The primary aim of this investigation was to evaluate a seven-week

multidisciplinary rehabilitation programme, with emphasis on

musculoskeletal disorders, for working-age people, by assessments at the

start and end of the rehabilitation programme, and at follow-up

examinations 6, 12 and 24 months after completion of the programme. A

further aim was to explore the experiences of people not returning to work

during a period of six years after participation in an extensive

multidisciplinary rehabilitation programme.

Sixty participants, 40 women and 20 men (mean age 46.8 ± SD 7.9), with

musculoskeletal disorders, mainly neck and back pain, participated in a 7-

week rehabilitation programme which was based on a combination of

theoretical and practical education, physical activities, relaxation and

individual guidance. Before and after the programme and at the follow-up

occasions all participants were evaluated with the Global Self-Efficacy

Index (GSI), Hospital Anxiety and Depression Scale (HAD), and Stress test

(Study I). A group of participants who were still full-time sick-listed (Group

I) at the end of the study period were compared with participants who were

part-time or not sick-listed (Group II) at the end of the study period (II, III,

IV). They were evaluated with the Disability Rating Index (DRI), with the

Pain Intensity Rating Index on a visual analogue scale (VAS) (II, III)),

mobility tests (III), GSI (III), HAD, and a stress test (IV). Seven women

(median age 48 years) and three men (53 years) (Group I) were interviewed

and the interviews were analysed by manifest content analysis (V).

At the 2-year follow-up full-time sick leave, anxiety, depression and selfexperienced

stress had decreased in both sexes. They also showed increased

quality of life (QoL) (I). In participants with full-time sick leave (Group I),

self-experienced physical disability and pain ratings were high and showed

no decrease up until the 2-year follow-up. In participants with part-time or

no sick leave (Group II), physical disability and pain ratings decreased

gradually throughout the 2-year follow-up period (II). Cervical and

thoracolumbar spine range of motion (ROM) was lower in Group I than in

Group II from the start of rehabilitation to a 2-year follow-up. Only Group

II showed a temporal improvement in ROM. No changes in DRI, VAS or

GSI were found in parallel with corresponding temporal changes in any of

the ROM (III). Group I experienced no change in anxiety or depression

during the study period, in contrast to Group II, in which this decreased.

Decreased stress was found in both groups (IV). Group I described

perceived barriers to and possibilities of returning to work, and also gave

information on what strategies they used, to cope with everyday life (V).

The majority of the participants improved and they continued to be

physically active, their QoL improved, and most participants returned to

work. Ten of the participants, however, were on full-time sick leave

throughout the whole study period, with high self-experienced physical

disability, high pain rating and no improvement in anxiety and depression.

They experienced barriers to re-entering the labour market as consequences

of physical symptoms and fatigue. But they also believed in possibilities of

returning to work if they could get a modified job adapted to their own

capacity.

Thus, persons with severe disability and pain did not improve by

rehabilitation in this project. New methods of treatment have to be

developed for improvement of symptoms resulting in reduction of

functional impairment and a consequent need for sick leave.