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|Inpatient multimodal occupational rehabilitation reduces sickness absence among individuals with musculoskeletal and common mental health disorders: a randomized clinical trial|
|Gismervik SO, Aasdahl L, Vasseljen O, Fors EA, Rise MB, Johnsen R, Hara K, Jacobsen HB, Pape K, Fleten N, Jensen C, Fimland MS|
|Scandinavian Journal of Work, Environment & Health 2020 Jul;46(4):364-372|
|7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; 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*|
OBJECTIVES: This 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. METHODS: Individuals on sick leave (2 to 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. RESULTS: SA 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 to 149) versus 117 (interquartile range 59 to 189)), p = 0.034). The hazard ratio for sustainable return to work was 1.9 (95% confidence interval 1.2 to 3.0) in favor of I-MORE. There were no clinically meaningful between-group differences in self-reported health outcomes. CONCLUSIONS: Among 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.