Abstract
Purpose Although functional restoration programs appear effective in assisting injured workers to return-to-work (RTW) after a work related musculoskeletal (MSK) disorder, the addition of Motivational Interviewing (MI) to these programs may result in higher RTW. Methods We conducted a cluster randomized controlled trial with claimants attending an occupational rehabilitation facility from November 17, 2014 to June 30, 2015. Six clinicians provided MI in addition to the standard functional restoration program and formed an intervention group. Six clinicians continued to provide the standard functional restoration program based on graded activity, therapeutic exercise, and workplace accommodations. Independent t tests and chi square analysis were used to compare groups. Multivariable logistic regression was used to obtain the odds ratio of claimants’ confirmed RTW status at time of program discharge. Results 728 workers’ compensation claimants with MSK disorders were entered into 1 of 12 therapist clusters (MI group = 367, control group = 361). Claimants were predominantly employed (72.7%), males (63.2%), with moderate levels of pain and disability (mean pain VAS = 5.0/10 and mean Pain Disability Index = 48/70). Claimants were stratified based on job attachment status. The proportion of successful RTW at program discharge was 12.1% higher for unemployed workers in the intervention group (intervention group 21.6 vs. 9.5% in control, p = 0.03) and 3.0% higher for job attached workers compared to the control group (intervention group 97.1 vs. 94.1% in control, p = 0.10). Adherence to MI was mixed, but RTW was significantly higher among MI-adherent clinicians. The odds ratio for unemployed claimants was 2.64 (0.69–10.14) and 2.50 (0.68–9.14) for employed claimants after adjusting for age, sex, pain intensity, perceived disability, and therapist cluster. Conclusion MI in addition to routine functional restoration is more effective than routine functional restoration program alone in improving RTW among workers with disabling MSK disorders.
Highlights
Musculoskeletal (MSK) disorders result in substantial direct costs to health care systems and even larger indirect losses on productivity [1]
We evaluated the effectiveness of Motivational Interviewing (MI) in a population of injured workers receiving workers’ compensation and undergoing work rehabilitation
We hypothesized that MI in addition to a standard functional restoration program would lead to a higher proportion of successful RTW among workers without jobs to return to
Summary
Musculoskeletal (MSK) disorders result in substantial direct costs to health care systems and even larger indirect losses on productivity [1]. Evidence indicates that incapacity and chronic work disability are behaviours that are often the result of psychosocial factors [3]. The majority of injured workers (approximately 80–85%) return-to-work (RTW) quickly and without complications; the remaining 15–20%, experience long periods of work disability [4]. Their disability may be coupled with personal, emotional and/or work related issues that contribute to their delay in returning to work [4, 5]. Physical limitations coupled with psychosocial issues influencing the worker’s behaviour may be contributing factors associated with the increase in the number of paid compensation days, an increase in claims cost and a delay in RTW
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