National research programme 53

project: Interdisciplinary intervention strategy for chronic MSDs

Background
Work-related musculoskeletal disorders are a persistent and expensive health challenge in all industrial countries including Switzerland. A recent European survey indicates that, among the working population, the three most common work health problems reported are: back pain (30%, increasing), stress (28%), muscular pain in arms or in legs (25%). The cost of work-related MSD in Switzerland has been estimated to about 2-4 Mia CHF per year. A relatively small group of patients causes relatively high health services costs and long absenteeism from work and furthermore show a high risk to loose workability.
Significant progresses have been made these last years in the understanding of the disorder occurrence and chronitisation. Despite of this, the management and successful rehabilitation of MSD suffering workers is still difficult. Recent reviews recommend an intervention strategy based on the bio-psycho-social model. Work hardening and work rehabilitation programs seek to achieve a balance between the physical and mental demands of the job and the individual's abilities. In a pilot project, we developed and tested the needed instruments and protocols for a multi-disciplinary intervention strategy that takes both aspects into account. This involves the application of clinical and occupation medical skills (rheumatology, occupational medicine, work psychology, ergonomics).

Aim
The goal of this controlled, blind, case control study is to compare the effectiveness of the multidisciplinary intervention strategy versus the standard treatment. The two methods will be compared with regard to patients' ability to return to work. The multidisciplinary intervention strategy consists of (1) work hardening, cognitive training, and psychosocial counseling directly related to the person's real work conditions and demands, and (2) job analysis and, if necessary, modification of work conditions. Patients will be recruited for participation in the two groups (120 patients in the intervention group and 120 patients in the control group) in collaboration with companies that have a work absence management system. Two research teams – with members from two rheumatology centers (University Hospital Zurich, URR) and from the two Swiss institutes working in the area of work and health (Center for Organizational and Occupational Sciences (ZOA), Swiss Federal Institute of Technology; Institut universitaire romand de Santé au Travail (IST), University of Lausanne), will conduct the case control study jointly. In addition, a research team at the University of Neuchâtel will conduct a cost-benefit analysis of the multidisciplinary and the standard treatment.

Significance
The whole study is expected to produce new strategies for the management of MSD and workplace rehabilitation as well as guidelines for both authorities and companies. Its potential impact in terms of risk and cost reduction for companies and the society is important.

Correspondence:
Prof. Dr. Brigitta Danuser
Institut universitaire romand de Santé au Travail
Rue du Bugnon 19
CH-1005 Lausanne
brigitta.danuser@hospvd.ch

Further applicants:
Michael Norberg, Hôpital orthopédique del Suisse romande, Lausanne
Andreas Klipstein, Departement Rheumatology and Inst. of Physical Medicine, Zürich
Thomas Läubli, Institute of Hygiene and Applied Physiology, Zürich
Claude Jeanrenaud, Institut de recherches économiques et régionales, Neuchâtel

Link to internal Site (download password protected) here

Institut de Santé et Travail, Uni Lausanne

Rheumaklinik und Institut für Physikalische Medizin, UniSpital Zürich

Zentrum für Organisations- und Arbeitswissenschaften, ETHZ

Spine Unit, Lausanne

Institut de Recherche Econimiques, Uni Neuchâtel