Gaps in the Organization of Rehabilitation Services for People with RMDs

Timely and well-coordinated rehabilitation is essential for people with rheumatic and musculoskeletal diseases (RMDs). In Norway, rehabilitation services are delivered across both specialist and municipal healthcare levels, yet their organisation, accessibility, and integration remain insufficiently explored from a patient perspective. While municipalities are responsible for most long-term rehabilitation services, evidence suggests that patient-centred goal setting and coordinated care are challenging to implement in practice.

To explore patients' experiences with rehabilitation and identify structural challenges relevant to health policy, the Norwegian Rheumatism Association (NRF) conducted a national member survey. The survey was distributed electronically to 720 eligible members in December, with 333 respondents (46% response rate). Most respondents were women (83%), and the most common diagnoses were osteoarthritis, fibromyalgia, and arthritis. Descriptive analyses assessed awareness of rehabilitation services, unmet needs, waiting times, service provision across care levels, use of digital rehabilitation, the role of voluntary-sector resources, and perceived outcomes.

Nearly half of respondents (47%) were unaware of available rehabilitation services in their local area, indicating limited transparency and insufficient patient guidance. Sixty percent reported a need for rehabilitation, yet 25% did not receive services they considered appropriate, and more than half waited over three months for access. Rehabilitation was predominantly delivered within specialist healthcare services (57%), while municipal provision was substantially lower (30%), highlighting an uneven distribution of responsibility. Digital rehabilitation was almost absent, despite its potential to improve accessibility. Notably, 32% of respondents believed that NRF activity-based services could have met all or part of their rehabilitation needs. Among those who received rehabilitation, 36% reported improved work participation.

These findings reveal systemic weaknesses in the organisation of rehabilitation services for people with RMDs in Norway, characterised by limited accessibility, long waiting times, and fragmented service delivery. From a health policy perspective, there is a clear need for stronger national governance of rehabilitation pathways, improved coordination between specialist and municipal services, and formal integration of digital and voluntary-sector resources. Strengthening collaboration with organisations such as the NRF may help address current capacity gaps and support more equitable, timely, and person-centred rehabilitation in line with EULAR principles of integrated care.