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M. Rivano Fischer et al.
Table IV. Description of background data on patients in multimodal rehabilitation (MMR), before and after 2009, and p-values for
statistical differences on background variables between the 2 time-points
Background variables Total Before 2009 After (≥ 2009)
Patients in MMR 2007–2011, n (%)
Sex
Men
Female
Age, years, mean (SD)
Pain duration, months, median (IQR) 7,297 1,602 (22) 5,695 (78)
1,898 (26)
5,399 (74)
42 (10.0)
64 (24–138) 387 (24)
1,215 (76)
42 (10.1)
59 (24–123) 1,511 (27)
4,184 (73)
43 (10.5)
66 (24–142)
1,191 (16)
3,974 (55)
1,593 (22)
276 (4) 271 (17)
938 (59)
320 (20)
12 (< 1) 80 (17)
296 (63)
92 (20)
3 (< 1)
2,895 (40)
1,615 (22)
2,461 (34) 658 (41)
345 (22)
479 (30) 2,237 (39)
1,270 (22)
1,982 (35)
3,155 (43)
1,633 (22)
2,148 (29) 660 (41)
370 (23)
416 (29) 2,495 (44)
1,263 (22)
1,732 (30)
4.3
4.6
2.8
3.7 4.3
4.6
2.5
3.7 3.9
4.1
3.3
3.0
ns
a
Education level, n (%)
Primary school (9 years)
Secondary school (3 years)
University
Other
HADS Anxiety, n (%) a
0–7
8–10
11–21
p  < 0.001
p  = 0.006
ns
p  = 0.004
HADS Depression, n (%) a
0–7
8–10
11–21
ns
MPI, median (IQR) d
Pain severity
Pain-related life interference
Life control
Affective distress
(4.0–5.0)
(3.8–5.2)
(2.0–3.5)
(2.7–4.3)
(4.0–5.0)
(3.8–5.2)
(1.8–3.3)
(2.7–4.3)
(3.3–4.7)
(3.3–4.9)
(2.5–4.0)
(2.0–4.0)
ns
ns
p  < 0.001
ns
a
missing value: on educational level n  = 263 (4%), on HADS anxiety 362 (5%), on HADS depression n  = 361 (5%), on MPI 184–220 (3%).
HADS: Hospital Anxiety and Depression Scale; MPI: Multidimensional Pain Inventory; ns: not significant; IQR: interquartile range, SD: standard deviation.
DISCUSSION
The main finding of this study was an observed de-
crease in sick-leave benefits during 2 years after MMR.
This is the first study to include all participants in the
SQRP during 2007–11, including most participants in
MMR at the tertiary level, and combining data from
these patients with data from the SSIA database. To our
knowledge, the SQRP is a unique national database for
people with complex problems due to non-malignant
chronic pain. This study also presents data on the
escalating sick-leave benefits during the year prior to
inclusion in MMR, providing valuable information
about the sick-leave process in patients with complex
chronic pain.
These results underline that time is an important
factor to consider in evaluating the process of RTW
after rehabilitation. Furthermore, the results of this
study indicate that patterns of sick leave should be
assessed during long periods of time, both before and
after rehabilitation. The changes observed prior to
MMR indicate that patients gradually increased their
absence from work, suggesting a deterioration in their
work-related activities prior to and leading up to MMR.
The changes observed after rehabilitation indicate that
MMR positively influences levels of sick-leave bene-
fits. Busch et al., in 2011, showed a similar pattern in
their 10-year follow-up; the total amount of sick-leave
decreasing up to 2 or even 3 years after rehabilitation
(22). The results, however, are inconclusive, and in
a recent Norwegian study, Brendbekken et al. (23)
reported that the level of improvement found after 1
year stabilized 2 years after rehabilitation. No previous
study, however, has yet included patterns of sick leave
prior to rehabilitation in the analyses; an area to which
the current study contributes valuable information.
In addition, these results show a shift from full-time
sick leave to no sick leave or partial sick leave catego-
ries when comparing patterns of sick leave from the
Table V. Percentage and number of patients in the 4 categories of sick leave for the time period before 2009 (n  = 1,602) and after 2009
(n  = 5,695) 1 year before multimodal rehabilitation (MMR) at (T0), before MMR (T1), at 1 year after MMR (T2) and at 2 years after MMR (T3)
Time period a for MMR before and after policy changes
Level of sick leave Before
T0 < 2009
% (n) After
T0 ≥ 2009
% (n) Before
T1 < 2009
% (n) After
T1 ≥ 2009
% (n) Before
T2 < 2009
% (n) After
T2 ≥ 2009
% (n) Before
T3 < 2009
% (n) After
T3 ≥ 2009
% (n)
No sick leave 39 (617) 48 (2741) 26 (414) 37 (2,083) 32 (518) 56 (3,166) 46 (743) 68 (3,854)
21 (337) 18 (1048) 25 (400) 23 (1,285) 26 (417) 17 (964) 25 (392) 13 (762)
30 (487)
10 (161) 22 (1232)
12 (674) 37 (590)
12 (198) 30 (1,689)
11 (638) 22 (355)
20 (312) 18 (1,045)
9 (520) 11 (174)
18 (293) 12 (654)
8 (425)
Partial sick leave b
p -value
Full sick leave c
Full permament sick leave
a
T0: 365–273 days before MMR, T1: 90–0 days before MMR, T2: at 1-year follow-up 320–410 days after MMR, T3: at 2 years after MMR; b temporary or permanent;
temporary or mixed temporary and permanent.
c
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