Abstract
Purpose To assess effects of an inpatient multicomponent occupational rehabilitation program compared to less comprehensive outpatient rehabilitation on sickness absence in persons with musculoskeletal- or mental health disorders. Methods Randomized clinical trial with parallel groups. Participants were individuals 18–60 years old on sick-leave for 2–12 months with a sick-leave diagnosis within the musculoskeletal, psychological or general and unspecified chapters of ICPC-2, identified in a national register. The inpatient program (4 + 4 days) consisted of Acceptance and Commitment Therapy (ACT), physical training and work-related problem-solving including creating a return to work plan and a workplace visit if considered relevant. The outpatient program consisted primarily of ACT (6 sessions during 6 weeks). Both programs were group based. Primary outcome was cumulated number of sickness absence days at 6 and 12 months follow-up. Secondary outcome was time until sustainable return to work. Results 168 individuals were randomized to the inpatient program (n = 92) or the outpatient program (n = 76). We found no statistically significant difference between the programs in median number of sickness absence days at 6 and 12 months follow-up. In the outpatient program 57% of the participants achieved sustainable return to work (median time 7 months), in the inpatient program 49% (log rank, p = 0.167). The hazard ratio for sustainable return to work was 0.74 (95% CI 0.48–1.32, p = 0.165), in favor of the outpatient program. Conclusions This study provided no support that the more comprehensive 4 + 4 days inpatient multicomponent occupational rehabilitation program reduced sickness absence compared to the outpatient rehabilitation program.
Highlights
Too many people leave the workforce prematurely due to health problems or disability, and too few workers with health problems are able to stay in work [1], due to musculoskeletal and mental health disorders [2]
This study provided no support that the more comprehensive 4 + 4 days inpatient multicomponent occupational rehabilitation program reduced sickness absence compared to the outpatient rehabilitation program
J Occup Rehabil (2018) 28:170–179 rehabilitation in Norway. These programs usually consist of cognitive behavioral therapy, physical exercise and patient education [7], but little workplace involvement [8]—which is considered important in improving return to work rates [9,10,11]
Summary
Too many people leave the workforce prematurely due to health problems or disability, and too few workers with health problems are able to stay in work [1], due to musculoskeletal and mental health disorders [2]. J Occup Rehabil (2018) 28:170–179 rehabilitation in Norway These programs usually consist of cognitive behavioral therapy, physical exercise and patient education [7], but little workplace involvement [8]—which is considered important in improving return to work rates [9,10,11]. Cognitive behavioral therapy is recommended for patients with chronic low back pain [12] and common mental health disorders [13], and is often included in return to work interventions [14]. Patient education is considered beneficial in treatments of chronic low back pain [12] and common mental health disorders [19], and often included in return to work programs [14, 20]. No randomized studies have assessed the effect of inpatient multicomponent occupational rehabilitation on work participation
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