REHSAM Web-based multimodal pain rehabilitation in primary health care.

Today musculoskeletal pain disorders, particularly stress-related disorders consume a large proportion of the health services and are the main causes of occupational disability and sick leave. The development of stress-related disorders can be described as a process over years with symptoms of fatigue and musculoskeletal tensions and pain that develops into psychosomatic and more severe musculoskeletal pain diagnoses for example persistent pain, chronic fatigue syndrome and emotional exhaustion. The diagnosis chronic fatigue syndrome implies that the aetiology can be long-term stress emanating from working life or life situation. Multimodal pain rehabilitation according to cognitive behavior therapy (CBT)-principles has been shown to reduce pain and stress levels and increase return to work.

The overall purpose

purpose is to evaluate a tailored web-based support programme as complement to multimodal rehabilitation in primary health care for patients with long-term non-specific neck/shoulder/back pain.

The specific objectives are to study

1. Effects of the program on self-perceived workability and days of sick-leave among the clients

2. Effects on costs and resource utilization in the primary health care system 

3. Effects on pain and function in the musculosceletal system, self-efficacy and coping with pain, sense of coherence, and general health and well-being among the clients.

4. Satisfaction and perceived usability, regarding both staff and clients, with the web-based support system

Randomization will be done at 10 primary health care centres in Norrbotten after screening to 1) multimodal pain rehabilitation with an added individually tailored web-based module according to CBT-principles or 2) multimodal pain rehabilitation. We suggest a clear rehabilitation chain where a web-based program is developed, evaluated and ready to implement if it shows positive effects on work-ability and/or is cost-effective. The research and implementation will be performed in a close cooperation between the County Council of North Bothnia and Luleå University of Technology.