Two-Year Follow-Up of a Randomized Clinical Trial of Inpatient Multimodal Occupational Rehabilitation Vs Outpatient Acceptance and Commitment Therapy for Sick Listed Workers with Musculoskeletal or Common Mental Disorders

Lene Aasdahl,Ottar Vasseljen,Sigmund Østgård Gismervik,Marius Steiro Fimland,Roar Johnsen

doi:10.1007/s10926-021-09969-4

Abstract

Purpose There is a lack of results on long-term effects of return to work interventions. We previously reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective in reducing sickness absence and facilitating return to work (RTW) at 12 months follow-up compared to an outpatient program that consisted mainly of Acceptance and Commitment Therapy (O-ACT). We now report the 2-year outcome data. Methods A randomized clinical trial with parallel groups. Participants were 18–60 years old, sick listed with musculoskeletal, common mental or general/unspecified disorders. I-MORE lasted 3.5 weeks and consisted of ACT, physical training and work-related problem solving. O-ACT consisted mainly of 6 weekly sessions (2.5 h. each) of ACT in groups. Outcomes were cumulated number of days on medical benefits and time until sustainable RTW (1 month without medical benefits) during 2-years of follow-up, measured by registry data. Results For the 166 randomized participants, the median number of days on medical benefits was 159 (IQR 59–342) for I-MORE vs 249 days (IQR 103–379; Mann–Whitney U test, p = 0.07), for O-ACT. At 2 years, 40% in I-MORE received long-term benefits (work assessment allowance) vs 51% in O-ACT. The crude hazard ratio (HR) for sustainable RTW was 1.59 (95% CI 1.04–2.42, p = 0.03) and the adjusted HR 1.77 (95% CI 1.14–2.75, p = 0.01), in favor of I-MORE. Conclusions The 2-year outcomes show that I-MORE had long-term positive effects on increasing work participation for individuals sick listed with musculoskeletal and mental disorders. Further follow-up and economic evaluations should be performed.

Highlights

Sickness absence has vast consequences at the individual and societal levels
In return to work (RTW) research, it is insufficient to document short term effects, as recurrent sickness absence spells are relatively common, and any effects on RTW must be sustainable to legitimate complex interventions
We reported the results at 12 months follow-up of a randomized controlled trial evaluating the effect of 3.5 weeks inpatient multimodal rehabilitation (I-MORE) for individuals sick listed due to musculoskeletal complaints or common mental disorders [10]

Summary

Introduction

Sickness absence has vast consequences at the individual and societal levels. Considerable resources are spent on preventing long-term work disability [1,2,3]. Despite considerable research on the effects of return to work (RTW) interventions during the last decades, results have been inconsistent [4,5,6,7]. Cullen et al [9] concluded that multimodal interventions were effective on sickness absence for individuals with musculoskeletal or mental health conditions. There was only a small number of high-quality studies and few with long-term follow-up. In RTW research, it is insufficient to document short term effects, as recurrent sickness absence spells are relatively common, and any effects on RTW must be sustainable to legitimate complex interventions

Methods

Results

Conclusion