Inpatient Occupational Rehabilitation Research Articles

Effects of Inpatient Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy on Sick Leave and Cost of Lost Production: 7-Year Follow-Up of a Randomized Controlled Trial.

Previously, we reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective than outpatient Acceptance and Commitment Therapy (O-ACT) in reducing sickness absence and was cost-effective over a 24-month period. Here we present 7-years of follow-up on sick leave and the cost of lost production. We randomized individuals aged 18-60, sick-listed due to musculoskeletal or mental health disorders to I-MORE (n = 82) or O-ACT (n = 79). I-MORE, lasting 3.5weeks, integrated ACT, physical training, and work-related problem-solving. In contrast, O-ACT mainly offered six weekly 2.5h group sessions of ACT. We measured outcomes using registry data for days on medical benefits and calculated costs of lost production. Our analysis included regression analyses to examine differences in sickness absence days, logistic general estimating equations for repeated events, and generalized linear models to assess differences in costs of lost production. Unadjusted regression analyses showed 80 fewer days of sickness absence in the 7-year follow-up for I-MORE compared to O-ACT (95% CI -264 to 104), with an adjusted difference of 114 fewer days (95% CI -298 to 71). The difference in costs of production loss in favour of I-MORE was 27,048 euros per participant (95% CI -35,009 to 89,104). I-MORE outperformed O-ACT in reducing sickness absence and production loss costs during seven years of follow-up, but due to a limited sample size the results were unprecise. Considering the potential for substantial societal cost savings from reduced sick leave, there is a need for larger, long-term studies to evaluate return-to-work interventions.

Economic Evaluation of Inpatient Multimodal Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy for Sick-Listed Workers with Musculoskeletal- or Common Mental Disorders

Purpose: To evaluate the cost-effectiveness and cost-benefit of inpatient multimodal occupational rehabilitation (I-MORE) compared to outpatient acceptance and commitment therapy (O-ACT) for individuals sick listed due to musculoskeletal- or common mental disorders during two-years of follow-up. Methods: We conducted an economic evaluation with a societal perspective alongside a randomized controlled trial with 24 months follow-up. Individuals sick listed 2 to 12 months were randomized to I-MORE (n = 85) or O-ACT (n = 79). The outcome was number of working days. Healthcare use and sick leave data were obtained by registry data. Results: Total healthcare costs during the 24 months was 12,057 euros (95% CI 9,181 to 14,933) higher for I-MORE compared to O-ACT, while the difference in production loss was 14,725 euros (95% CI -1,925 to 31,375) in favour of I-MORE. A difference of 43 (95% CI -6 to 92) workdays, in favour of I-MORE, gave an incremental cost-effectiveness ratio of 278 euros for one workday, less than the cost of one day production (339 euros). Net societal benefit was 2,667 euros during two years of follow-up. Conclusion: Despite considerable intervention costs, the lower production loss resulted in I-MORE being cost-effective when compared to O-ACT. Based on economic arguments, I-MORE should be implemented as a treatment alternative for individuals on long-term sick leave. However, more research on subgroup effects and further follow-up of participants’ permanent disability pension awards are warranted.

Insomnia is Associated with the Effect of Inpatient Multimodal Occupational Rehabilitation on Work Participation in Workers with Musculoskeletal or Mental Health Disorders: Secondary Analyses of a Randomized Clinical Trial.

Study ObjectivesInsomnia is common among people with musculoskeletal and/or mental health disorders. This study aimed to assess whether insomnia is associated with the favorable effect from inpatient multimodal occupational rehabilitation on future work participation among individuals with these conditions.MethodsInsomnia was measured at baseline through a randomized clinical trial that compared the effect of inpatient multimodal occupational rehabilitation with a less-comprehensive program of outpatient acceptance and commitment therapy on future work participation. The inpatient multimodal program lasted 3.5 weeks at the rehabilitation center, comprising psychoeducational sessions (including sleep education), fixed schedules, acceptance and commitment therapy, physical exercise and work-related problem-solving, whereas the outpatient program comprised mainly six weekly acceptance and commitment therapy sessions. Both programs were group-based. The study tracked cumulative sick leave during the 12 months of follow-up using national registry data.ResultsAmong the 163 adults included in this subgroup analysis, 56% (n=91) reported insomnia. Overall, we found statistical evidence of interaction between the occupational program and insomnia concerning cumulative sick leave (p=0.03). Compared with people without insomnia in the comprehensive inpatient multimodal program, people with insomnia had 12 (95% CI: −48 to 24) fewer days with sick leave if they participated in the inpatient program and 46 (95% CI: 8 to 83) more days if they participated in the outpatient program.ConclusionThese findings suggest that insomnia should be addressed specifically before individuals on sick leave are considered for participation in occupational rehabilitation and that individuals with insomnia may benefit in particular from inpatient rehabilitation.

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

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.

Aligning stakeholders’ understandings of the return-to-work process: a qualitative study on workplace meetings in inpatient multimodal occupational rehabilitation

ABSTRACT Purpose: Although it is believed that involving the workplace and stakeholders in return-to-work interventions is beneficial, Norwegian occupational rehabilitation programmes rarely do. During 2015–2016, Hysnes Rehabilitation Centre provided inpatient multimodal occupational rehabilitation, including workplace meetings with employees, supervisors, and rehabilitation therapists. This study aims to explore the meetings´ content and stakeholders´ experiences.Methods: This was a multiple case study including non-participant observation of workplace meetings and interviews with participantsResults: Essential features of meetings included revealing and aligning the employee’s and supervisor’s understandings. Three components seemed instrumental in developing shared understandings leading to appropriate adjustments: 1) disclosing causes of absence, 2) validating difficulties, attitudes, and efforts, and 3) delimiting responsibility. Therapists played a vital role in addressing these components, supporting employees, and ensuring planning of appropriate solutions.Conclusion: Developing shared understandings by addressing and aligning illness- and return-to-work representations appears important for return-to-work interventions. Although pivotal to developing appropriate adjustments, disclosure depends upon supervisors’ display of understanding and should not be encouraged without knowledge of the employee´s work situation. How supervisors relate to employees and implement adjustments may be as important as the types of adjustments. The therapist’s support and validation of employees in vulnerable situations also seem valuable.Trial registration: The trial is registered at clinicaltrials.gov (NCT02541890), 4 September 2015. https://clinicaltrials.gov/ct2/show/NCT02541890.

Return-to-work self-efficacy after occupational rehabilitation for musculoskeletal and common mental health disorders: Secondary outcomes of a randomized clinical trial.

ObjectiveTo assess the effects of adding a workplace intervention to inpatient occupational rehabilitation on return-to-work self-efficacy, and whether changes in return-to-work self-efficacy were associated with future work outcomes.DesignRandomized clinical trial.SubjectsIndividuals aged 18–60 years, sick-listed 2–12 months were randomized to multimodal inpatient rehabilitation with (n = 88) or without (n = 87) a workplace intervention.MethodsBetween-group differences for 4 months follow-up were assessed using linear mixed models. Associations between self-efficacy scores and future sickness absence days during 12 months of follow-up were assessed by linear regression.ResultsThere were no statistically significant between-group differences in self-efficacy during follow-up. Participants with high or medium self-efficacy scores at the end of rehabilitation had fewer sickness absence days during follow-up compared with participants with low scores. Participants with consistently high scores or an increasing score throughout the programme showed fewer sickness absence days than those with reduced or consistently low scores.ConclusionReceiving an added workplace intervention did not increase return-to-work self-efficacy more than standard inpatient occupational rehabilitation alone. High scores and a positive development in return-to-work self-efficacy were associated with higher work participation. This suggests that return-to-work self-efficacy could be an important factor to consider in the return-to-work process.LAY ABSTRACTReturn-to-work self-efficacy is related to a person’s beliefs about coping with challenges related to return-towork after sick leave. Several studies have suggested that having high return-to-work self-efficacy is associated with shorter time to return-to-work. This study assessed the effect of adding a workplace intervention to standard inpatient occupational rehabilitation on return-to-work self-efficacy, and whether changes in return-to-work self-efficacy were associated with future work outcomes. The results showed no difference in return-to-work self-efficacy between the participants receiving the added workplace intervention compared with the participants receiving only the standard inpatient occupational rehabilitation. However, participants with a high- or an increasing score in return-to-work self-efficacy had less sickness absence in the follow-up period. This suggests that return-to-work self-efficacy is important in the process of return-to-work after sickness absence.

Inpatient multimodal occupational rehabilitation reduces sickness absence among individuals with musculoskeletal and common mental health disorders: a randomized clinical trial.

ObjectivesThis study aimed to investigate whether inpatient multimodal occupational rehabilitation (I-MORE) reduces sickness absence (SA) more than outpatient acceptance and commitment therapy (O-ACT) among individuals with musculoskeletal and mental health disorders.MethodsIndividuals on sick leave (2-12 months) due to musculoskeletal or common mental health disorders were randomized to I-MORE (N=86) or O-ACT (N=80). I-MORE lasted 3.5 weeks in which participants stayed at the rehabilitation center. I-MORE included ACT, physical exercise, work-related problem solving and creating a return to work plan. O-ACT consisted mainly of 6 weekly 2.5 hour group-ACT sessions. We assessed the primary outcome cumulative SA within 6 and 12 months with national registry-data. Secondary outcomes were time to sustainable return to work and self-reported health outcomes assessed by questionnaires.ResultsSA did not differ between the interventions at 6 months, but after one year individuals in I-MORE had 32 fewer SA days compared to O-ACT (median 85 [interquartile range 33–149] versus 117 [interquartile range 59–189)], P=0.034). The hazard ratio for sustainable return to work was 1.9 (95% confidence interval 1.2–3.0) in favor of I-MORE. There were no clinically meaningful between-group differences in self-reported health outcomes.ConclusionsAmong individuals on long-term SA due to musculoskeletal and common mental health disorders, a 3.5-week I-MORE program reduced SA compared with 6 weekly sessions of O-ACT in the year after inclusion. Studies with longer follow-up and economic evaluations should be performed.

Effectiveness of adding a workplace intervention to an inpatient multimodal occupational rehabilitation program: A randomized clinical trial.

ObjectivesThis study aimed to evaluate the effectiveness of a workplace intervention (WI) added to an inpatient multimodal occupational rehabilitation program (I-MORE) on sickness absence.MethodsIn this researcher-blinded randomized controlled trial with parallel groups, individuals on sick leave due to musculoskeletal, unspecified- or common mental health disorders were randomized to I-MORE (N=87) or I-MORE+WI (N=88). I-MORE lasted 2+1 weeks (with one week at home in between) and consisted of “acceptance and commitment therapy”, physical exercise, and work-related problem solving. The additional WI consisted of a preparatory part, a workplace meeting involving the sick-listed worker, the employer, and the primary rehabilitation therapist at the rehabilitation center, and follow-up work related to the meeting. The primary outcomes were number of sickness absence days and time until sustainable return to work (RTW) during 12 months of follow-up, measured by registry data.ResultsThe median number of sickness absence days during the 12-month follow-up for I-MORE was 115 days [interquartile range (IQR) 53–183] versus 130 days (IQR 81–212) for I-MORE+WI. The difference between groups was not statistically significant (P=0.084). The hazard ratio for sustainable RTW was 0.74 (95% confidence interval 0.48–1.16; P=0.192) in favor of I-MORE.ConclusionsThis study provided no evidence in favor of I-MORE+WI compared to only I-MORE for long-term sickness absent individuals with musculoskeletal-, common mental- or unspecified disorders.

Physical activity after inpatient occupational rehabilitation: Secondary outcomes of two randomized controlled trials.

To assess whether inpatient multicomponent occupational rehabilitation, including physical activity (PA), increases the PA level of participants more than an outpatient program without PA, and whether changes in PA are associated with future work outcomes. A total of 265 participants were included in one of two randomized clinical trials. Participants had been sick listed 2-12months with a musculo-skeletal, psychological, or general/unspecified diagnosis. We measured PA by questionnaires at the start of the programs and at 3, 6, and 12months of follow-up. Between-group differences in PA were assessed using linear mixed models. Associations between change in PA and future work outcomes were assessed by logistic and linear regression. There was no difference in change in PA between the inpatient and outpatient programs during 12months of follow-up. We did not find any associations between the amount of PA and future work outcomes. However, intensity of PA was positively associated with return to work (RTW); participants reporting increased vigorous PA had an odds ratio (OR) for RTW of 4.1 (95% confidence interval [CI] 1.1-15.7) whereas participants reporting consistently high intensity of PA had an OR of 3.1 (95% CI 1.0-9.7), compared to participants reporting low-intensity PA. Inpatient occupational rehabilitation, including PA, did not increase PA-level in the follow-up period more than a less comprehensive program without PA. The amount of PA was not associated with future work outcomes. However, vigorous PA showed a positive association with RTW.

Occupational Rehabilitation Is Associated With Improvements in Cognitive Functioning.

IntroductionOccupational rehabilitation may be offered to workers on long-term sick leave who often report problems with cognitive functioning, anxiety, depression, pain, and reduced work ability. The empirical knowledge is sparce on how occupational rehabilitation may influence cognitive and emotional functioning and patients have not previously been subjected to comprehensive objective testing. The main aim of this study was to assess possible changes in cognitive and emotional functioning such as memory, attention, executive function, and emotion recognition among patients in occupational rehabilitation.MethodsA large sample of 280 sick-listed workers referred to inpatient and outpatient occupational rehabilitation was recruited. The rehabilitation programs had a mean duration of 28 days and comprised physical activity, cognitive behavior treatment components and collaboration with the workplace. A pre–post design was applied to investigate possible changes in cognitive and emotional functioning (primary outcomes) and work and health measures (secondary outcomes), comparing the rehabilitation group with a control group of 70 healthy workers. Individuals in the control group were tested at random time points with an approximately 28 day interval between pre- and post-test, thus coinciding with the duration of rehabilitation. Repeated measures analysis of variance was used for the main analyses.ResultsCompared to the control group, the rehabilitation group had greater gains from pre- to post-test in focused and sustained attention, as well as greater improvements in work ability and reduction in subjective health complaints (SHC), helplessness, pain, pain related to work, anxiety, and depression. In the rehabilitation group, exploratory correlational analysis indicated that improvements in focused and sustained attention were associated with improvements in return-to-work self-efficacy, work ability as well as a reduction in SHC.ConclusionThe sick-listed workers improved in focused and sustained attention and work and health measures after participating in occupational rehabilitation. This study is one of the first to systematically investigate changes in cognitive and emotional functioning during occupational rehabilitation. Clinical practice should benefit from increased knowledge about all cognitive functions and should be specifically aware of the improvements in focused and sustained attention, while memory, executive function and emotion recognition remained unchanged. The results can be used as a motivation to tailor specific interventions to gain further improvements in all cognitive and emotional functions.

Effects of Inpatient Multicomponent Occupational Rehabilitation on Physical Activity Levels

PURPOSE: To assess whether inpatient multicomponent occupational rehabilitation, including physical activity (PA), increases the PA level of participants more than an outpatient program without PA, and whether changes in PA are associated with future work outcomes. METHODS: 265 participants were included in one of two randomized clinical trials. Participants had been sick listed 2 to 12 months with a musculoskeletal, psychological or general/unspecified diagnosis. We measured PA by questionnaires at the start of the programs, and at 3, 6 and 12 months of follow-up. Between-group differences in PA were assessed using linear mixed models. Associations between change in PA and future work outcomes were assessed by logistic and linear regression. RESULTS: There was no difference in change in PA between the inpatient and outpatient programs during 12 months of follow-up. We did not find any associations between the amount of PA and future work outcomes. However, intensity of PA was positively associated with return to work (RTW); participants reporting increased vigorous PA had an odds ratio (OR) for RTW of 4.1 (95% confidence interval [CI] 1.1 to 15.7) whereas participants reporting consistently high intensity of PA had an OR of 3.1 (95% CI 1.0 to 9.7), compared to participants reporting low intensity PA. CONCLUSION: Inpatient occupational rehabilitation, including PA, did not increase PA-level in the follow up period more than a less comprehensive program without PA. The amount of PA was not associated with future work outcomes. However, vigorous PA showed a positive association with RTW.

Changes in fear-avoidance beliefs and work participation after occupational rehabilitation for musculoskeletal- and common mental disorders: secondary outcomes of two randomized clinical trials.

To assess: (i) whether changes in the Fear-Avoidance Beliefs Questionnaire (FABQ) were greater for multicomponent inpatient rehabilitation vs outpatient cognitive behavioural therapy, and (ii) whether baseline scores and changes (pre- to post-intervention) in FABQ were associated with future work-participation. Individuals sick-listed for 2-12 months were randomized to inpatient multicomponent rehabilitation (3.5 weeks or 4+4 days) or outpatient cognitive behavioural therapy (6 sessions/6 weeks). A total of 334 subjects were included. There were no significant differences on FABQ between the in- and out-patient programmes during follow-up. Participants with consistently low scores on the work subscale had more work-participation days, followed by those who reduced their scores. Participants who increased, or had consistently high scores had the least workdays. For the physical activity subscale, the associations were weaker. FABQ-work scores at baseline were associated with number of work-participation days for both musculoskeletal and psychological diagnoses, and more strongly for the latter group. This study suggests that FABQ could be a useful prognostic tool for individuals on sick leave due to musculoskeletal or psychological disorders. There was no evidence that inpatient occupational rehabilitation reduces FABQ scores more than outpatient cognitive behavioural therapy.

The acceptance and commitment therapy model in occupational rehabilitation of musculoskeletal and common mental disorders: a qualitative focus group study

Aims: The aim of this study was to examine whether and how intended processes of behavioural change were reflected in participants’ experiences after an inpatient occupational rehabilitation programme. The programme was transdiagnostic, lasted 3½ weeks and was based on the acceptance and commitment therapy model.Methods: Twenty-two participants (17 women and 5 men) took part in five qualitative focus group interviews after the programme. Analysis was data-driven, categorising participants’ experiences using an initial explorative phenomenological approach. The emerging data-driven categories were re-contextualised within the theoretical framework of the therapy model.Results: The participants referred to experiences within all three intended domains of the model (openness, awareness, and engagement). Our results indicate that the transdiagnostic approach may have facilitated openness, while the attainment of flexible self-awareness was less evident. Participants expressed engagement and behavioural changes linked to personal values, but did not mention actions leading to imminent return to work.Conclusions: The results imply that for implementation in occupational rehabilitation, further development of this model is needed specifically regarding processes related to self-awareness and committed action towards work. These findings are relevant for the interpretation of results from randomised clinical trials on acceptance and commitment therapy in occupational rehabilitation.Implications for rehabilitationAcceptance and commitment therapy seems to be a feasible component in an occupational rehabilitation programme for persons with different diagnoses.A transdiagnostic approach mixing musculoskeletal pain disorders and common mental disorders in the same rehabilitation programme seems to facilitate the process of openness and acceptance.There is a need to further develop and operationalise some of the processes in Acceptance and commitment therapy to accommodate the approach to the occupational rehabilitation context.

Patient perceptions of participation in group-based rehabilitation in an inpatient brain injury rehabilitation setting

ObjectivesThe use of groups is common in healthcare. There is a paucity of research which captures patient experiences of group participation. The aims of this study were to explore the perceptions and experiences of people with traumatic brain injury (TBI) about their participation in inpatient occupational therapy rehabilitation groups. MethodA phenomenological approach guided the study. Patients with a TBI who were participating in an inpatient occupational therapy group program were recruited. Data were collected through semi-structured interviews and analysed using content analysis. ResultsFifteen participants consented to the study. Three themes emerged from the data; 1) feeling normal, comfortable and connected; 2) learning by doing, seeing and sharing and; 3) practicalities of groups. Participants highlighted that groups facilitated opportunities to practice skills and prepared them for the real world. Opportunities for interaction and support were also emphasised as positive by participants. ConclusionPerceptions of patients about participation in groups were generally positive, and as such a consumer-focused approach to healthcare would support the use of occupational therapy groups in TBI rehabilitation. Practice implicationsRecommendations from the perspectives of patients include consideration of the selection of group participants, and meeting individual needs and goals within a group setting.

Unfolding the values of work \u2013 therapists\xb4 experience of addressing the return to work process in occupational rehabilitation based on Acceptance and Commitment Therapy

BackgroundFacilitating return to work can be challenging due to the complexity of work disability. Few studies have examined rehabilitation programs based on Acceptance and Commitment Therapy that intend to support return to work, and none have investigated therapists’ experience with providing such programs. The aim of this study was therefore to explore therapists’ experience of addressing the return to work process in an inpatient occupational rehabilitation program based on Acceptance and Commitment Therapy.MethodsThis was a qualitative interview study supported by participant observation. Therapists were interviewed regarding their experiences with addressing return to work in an inpatient occupational rehabilitation program based on Acceptance and Commitment Therapy. In addition, the rehabilitation program was investigated through participant observation. The interviews were analysed according to Interpretative Phenomenological Analysis and informed by an analysis of field notes from the participant observation.ResultsAcceptance and Commitment Therapy was experienced as a meaningful approach to facilitate return to work, as it allowed therapists to address all relevant aspects of the individual participant’s life that might influence work participation. The therapists’ twofold goal was to support participants in building both a meaningful life and sustainable work participation. To do so, they attempted to instil long-term and interrelated processes concerning ownership, causes of sick leave, relation to expectations, the values of work, and the scope of agency.ConclusionUnfolding values connected to work participation might reconcile the tension between work and family life by integrating work with other areas of life. Providing work participation with personal meaning also seems especially commensurable with a context where economy presents a poor incentive for return to work. Therapists should, however, be attentive to the need to secure the prominence of return to work by relating participants’ chosen themes explicitly to their return to work process. Therapists should also be aware of the dilemma that may arise when they attempt to refrain from providing advice while simultaneously encouraging actions they consider appropriate to facilitate sustainable work participation. In addition, having an individual-oriented approach to occupational rehabilitation may obscure the extent to which return to work is a multi-stakeholder process.

Design of a study evaluating the effects, health economics, and stakeholder perspectives of a multi-component occupational rehabilitation program with an added workplace intervention - a\xa0 study protocol

BackgroundRecent research has suggested that interventions at the workplace might be the most potent ingredient in return to work interventions, but few studies have investigated the different effects of workplace interventions as part of occupational rehabilitation programs. The comprehensive design described in this article includes effect (on return to work and health outcomes), and health economic evaluations of a workplace intervention added to a multicomponent rehabilitation program. Qualitative and mixed method studies will investigate sick-listed persons’, rehabilitation therapists’ and employers’ perspectives on the usability and outcomes of the rehabilitation program and the workplace intervention. The program and intervention are provided to patients with musculoskeletal, psychological or general and unspecified diagnoses. The program is multi-component and includes Acceptance and Commitment Therapy, physical exercise, patient education and creating a plan for increased work participation.MethodsPersons who are employed, aged from 18 to 60 years, with a current sick leave status of 50% or more and a diagnosis within the musculoskeletal, psychological or general and unspecified chapters of International Classification of Primary Care-2 (ICPC-2) will be recruited to a researcher-blinded parallel-group randomized controlled trial. All participants take part in an in-patient occupational rehabilitation program, while the intervention group also takes part in an intervention at the workplace. The effect and economic evaluation will investigate the effect of the added workplace intervention. The primary outcome measures will be time until full sustainable return to work and total number of sickness absence days in the 12 months after inclusion. Health economic evaluations will investigate the cost-effectiveness and cost-utility. Qualitative studies will investigate rehabilitation therapists’ experiences with working towards return to work within an ACT-approach and stakeholders’ experiences with the workplace intervention. A mixed methods study will combine quantitative and qualitative findings on the participants’ expectations and motivation for return to work.DiscussionThe outline of this comprehensive study could represent an important addition to the standard designs of return to work evaluation. The mixed methods design, with qualitative approaches as well as a rigorous randomized controlled trial, might prove useful to shed light on contextual factors.Trial registrationClinicalTrials.gov: NCT02541890. September 4, 2015.

How do occupational rehabilitation clinicians approach participants on long-term sick leave in order to facilitate return to work? A focus group study

BackgroundThe objective of this study was to explore occupational rehabilitation clinicians’ experiences on how to approach their participants on long-term sick leave in order to facilitate return to work (RTW).MethodsAn exploratory qualitative design was used. Four focus groups were conducted with 29 clinicians working on interdisciplinary inpatient and outpatient occupational rehabilitation teams in Norway. The clinicians shared narratives from clinical practice. Transcripts were analysed, and results were reported by use of systematic text condensation.ResultsThe clinicians used several approaches to facilitate RTW among individuals on sick leave. Three themes emerged as especially important in order to succeed: 1) To get a basic understanding of the participant’s life-world through a mapping process; 2) To build a therapeutic alliance through communication characterised by sensitivity to the participants’ needs and emotional concerns; and 3) To initiate processes of change that increase the possibilities for RTW. Four main areas targetable for change were identified, three directed at the individual and one encompassing the participants’ surroundings. These approaches were: a) To increase feelings of confidence and coping; b) To increase the participants’ awareness of their own limits; c) To challenge inefficient and negative attitudes and thoughts related to the sick-role; and d) Close and immediate dialogue with key stakeholders.ConclusionsTo increase the possibilities for RTW among individuals on long-term sick leave, a thorough mapping process and the construction of a therapeutic alliance are seen as crucial elements in approaches by occupational rehabilitation clinicians. By gaining the participants’ trust and identifying their barriers and possibilities for work, the clinicians can target modifiable factors, especially at the individual level, and obstacles for RTW in their individual surroundings. This study elucidates what occupational rehabilitation clinicians do, say and provide to increase their participants’ abilities and possibilities to RTW.

Effect of Inpatient Multicomponent Occupational Rehabilitation Versus Less Comprehensive Outpatient Rehabilitation on Sickness Absence in Persons with Musculoskeletal- or Mental Health Disorders: A Randomized Clinical Trial

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.

Effects of Inpatient Multicomponent Occupational Rehabilitation versus Less Comprehensive Outpatient Rehabilitation on Somatic and Mental Health: Secondary Outcomes of a Randomized Clinical Trial

Purpose To evaluate effects on somatic and mental health of a multicomponent inpatient occupational rehabilitation program compared to a less comprehensive outpatient program in individuals on sick leave for musculoskeletal complaints or mental health disorders. Methods A randomized clinical trial with parallel groups. Participants were individuals on sick-leave for 2–12 months with a sick-leave diagnosis within the musculoskeletal, psychological or general and unspecified chapters of ICPC-2. Potential participants were identified in the Social Security System Registry. The multicomponent inpatient program (4 + 4 days) consisted of Acceptance and Commitment Therapy, physical training and work-related problem-solving including creating a return to work plan and a workplace visit if considered relevant. The comparative outpatient program consisted primarily of ACT (6 sessions during 6 weeks). Self-reported health-related quality of life, subjective health complaints, pain and anxiety and depression symptoms were assessed up to 12 months after the program. Results 168 individuals were randomized to the multicomponent inpatient program (n = 92) or the outpatient program (n = 76). Linear mixed models showed no statistically significant differences between the programs, except for slightly more reduced pain after the outpatient program. Conclusions This study presents no support that a 4 + 4 days multicomponent inpatient rehabilitation program is superior to a less comprehensive outpatient program, in improving health outcomes.

Sick-listed persons’ experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy: a qualitative focus group interview study

BackgroundOccupational medicine has shifted emphasis from disease treatment to disability rehabilitation and management. Hence, newly developed occupational rehabilitation programs are often generic and multicomponent, aiming to influence the sick-listed persons’ perception on return to work, and thereby support the return to work process. The aim of this study was to explore sick-listed persons’ experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy.MethodsTwenty-nine adults on sickness benefit or work assessment allowance due to musculoskeletal and/or common mental health disorders participated in this study. They were interviewed in focus groups at the beginning and at the end of a 3.5 week inpatient group-based occupational rehabilitation program in Central Norway. Key elements in the program were Acceptance and Commitment Therapy (ACT), physical exercise and creating a work-participation plan. The program was mainly group-based including participants with different diagnoses. Data was analyzed according to a phenomenological approach.ResultsAt the start of the program most participants expressed frustration regarding being sick-listed, external anticipations as well as hindrances towards returning to work, and described hope that the program would provide them with the skills and techniques necessary to cope with health problems and being able to return to work. At the end of the program the participants described that they had embarked upon a long process of increased awareness. This process encompassed four areas; an increased awareness of what was important in life, realizing the strain from external expectations and demands, a need to balance different aspects of life, and return to work as part of a long and complex process.ConclusionsThe occupational rehabilitation program induced a perceived meaningful reorientation encompassing several aspects of life. However, the return to work process was described as diffuse and uncertain for most participants. The providers of occupational rehabilitation program should balance this reorientation with specific steps towards return to work. Effect studies and long-term qualitative studies evaluating how this affects long-term work- and health outcomes are underway.