Team-based rehabilitation in primary care for patients with musculoskeletal disorders Experiences, effect- and process evaluation

Abstract

Most people will experience musculoskeletal disorders at some point in their lives, ranging from a manageable problem to significant difficulties with mobility, sleeping, performing daily activities, and working. There is a link between pain and psychological well-being, which may need to be considered during treatment to try to prevent the problems from becoming long-lasting. In addition to the impact on a person’s life, musculoskeletal disorders may also entail costs for society in the form of healthcare utilisation and sickness absence. Aim: The overall aim of this thesis was to evaluate team-based rehabilitation in primary care for patients with musculoskeletal disorders; to explore patients’ and healthcare professionals’ experiences of team-based rehabilitation, and to examine effects and the implementation process of a new rehabilitation model. Methods: To explore experiences of change related to team-based rehabilitation, individual interviews were conducted with patients with chronic musculoskeletal disorders and analysed with systematic text condensation (Study I). To evaluate effects and implementation process of a new rehabilitation model in primary care for those with acute/subacute musculoskeletal pain and psychological risk factors, and the staff’s experiences of working according to the model, three studies were conducted: one randomised controlled trial (Study II), one focus group study analysed with focus group methodology (Study III), and one process evaluation (Study IV). Results: For patients with chronic musculoskeletal disorder, all parts of the team-based rehabilitation were perceived as important, although at different times during the rehabilitation process, to facilitate a positive change. This was thematically interpreted as "A sense of increased living space". No statistically significant differences were found in sickness absence between the new team-based rehabilitation model and treatment as usual, and both groups improved in patient-reported outcomes. The new rehabilitation model was well received by healthcare professionals working according to the model. The model’s essential components were delivered to a high degree, but contextual challenges were identified which may have affected the trial’s outcomes. Conclusion: Team-based rehabilitation in primary care contributed with positive experiences for people with musculoskeletal disorders of different durations and for the healthcare professionals who provided the intervention. In the prevention of sickness absence and development of long-term problems in those with acute/subacute musculoskeletal disorders, no statistically significant differences were found between the new rehabilitation model and treatment as usual. The healthcare professionals found screening for risk factors important but not enough to capture those in need for more comprehensive rehabilitation. To provide individualised rehabilitation, sufficient time is needed for an assessment with a person-centred approach to clarify the patients’ goals, expectations, resources, and motivation to engage in their rehabilitation.