Motivational Interviewing Improves Sustainable Return to Work in Injured Workers After Rehabilitation: A Cluster Randomized Controlled Trial

Abstract

ObjectiveTo examine whether motivational interviewing (MI) leads to more sustainable return-to-work outcomes for injured workers undergoing rehabilitation. DesignCluster randomized controlled trial. SettingWorkers' compensation rehabilitation facility. ParticipantsClaimants (N=728) undergoing rehabilitation for musculoskeletal conditions, who were predominantly employed (529, 72.7%) men (460, 63.2%) with chronic conditions (mean duration, 234d). InterventionsMI is a goal-oriented, client-centered counseling approach that facilitates behavioral change through identifying and resolving ambivalence. Treating clinicians at the facility were randomized into 2 groups. One group included 6 clinicians who were trained to conduct MI interventions during rehabilitation, while the control group included 6 clinicians who continued standard procedures. Main Outcome MeasuresOutcomes included compensation outcomes over 1 year after discharge. This included reception of disability benefits and recurrence rates. Analysis was stratified by admission employment status and included chi-square test, t test, and multivariable regression. ResultsParticipants included 728 claimants, of whom 367 (50.4%) were treated with MI. Unemployed claimants in the MI group received significantly more partial temporary disability benefits (mean, 8.2d vs 0.2d; P=.02), indicating return to modified work duties. Employed claimants in the control group had a higher recurrence rate (9.1% vs 4.5%; P=.04). The adjusted odds ratio for benefit recurrence was 2.7 (95% confidence interval, 1.1–6.5) after controlling for age, sex, and number of previous claims. ConclusionsUse of MI appears to lead to more sustainable return to work after rehabilitation and facilitates transition to modified work duties.