5	0	0;4	0.078
Three months following baseline, all diagnoses gross days	8.63	22.4	0	0;0	12.40	25.7	0	0;9.25	0.126
Three months following baseline, all diagnoses net days	7.60	20.9	0	0;0	11.55	24.7	0	0;9	0.112

Notes: Mann–Whitney U Test, SD: standard deviation, Q1;Q3: first and third quartile. M “Diseases of the musculoskeletal system and connective tissue.” S “Injuries, poisonings, and certain other consequences of external causes.” F “Mental and behavioural disorders.” R “Symptoms, signs of disease and abnormal clinical and laboratory findings not elsewhere classified.”

Table 7. Comparison of proportion of patients with self-reported sickness absence between the PREVSAM group and TAU.

	PREVSAM group, n = 128		TAU, n = 122
Time period	Proportion   95% CI		Proportion   95% CI		Proportion difference	p Value
Three months following baseline, self-reported sickness absence for inclusion condition	0.539	−0.060;0.185	0.475	−0.060;0.184	0.064	0.314

Table 8. Comparison of self-reported sickness absence days between the PREVSAM group and TAU.

Time period	PREVSAM group, n = 128				TAU, n = 122
	Mean ­    SD     Median   Q1;Q3				Mean ­    SD     Median   Q1;Q3				p Value
Three months following baseline, gross self-reported sickness absence days for inclusion condition	12.43	23.18	2.00	0.00;11.75	14.49	27.04	0.00	0.00;15.00	0.634

Note: Mann–Whitney U Test, SD: standard deviation; Q1;Q3: first and third quartile.

Figure 2. Mean self-reported sick days per week for the PREVSAM and TAU groups.

Shows two lines representing PREVSAM respectively TAU regarding weekly mean of self-reported sick days per week.

Table 9. Differences in patient-reported health outcomes within and between groups.

	PREVSAM group		Within-group analysis	TAU		Within-group analysis	Between-groups analysis
	n = 129		Wilcoxon signed rank test	n = 125		Wilcoxon signed rank test	Mann–Whitney U test
Instrument	Baseline Median (Q1;Q3)	Three months follow-up Median (Q1;Q3)	p Value	Baseline Median (Q1;Q3)	Three months follow-up Median (Q1;Q3)	p Value	p Value
ÖMPSQ-SF	51 (45;58.5) n = 129	39 (29;49) n = 103	<0.001	52 (45;59) n = 121	42 (30;52) n = 86	<0.001	0.34
WAS	6 (4;8) n = 126	8 (6;9) n = 107	<0.001	6.5 (3;8) n = 120	7.5 (5;9) n = 86	<0.001	0.48
DRI	38.17 (20.75;53.75) n = 103	21.71 (4.92;40.5) n = 92	<0.001	40.17 (18.25;59.25) n = 98	25.38 (8.25;44.88) n = 78	<0.001	0.78
PNRS	5 (3;6) n = 127	3 (1;5) n = 107	<0.001	5 (3;7) n = 120	3 (1;4) n = 88	<0.001	0.33
Pain frequency	2 (1;3) n = 127	3 (2;4) n = 107	<0.001	2 (1;3) n = 120	3 (2;4) n = 88	<0.001	0.23
PSEQ-2SV	8 (6;10) n = 67	10 (8;12) n = 70	0.003	8 (6;10) n = 66	10 (8;12) n = 55	<0.001	0.34
GSE	31 (27;36) n = 67	31 (29;36) n = 68	0.24	31 (28;34) n = 66	32 (30;34) n = 55	0.20	0.94
HADS-A	7 (4;12) n = 123	6 (3;10) n = 104	<0.001	6 (4;10) n = 119	5 (3;9) n = 84	0.047	0.45
HADS-D	4 (2;8) n = 125	2.5 (1;7) n = 106	<0.001	3 (1;6) n = 120	2.5 (1;6) n = 86	0.36	0.76
EQ VAS	51.5 (40;70) n = 124	69 (51;80) n = 107	<0.001	56 (40;71) n = 120	70 (48.25;80) n = 84	0.006	0.69

Note: ÖMPSQ-SF: Örebro Musculoskeletal Pain Screening Questionnaire Short Form; WAS: Work Ability Score; DRI: Disability Rating Index; PNRS: Pain Numeric Rating Scale; Pain frequency: four-point Likert scale from 1 = “always/nearly always” to 4 = “rarely”; PSEQ-2: Pain Self-Efficacy Questionnaire two-items; GSE: General Self-Efficacy Scale; HADS: Hospital Anxiety Depression Scale; EQ VAS: The European Quality of Life Visual Analogue Scale. Boldface indicates statistical significance at p < 0.05.

Data availability statement

The data are available on reasonable request.