Effektivität FCE-basierter medizinischer Rehabilitation bei Patienten mit chronischen Muskel-Skelett-Erkrankungen – Ergebnisse einer randomisierten kontrollierten Studie

PURPOSE: This paper examines the influence of work-related interventions on vocational participation in the field of inpatient multidisciplinary rehabilitation in patients with Chronic Musculoskeletal Disorders (CMSD). MATERIALS AND METHODS: A randomized controlled trial (RCT) was carried out. The sample of this analysis consisted of patients with CMSD facing substantial work related problems (n=222). The intervention group passed through the work-related intervention in which the evaluation of functional capacity according to Isernhagen and a functional training were utilized (FCE MR). The control group completed the conventional multidisciplinary rehabilitation (MR).The analyses are based on the data of the 1-year-follow-up. The number of sick leaves (in weeks) and the employment status in the year after the intervention as well as the interaction of both parameters (active employment and sick leaves below six months) were measured as primary outcome criteria. The Pain Disability Index (PDI) for measuring the pain related disabilities as well as the scale of functional capacity of the MOS-36 were used as secondary outcomes. RESULTS: One year after the intervention valid data of n=102 patients could be referred to (n I =55, n K =47). No significant effects of the FCE MR on sick leaves (−8.0 weeks [−17.4; 1.4], p=.095) and on employment status (OR=2.3 [0.9; 5.8], p=.088) were be observed, yet could be found out in case of the interaction of both parameters (OR=3.4 [1.3; 8.9], p=.014). Furthermore a significant effect through the intervention in the PDI was identified (−6.5 [−12.6; −0.4], p=.038). DISCUSSION AND CONCLUSIONS: Effects on sick leave and on employment status could not be verified. Though the significant difference regarding the interaction of both parameters indicate the effectiveness of the FCE MR regarding the protection of constant vocational participation. This underlines findings of others studies showing that work-related interventions, which apply the principle of operant reinforcement, are more effective in patients facing substantial work related problems that plain MR.