OBJECTIVE: To examine whether motivational interviewing (MI) leads to more sustainable return-to-work outcomes for injured workers undergoing rehabilitation. MI is a client-centred counselling approach that facilitates behavioural change through identifying and resolving ambivalence. DESIGN: A cluster randomised controlled trial was conducted with analysis at level of claimant (registration ISRCTN45748422). SETTING: The study was conducted at a workers' compensation rehabilitation facility in Edmonton, Canada. PARTICIPANTS: Data were collected on claimants undergoing rehabilitation for musculoskeletal conditions. Participants were predominantly employed (72.7%) males (63.2%) with chronic conditions (mean duration 234 days). INTERVENTIONS: Treating clinicians at the facility were randomised into 2 groups. One group included 6 clinicians who were trained to conduct MI interventions during the course of rehabilitation, while the control group included 6 clinicians who continued standard procedures. MAIN OUTCOME MEASURES: Outcomes included compensation outcomes over 1 year after discharge. This included reception of disability benefits and recurrence rates. Analysis was stratified by admission employment status and included Chi square, t tests, and multivariable regression. RESULTS: Participants included 728 claimants of whom 367 (50.4%) were treated with MI. Unemployed claimants in the MI group received significantly more partial disability benefits (average of 8.2 versus 0.2 days, p = 0.02), indicating return to modified work duties. Employed claimants in the control group had a higher recurrence rate (9.1% versus 4.5%, p = 0.04). Adjusted odds ratio for benefit recurrence was 2.7 (1.1 to 6.5) after controlling for age, sex, and number of previous claims. CONCLUSIONS: Use of MI appears to lead to more sustainable return-to-work following rehabilitation, and facilitates transition to modified work duties.

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