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Work-directed rehabilitation or physical activity to support work ability and mental health in common mental disorders: a pilot randomized controlled trial [with consumer summary]
Danielsson L, Waern M, Hensing G, Holmgren K
Clinical Rehabilitation 2020 Feb;34(2):170-181
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate feasibility and potential effectiveness of work-directed rehabilitation in people with common mental disorders. DESIGN: Pilot randomized controlled trial. SETTING: Primary healthcare, Sweden. SUBJECTS: Working adults (n = 42) of mean age 46.2 +/- 11.1 years with depression or anxiety disorder. INTERVENTIONS: Eight weeks of work-directed rehabilitation (n = 21) or physical activity (n = 21). Work-directed rehabilitation included sessions with a physiotherapist and/or an occupational therapist, to develop strategies to cope better at work. Physical activity included a planning session and access to a local gym. MAIN MEASURES: Feasibility: attendance, discontinuation and adverse events. Measurements were the Work Ability Index, the Global Assessment of Functioning, the Montgomery-Asberg Depression Rating Scale, the Beck Anxiety Inventory and the World Health Organization-Five Well-Being Index. RESULTS: Attendance to rehabilitation sessions was 88% (n = 147/167) and discontinuation rate was 14% (n = 3/21). No serious adverse events were reported. Within both groups, there was a significant improvement in Work Ability Index score (mean change: 3.6 (95% confidence interval (CI) 0.45 to 6.7) in work-directed rehabilitation and 3.9 (95% CI 0.9 to 7.0) in physical activity) with no significant difference between groups. For the other outcomes, significant improvements were found within but not between groups. Per-protocol analysis showed a trend toward the antidepressant effect of work-directed rehabilitation compared to physical activity (mean difference in depression score -3.1 (95% CI -6.8 to 0.4), p = 0.075). CONCLUSION: Work-directed rehabilitation was feasible to persons with common mental disorders and improved their work ability and mental health. Comparable improvements were seen in the physical activity group. Suggested modifications for a larger trial include adding a treatment-as-usual control.

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