Fit for Work Europe: Turning MSDs into manageable conditions

8/8/2019 Fit for Work Europe: Turning MSDs into manageable conditions

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Turning MSDs into manageable conditions:

What remains to be done to set up effective

systems at national levelSwedish experiences

Ingemar Petersson, MD, PhD, Ass.professor

Skåne University Hospital LundLund

Sweden



The problems with MSDs in Sweden:The positive aspects

Focus on Working Life Research

Return to Work (RTW) programs promoting work ability through

interventions at the work place (Ref. Cochrane report 2009)

Inclusive Working Life

Governmental report 2009 (Vingård et al, SOU 2009:93)

Research Funding

AFA Insurance

FAS

VINNOVA



The problems with MSDs in Sweden:The positive aspects

National Rehabilitation Program for MSD:s (pain) and

mental illness 2009- 2011- ?

90 000 000 Euros (population 9 000 000 people)

yearly

About half for MSK pain; mainly LBP

Approximately 480 000 indviduals seeking health care for Low Back Pain

(LBP)

Approximately 10 000 treatments per year



The impact of MSDs/MSCs-a Swedish example

National Rehabilitation Program for MSD:s (pain) and mental

illness:

Nationwide access since 2009 with a total of 17 000 patients

treated first year

Muskuloskeletal pain (South Sweden):

Significantly improved Health Related Quality of Life

Improved Function as measured by ICF

Tendency to RTW directly

National Report 2010 (Jensen, Busch, Petersson et al)



-.6

-.4

-.2

0

.2

.4

.6

.8

1

EQ-5D index, MMS

Inskrivning Utskrivning

-.6

-.4

-.2

0

.2

.4

.6

.8

1

EQ5 index, kvinnor, MMS


-.6

-.4

-.2

0

.2

.4

.6

.8

1

EQ5 index, män, MMS




Low Back Pain Sweden 2010




Strömbeck B, Englund E, Bremander A, Jacobsson L , Kedza L,Kobelt G, Petersson IF. Cost of illness from the public payers´

perspective in patients with ankylosing spondylitis.

J Rheumatology. 2010: in press

Olofsson T, Englund M, Saxne T, Jöud A, Jacobsson LT H,

Geborek P, Allaire S, Petersson IF. Decrease in sick leave

among patients with rheumatoid arthritis in the first 12

months after start of treatment with tumour necrosis factor

antagonists: a population-based controlled cohort study.

Ann Rheum Dis Published Online First: 6 August 2010



Substantial and sustained decrease in sick leave among RA-patientsfirst 12 months after start of treatment with TNF-antagonists

Tor Olofsson, Martin Englund, Tore Saxne, Anna Jöud, Lennart T.H.

Jacobsson, Pierre Geborek, Saralynn Allaire, Ingemar F. Petersson.

Ann Rheum Dis Published Online First: 6 August 2010



Results

Days before and after treatment start

-360-300 -240-180 -120 -60 0 60 120 180 240 300 360

P

e r c e n t a g e o f s u b j e c t s o n

S L

0

10

20

30

40

50

RA cases

Controls

Treatment start

n=365

n=1460

p<0.001 p<0.001

p=1.0p=0.91

Point prevalence of sick leave

Ann Rheum Dis published online August 6, 2010



FOLLOW-UP:Sick Leave in patients with Ankylosing Spondylitis (AS) treated with TNF blockers 2004-2007 in south Sweden as compared to controls

Data from the MORSE

project and the SSATG

register

(Lars-Erik Kristensen,

Pierre Geborek, Tor

Olofsson, MartinEnglund, Thor Lithman,

Ingemar F Petersson,

EULAR 2010, oral

presentation)

www.morse.nu

Start TNF blocker treatment



Which way for the future in Sweden??



Health Inequities in MusculoskeletalDisorders (MSD)- some examples

Sick leave and work disability

Regional differences

National differences

Access to care for MSD:s

Diagnosis

Standards of care

Treatments

Pharmacological treatment

Surgical treatment

Rehabilitation

Work place changes




National plans/guidelines for RA, SpA/AS/PsA, OA, Trauma, OP, (Pain)

Biologics for 10-20 % of patients with RA/SpA/AS

National and regional structured follow-up

Registers

Surveys

Linking to sick leave data etc (MORSE; www.morse.nuwww.morse.nu ))

National clinical trials

the SWEFOT study.

Addition of infliximab compared with addition of sulfasalazine andhydroxychloroquine to methotrexate in patients with early rheumatoid

arthritis (Swefot trial): 1-year results of a randomised trial. R F van

Vollenhoven, S Ernestam, P Geborek, I F Petersson, et al. Lancet 2009; 374:

45966)




National plans/guidelines for RA, SpA/AS/PsA, OA, Trauma, OP,(Pain)

Register follow-up

National (ARTIS) and Regional (SSATG and MORSE in Skåne).

National Register for Pain Management (NRR)

New register for National Rehabilitation Program

South Sweden (Skåne Region)

RACKS



µEvery muscle is burning-as soon as I move, deardoctor Svenssonµ

µI am really sorry, fibromyalgiadiagnosis does not exist inSweden any more. Now, please

be socially responsible. I write µAsthmaµ on the sick noteinstead«µ




EU

National authorities

Patients/Consumers

Medical associations

EULAR

EFORT

Others

Collaborative efforts

EUMUSC.NET

Fit for Work

The Bone and Joint Decade



A better life for patients with MSDs:An integral view

Documents

Fit for Work Europe: Turning MSDs into manageable conditions