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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
clinical trial
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.

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