Program > Friday > 10:30 > Session 3. Retour au travail permanent (1 de 3)

Paper: Long-term impact of an early multidisciplinary return-to-work program for workers on sick leave due to musculoskeletal disorders
Author(s) and Affiliation(s):
Michèle Rivard , Département de médecine sociale et préventive, Université de Montréal. Institut de Recherche en Santé Publique de l’Université de Montréal.
Valérie Lederer, Faculté de médecine, Université de Montréal. Institut de Recherche en Santé Publique de l’Université de Montréal.
Michel Rossignol, Department of Epidemiology, Biostatistics and Occupational health, McGill University.
André-Pierre Contandriopoulos, Département d’administration de la santé, Université de Montréal. Institut de Recherche en Santé Publique de l’Université de Montréal.
Geneviève Ste-Marie, Institut de Recherche en Santé Publique de l’Université de Montréal.
Session : 3. Retour au travail permanent (1 de 3)
Day/Time: Friday at 10:30
Room: St. Patrick Room, 3rd Floor
Objectives:

This study assesses the impact of a pilot project implemented in Quebec between 2000 and 2004: the PREVICAP program (Sherbrooke model). PREVICAP consists in an early comprehensive intervention aimed at returning injured workers with musculoskeletal disorders to their regular job. The efficacy of PREVICAP has been demonstrated 1 and replicated 2 in two randomized controlled trials, that is, in ideal settings. However its effectiveness and cost-benefit in real-world situations subject to implementation constraints has never been demonstrated.

Methods:

A mixed methods research strategy was used with a multiple case study design combined with two quasi-experimental designs, including a cohort study of injured workers. 117 subjects referred to PREVICAP were compared to 391 controls receiving usual care. Controls were matched to experimental subjects according to date of injury, Quebec compensation board regional office, history of disability compensation in the previous year and duration of compensation benefit between accident and program referral (lead-time for referral). Data were collected over a three-year follow-up period. Main outcomes are time until sustainable return to work, duration of compensation benefits, disability management costs and net benefit (NB) over a three-year period. Data were analyzed using multivariate Cox models and NB regression models.

Results:

PREVICAP is more effective in terms of sustainable return to work (adjusted (HR) ̂ = 2.86; 95%CI 1.99–4.12). Effect on duration of compensation benefits was also substantial (adjusted (HR) ̂ = 1.75; 95%CI 1.27–2.40). Overall, mean costs are higher for PREVICAP workers ($60,873 vs $53,990). However, when taking into account the difference in saved compensation days, six months on average, PREVICAP is more cost-beneficial. In particular, among workers with no history of compensation in the last five years, the difference in adjusted NB between groups is $17,119 in favor of PREVICAP (adjusted NB: +$918 vs -$16,201; p=0.003).

Conclusions:

Our evaluation confirms the positive value of the PREVICAP intervention. Furthermore, these results were observed in a vulnerable population of workers with prolonged disability, referral to the program occurring six to 12 months after the accident for a majority of them. Long-term cost-benefit results suggest that this program is worthwhile from a social insurer perspective.

References:

1. Loisel P, Abenhaim L, Durand P, et al. A population-based, randomized clinical trial on back pain management. Spine 1997;22:2911-8.
2. Steenstra IA, Anema JR, Bongers PM, et al. Cost effectiveness of a multi-stage return to work program for workers on sick leave due to low back pain, design of a population based controlled trial [ISRCTN60233560]. BMC Musculoskeletal Disorders 2003;4:1-11.