Abstract
The Danish national return-to-work (RTW) program aims to improve the management of municipal sickness benefit in Denmark. A study is currently ongoing to evaluate the RTW program. The purpose of this article is to describe the study protocol. The program includes 21 municipalities encompassing approximately 19 500 working-age adults on long-term sickness absence, regardless of reason for sickness absence or employment status. It consists of three core elements: (i) establishment of multidisciplinary RTW teams, (ii) introduction of standardized workability assessments and sickness absence management procedures, and (iii) a comprehensive training course for the RTW teams. The effect evaluation is based on a parallel group randomized trial and a stratified cluster controlled trial and focuses on register-based primary outcomes - duration of sickness absence and RTW - and questionnaire-based secondary outcomes such as health and workability. The process evaluation utilizes questionnaires, interviews, and municipal data. The effect evaluation tests whether participants in the intervention have a (i) shorter duration of full-time sickness absence, (ii) longer time until recurrent long-term sickness absence, (iii) faster full RTW, (iv) more positive development in health, workability, pain, and sleep; it also tests whether the program is cost-effective. The process evaluation investigates: (i) whether the expected target population is reached; (ii) if the program is implemented as intended; (iii) how the beneficiaries, the RTW teams, and the external stakeholders experience the program; and (iv) whether contextual factors influenced the implementation. The program has the potential to contribute markedly to lowering human and economic costs and increasing labor force supply. First results will be available in 2013. The trial registrations are ISRCTN43004323, and ISRCTN51445682.
Highlights
We present the content of the Danish RTW program
In a recent systematic review of the effectiveness of RTW interventions for persons on sickness absence due to musculoskeletal problems [25], the authors concluded that most interventions appear beneficial but effects are rather small and publication bias may have occurred
The program combines a multidisciplinary, coordinated, and tailored approach delivered by specially trained RTW coordinators and multidisciplinary RTW teams within the municipal sickness benefit offices
Summary
We first describe care as usual, which comprises the ordinary sickness benefit management procedures in Denmark. We hypothesize that the three elements promote a faster and more interdisciplinary workability assessment process, improve coordination between RTW teams and external stakeholders (ie, workplaces, general practitioners), and ensure a faster initiation of RTW activities that are better tailored to the needs of the sick-listed beneficiary. The RTW coordinator is responsible for conducting regular follow-up of all sick-listed participants in accordance with the law (at least every fourth week for beneficiaries in category 2) and coordinate RTW initiatives with the other members of the multidisciplinary RTW team. To further support a more standardized sickness management procedure and good information flow between all RTW team members, several other tools have been developed for the program These include guides for the meetings between the sick-listed beneficiary and the other RTW team members (psychologists, physiotherapists, physicians, and psychiatrists) and a number of templates for information exchange between RTW team members. Two course managers from the research group at the NRCWE visit all RTW teams throughout the program period to facilitate the implementation process
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