Background and purpose: A new concept to increase return to work for patients listed as sick with chronic musculoskeletal pain has been used at a rehabilitation centre in Luleå, Sweden. The programme includes work for three days a week and intensive rehabilitation for two days a week, for 12 weeks, as a combination of 'on the job' training and rehabilitation after a period off work sick. The rehabilitation programme focused on pain reduction, identifying and finding solutions to pain problems in actual work and life situations and training of the functional capacities needed in the work and life situation. The aim of the study was to describe patients' perceptions of motivating factors for return to work.
Methods: A phenomenological method was used. A naïve reading of interview notes was followed by structural analyses and reflections on the interpreted whole. Inclusion criteria for the study were musculoskeletal pain for at least one year and a period of at least four weeks' sick leave during that time. Ten patients, aged 30-54 years, participated in the study. An initial conceptual framework was developed to inform the scope of the study and to guide data collection and analysis.
Results: Different factors in the study framework influenced motivation to return to work. Among structural factors the division of labour at work was the most important motivator, particularly the ability to do as much as work colleagues, quantitatively and qualitatively. All the patients had jobs in the healthcare or service sectors, jobs with many social contacts. They perceived their work task content as being of minor importance compared to whether the tasks were perceived as meaningful or highly needed by others. All wanted a meaningful job content and a job which they could do in a satisfactory way according to their own norms and compared to colleagues. This highly increased motivation for return to work. Relationships (in terms of co-operation with colleagues and service to patients or clients) were important motivating factors for return to work. Self-confidence was a new factor of importance for return to work; work tasks had to be meaningful and needed by others, work must be done in a way satisfactory for the individual and in a way that was acceptable to others in the group. Everyday responsibility, feedback and support in daily work tasks were important. These aspects increased self-confidence. The results supported the development of a new conceptual framework for possible motivating factors for return to work.
Conclusions: Structure, content, relationships, health and self-confidence were all important motivating factors for return to work.