Background & Aims

Musculoskeletal pain is common and concerns more than half of the visits to primary care (1). Approximately 10%-20% may lead to long-term disability, reduced work capacity, and sickness absence (2). There is a knowledge gap on if early identification of psychological risk factors and a person-centred team-based rehabilitation for musculoskeletal pain within primary care is effective in preventing long-term problems and sickness absence. The rehabilitation model PREVSAM, PREVention of Sickness Absence for Musculoskeletal pain, was designed with the aim to prevent long-term problems and sickness absence (3). The PREVSAM model was delivered in primary care in Sweden by physiotherapists and occupational therapists. The healthcare professionals created a team with the patient, with the possibility to include a psychotherapist. This process evaluation was conducted alongside the trial with the aim to provide insight into how and why the PREVSAM model intervention was effective or not.

Methods

The process evaluation followed the Medical Research Council guidance. To evaluate what was implemented, mechanisms of impact and factors affected by the context, both quantitative and qualitative data were obtained. Readiness for change, recruitment, reach, retention, intervention fidelity, and dose were investigated. Experiences of working according to the PREVSAM model were collected from a focus group discussion with healthcare professionals. The patients’ experiences of rehabilitation according to the PREVSAM model were included from an interview study with participants in the trial’s intervention.

Results

The essential components of the PREVSAM model were generally delivered according to protocol for most patients. The healthcare professionals answered positively in all measures of the readiness measures after being trained in the PREVSAM model and before delivering the intervention. This positive attitude towards the PREVSAM model remained at the follow-up. However, concerns were raised about implementing screening and teamwork when already having a high workload.
Due to rapidly changed conditions during the Covid-19 pandemic the recruitment, reach and retainment of participating clinics were negatively affected. The clinics that remained in the trial had difficulties to prioritise teamwork.

Conclusions

The PREVSAM model’s essential components were generally delivered for most patients. Contextual factors partly influenced the way it was delivered, mainly due to a higher staff-turn over at some clinics and a higher sickness absence among both patients and healthcare professionals due to the Covid-19 pandemic.
The model’s components of a person-centred approach with a biopsychosocial understanding of pain, interdisciplinary teamwork and a joint health-plan were appreciated both by healthcare professionals and patients. The psychotherapist was involved in the teamwork in about 40% of the cases. Very few patients requested the healthcare professionals to collaborate with their workplace. The great variation in the patients needs led to that the interventions delivered in rehabilitation according to the PREVSAM model were individualised, in accordance with the protocol. However, for many the rehabilitation provided was close to treatments as usual, i.e., mainly physiotherapy alone.

References

1.Wiitavaara B, Fahlström M, Djupsjöbacka M. Prevalence, diagnostics and management of musculoskeletal disorders in primary health care in Sweden – an investigation of 2000 randomly selected patient records. Journal of evaluation in clinical practice. 2017;23(2):325-32.
2.Bevan S. Economic impact of musculoskeletal disorders (MSDs) on work in Europe. Best practice & research Clinical rheumatology. 2015;29(3):356-73.
3.Larsson M, Nordeman L, Holmgren K, Grimby-Ekman A, Hensing G, Björkelund C, et al. Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal pain (PREVSAM): a randomised controlled trial protocol. BMC musculoskeletal disorders. 2020;21(1):790.

Presenting Author

Annika Ekhammar

Poster Authors

Annika Ekhammar

PhD-student

Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska A

Lead Author

E-mail

Maria EH Larsson

Institute of Neuroscience and Physiology, University of Gothenburg, Sweden

Lead Author

E-mail

Karin Samsson

Lead Author

E-mail

Susanne Bernhardsson

Lead Author

E-mail

Topics

  • Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science