British Medical Bulletin Advance Access originally published online on September 11, 2006
British Medical Bulletin 2006 77-78(1):55-69; doi:10.1093/bmb/ldl008
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Preventing incapacity in people with musculoskeletal disorders
Unumprovident Centre for Psychosocial and Disability Research, Cardiff University, Cardiff, UK
Correspondence to: Gordon Waddell, 6 Heatherbrae, Bishopbriggs, Glasgow G64 2TA, UK. e-mail: gordon.waddell{at}virgin.net
Musculoskeletal disorders are among the most common causes of sickness absence, long-term incapacity for work and ill-health retirement. The number of Incapacity Benefit (IB) recipients in the United Kingdom has trebled since 1979, despite improvement in objective measures of health. Most of the trend is in non-specific conditions (largely subjective complaints, often with little objective pathology or impairment). Understanding incapacity requires a biopsychosocial model that addresses all the physical, psychological and social factors involved in human illness and disability. Rehabilitation should be directed to overcome biopsychosocial obstacles to recovery and return to work. These principles are fundamental to better clinical and occupational management and minimizing incapacity. Sickness absence and incapacity from non-specific musculoskeletal conditions could be reduced by 33–50%, but that depends on getting all stakeholders onside and a fundamental shift in thinking about these conditions—in health care, in the workplace and in society.
Keywords: musculoskeletal conditions • biopsychosocial • sickness • disability • incapacity • primary care • clinical management • occupational health • rehabilitation