OBJECTIVES: This study aimed to assess 12-month outcomes on return to work (RTW) and cost-effectiveness in adults on sick leave due to musculoskeletal disorders who were randomized to either usual case management (UC), UC plus motivational interviewing (MI) or UC plus stratified vocational advice intervention (SVAI). METHODS: The study was conducted in the Norwegian Labor and Welfare Administration (NAV). Workers on sick leave due to musculoskeletal disorders for >= 50% of their contracted work hours for >= 7 consecutive weeks were included. Trained caseworkers delivered MI in two face-to-face sessions, and physiotherapists provided SVAI and identified RTW obstacles. The main outcomes were sick leave days over 12 months and cost-effectiveness, cost-utility and cost-benefit. RESULTS: The trial included 509 workers with a mean age of 48 years. There were statistically significant differences between UC plus MI versus UC (-15.6 days, 95% confidence interval (CI) -31.0 to -0.2), and UC plus SVAI versus UC (-17.6 days, 95% CI -33.0 to -2.2). Compared to UC, odds ratios (OR) for receiving wage replacement benefits each month were lower for UC plus MI (OR 0.73, 95% CI 0.64 plus 0.84), and UC plus SVAI (OR 0.74, 95% CI 0.64 to 0.84). The probabilities of cost-effectiveness were high for adding either MI or SVAI to UC (ceiling ratio 0.90), and the net benefit for MI was 5225 (95% CI -592 to 10 985) and for SVAI 7214 ((95% CI 1548 to 12 851) per person. CONCLUSIONS: Adding MI or SVAI to UC significantly improved RTW outcomes and was cost-effective among people on sickness absence due to musculoskeletal disorders.

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