Returning to work by working together - Experiential perspectives on sick leave due to chronic pain and an evaluation of a remote person-centred intervention

Abstract

Background: Chronic pain is a public health issue and a leading cause of health care visits and absence from the workplace. Overall aim: The overall aim of this thesis was to increase the understanding of chronic pain, sick leave and return-to-work (RTW) experiences, evaluate a remote person-centred intervention and explore health care utilization patterns among persons with chronic pain. Methods: Quantitative and qualitative approaches were employed to address the aim from multiple perspectives. In study I and II phenomenological hermeneutics were used to interpret the experi-ences of persons on sick leave due to chronic pain as well as the meaning of support in the process of returning to work. Study III was a randomized controlled trial (RCT) evaluating whether a person-centred intervention improved self-efficacy and sick leave outcomes compared with a control group. Study IV was a register-based analy-sis of health care utilization among the participants in the RCT. Results: Studies I and II revealed that sick leave due to chronic pain threatens personal identity and integri-ty, causing profound suffering. Feelings of being invisible and unjustly treated domi-nated, highlighting the need for recognition of patients’ experiences in their care and support. Being able to work was of great importance to the participants. However, the RTW process was often experienced as a solitary struggle, involving fragmented inter-ventions and stakeholder cooperation. Study III showed a statistically significant difference between the groups, where the control group deteriorated while the inter-vention group largely remained unchanged, suggesting that PCC may play a protec-tive role. Study IV revealed frequent utilization of health care, where primary health care services accounted for most of the care contacts, and physicians followed by physiotherapists were the most consulted health care professionals. Conclusion: This thesis highlights the profound personal impact of chronic pain. Being on sick leave is challenging and often leads to suffering, while trustful and collaborative stakeholder relationships are essential for a successful RTW. The findings also suggest that person-centred interventions play a protective role regarding self-efficacy and sick leave. Understanding the high frequency of health care utilization is crucial and reflects the care needs of individuals with chronic pain. The results indicate that further research to evaluate person-centred interventions as part of pain management strategies in clinical practice is warranted to inform and optimize future health care.