Table 1 Cognitive-behavioural rehabilitation.
Staff category | Investigation and treatment phase, 2 – 8 weeks | Frequency |
|---|---|---|
Physician | Mapping out of medical obstacles to working. Handling of the sick-listing. If needed, prescription of drugs (antidepressants, analgesics etc.) and injections of cortisone (in shoulder- or hip-muscle attachments etc.)[25]. | 1 – 2 (consultations)/week. |
Physiotherapist | Mapping out of biomechanical obstacles to working including a visit to the work place [14]. Start of graded activity: the patient first carried out an activity measurable in minutes, metres, etc., for example a walk, until the pain increased. The starting level was about 25% below that. A gradual increase of the activity was decided on check-ups, the final aim being to manage the load in a job, for the unemployed an imaginary one [14]. If needed, manual therapy [25]. | 2 – 3 consultations. 1/week. 1/week. |
Psychologist or social worker | Mapping out of psychosocial obstacles to working. Cognitive- behavioural therapy focussed on anxiety and depression [46]. | 1/week. |
Health-care adviser | Start of education in applied relaxation [46]. | 1/week for 6 – 8 w. |
|  | Action phase, 2 – 8 months |  |
Team | Conference that produced a written rehabilitation plan with: 1. Final aim = the optimal degree of work ability that could be achieved and maintained for at least 30 consecutive days. 2. Partial aims concerning functioning only (for example, increase of vocational training by five hours/week); symptom aims, for example, pain reduction, were excluded [14]. 3. Means of reaching the aims (for example, increase of vocational training 1/2 hour/day week 1, 1 hour/day w. 2 etc.). | At the start of the action phase. |
Team | Check-up conferences produced fresh partial aims. | 1/3 – 4 weeks. |
Team member (usually the physiotherapist) | Vocational conferences with the employer and a clerk from the Social Insurance Agency or, for unemployed patients, the Employment Office. | Â |
Physician | Handling of the sick-listing. | 1/3 – 4 weeks. |
Physiotherapist | Completion of graded activity. Check-ups less frequent. | 1/3 – 4 weeks. |
Health-care adviser | Completion of education in applied relaxation. | 1/week (f. 6 – 8 w.) |
Psychologist or social worker | If needed: cognitive-behavioural therapy as support during the re-training process. | 1/week. |
| Â | When the final aim was reached, or when it was obvious that return-to-work would not be achieved. | The end of rehabilitation. |