Prognostic Factors for Duration of Sick Leave Due to Low-Back Pain in Dutch Health Care Professionals

Background: Information on prognostic factors for duration of sick leave due to low-back pain (LBP) is growing. In this prospective cohort study prognostic factors for duration of sick leave and course of disability were identified in a very early stage of sick leave due to LBP in an occupational health care setting. Methods: A total of 615 workers calling in sick from work due to LBP at an occupational health service (OHS) of one institution completed a questionnaire. Duration of follow-up was 26 weeks. Prognostic factors were identified by means of Cox regression analysis and multiple linear regression analysis, and explained variance was calculated. Results: Median time to first return to work (RTW) was 5 days (Inter Quartile Range (IQR) = 2–12). Median time to lasting return to work (LRTW) was 6 days (IQR = 3–13). The final model for delayed RTW included self-reported expected duration of sick-leave, treatment by GP or specialist, care-seeking, diminished mobility, and the interaction between care-seeking and diminished mobility. The final model for LRTW included: self-reported expected duration of sick-leave, treatment by GP or specialist, care-seeking, the interaction between the self-reported expected duration of sick-leave and seeking care at OHS, complaints due to job stress, diminished mobility, and the interactions between expected duration of more then 10 days and seeking OP care and diminished mobility. Median total days on sick leave (TDSL) was 6 days (IQR = 3–13 days). The final model for TDSL included: age, expected duration of sick leave, treatment by GP or medical specialist, seeking OP care, complaints due to physical load, and diminished mobility. Explained variance (R²) of these models ranged from 30 to 35%. Conclusions: Poor prognosis for duration of sick leave can be identified by means of a simple questionnaire administered on the first day of sick leave. Workers at high risk for longer duration of sick leave (all outcomes) expected to stay off work longer, were already being treated by a MD, sought OP care, and had diminished mobility. In case of delayed LRTW workers reported job stress as a possible cause of sick leave. Interactions were found in both RTW and LRTW between care-seeking and diminished mobility and in LRTW between expected duration of sick leave and seeking OP care. Older age increased TDSL with borderline significance.     

A Participatory Return-to-Work Intervention for Temporary Agency Workers and Unemployed Workers Sick-Listed Due to Musculoskeletal Disorders: Results of a Randomized Controlled Trial

Introduction Within the labour force workers without an employment contract represent a vulnerable group. In most cases, when sick-listed, these workers have no workplace/employer to return to. Therefore, the aim of this study was to evaluate the effectiveness on return-to-work of a participatory return-to-work program compared to usual care for unemployed workers and temporary agency workers, sick-listed due to musculoskeletal disorders. Methods The workers, sick-listed for 2–8 weeks due to musculoskeletal disorders, were randomly allocated to the participatory return-to-work program (n = 79) or to usual care (n = 84). The new program is a stepwise procedure aimed at making a consensus-based return-to-work plan, with the possibility of a temporary (therapeutic) workplace. Outcomes were measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure was time to sustainable first return-to-work. Secondary outcome measures were duration of sickness benefit, functional status, pain intensity, and perceived health. Results The median duration until sustainable first return-to-work was 161 days in the intervention group, compared to 299 days in the usual care group. The new return-to-work program resulted in a non-significant delay in RTW during the first 90 days, followed by a significant advantage in RTW rate after 90 days (hazard ratio of 2.24 [95% confidence interval 1.28–3.94] P = 0.005). No significant differences were found for the measured secondary outcomes. Conclusions The newly developed participatory return-to-work program seems to be a promising intervention to facilitate work resumption and reduce work disability among temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders.     

A Participatory Workplace Intervention for Employees With Distress and Lost Time: A Feasibility Evaluation Within a Randomized Controlled Trial

Introduction Little is known about feasibility and acceptability of return to work (RTW) interventions for mental health problems. RTW for mental health problems is more complicated than for musculoskeletal problems due to stigmatization at the workplace. A participatory workplace intervention was developed in which an employee and supervisor identify and prioritize obstacles and solutions for RTW guided by a RTW coordinator. This paper is a feasibility study of this innovative intervention for employees with distress. The aims of this study were to describe the reach and extent of implementation of the workplace intervention, the satisfaction and expectations of all stakeholders, and the intention to use the workplace intervention in the future. Methods Eligible for this study were employees who had been on sick leave from regular work for 2–8 weeks with distress. Data were collected from the employees, their supervisors, RTW coordinators, and occupational physicians by means of standardized matrices and questionnaires at baseline and 3 months follow-up. Reach, implementation, satisfaction, expectations, and maintenance regarding the workplace intervention were described. Results Of the 56 employees with distress eligible to receive the workplace intervention, 40 employees, their supervisors and RTW coordinators actually participated in the intervention. They identified 151 obstacles for RTW mostly related to job design, communication, mental workload and person-related stress factors. The 281 consensus-based solutions identified were mostly related to job design, communication and training. Of those solutions, 72% was realized at the evaluation with the employee and supervisor. Overall, employees, supervisors and occupational health professionals were satisfied with the workplace intervention and occupational health professionals rated it with a 7.1. Time-investment was the only barrier for implementation reported by the occupational health professionals. Conclusions The results of this study indicate a high feasibility for a broad implementation of a participatory workplace intervention for employees with distress and lost time, and their supervisors.     

Bridging Health Care and the Workplace: Formulation of a Return-to-Work Intervention for Breast Cancer Patients Using an Intervention Mapping Approach

Purpose An increasing number of breast cancer (BC) survivors of working age require return to work (RTW) support. Objective of this paper is to describe the development of a RTW intervention to be embedded in the care process bridging the gap between hospital and workplace. Method The Intervention Mapping (IM) approach was used and combined formative research results regarding RTW in BC patients with published insights on occupational therapy (OT) and RTW. Four development steps were taken, starting from needs assessment to the development of intervention components and materials. Results A five-phased RTW intervention guided by a hospital-based occupational therapist is proposed: (1) assessing the worker, the usual work and contextual factors which impacts on (re-)employment; (2) exploration of match/differences between the worker and the usual work; (3) establishing long term goals, broken down into short term goals; (4) setting up tailored actions by carefully implementing results of preceding phases; (5) step by step, the program as described in phase 4 will be executed. The occupational therapist monitors, measures and reviews goals and program-steps in the intervention to secure the tailor-made approach of each program-step of the intervention. Conclusion The use of IM resulted in a RTW oriented OT intervention. This unique intervention succeeds in matching individual BC patient needs, the input of stakeholders at the hospital and the workplace.     

Workplace-Based Return-to-Work Interventions: A Systematic Review of the Quantitative Literature

Introduction: A systematic review was conducted to review the effectiveness of workplace-based return-to-work (RTW) interventions. Method: Seven databases were searched, in English and French, between January 1990 and December 2003 for peer-reviewed studies of RTW interventions provided at the workplace to workers with work disability associated with musculoskeletal or other pain-related conditions. Methodological quality appraisal and data extraction were conducted by pairs of reviewers. Results: Of a total of 4124 papers identified by the search, 10 studies were of sufficient quality to be included in the review. There was strong evidence that work disability duration is significantly reduced by work accommodation offers and contact between healthcare provider and workplace; and moderate evidence that it is reduced by interventions which include early contact with worker by workplace, ergonomic work site visits, and presence of a RTW coordinator. For these five intervention components, there was moderate evidence that they reduce costs associated with work disability duration. Evidence for sustainability of these effects was insufficient or limited. Evidence regarding the impact of supernumerary replacements was insufficient. Evidence levels regarding the impact of the intervention components on quality-of-life was insufficient or mixed. Conclusions: Our systematic review provides the evidence base supporting that workplace-based RTW interventions can reduce work disability duration and associated costs, however the evidence regarding their impact on quality-of-life outcomes was much weaker. Donald Cole, Jeremy Dacombe, Jaime Guzman, Sheilah Hogg-Johnson, Ellen MacEachen, Victoria Pennick, Anusha Raj, Rhoda Reardon, Dwayne Van Eerd.     

Return to Work in a Cohort of Low Back Pain Patients: Development and Validation of a Clinical Prediction Rule

Background From the viewpoint of cost prevention, it is necessary to identify patients that are of high risk for long-term work disability, production loss and sick-leave. Methods Secondary data analysis in a cohort of 628 workers on sick-leave between 3 and 6 weeks due to low back pain (LBP). The association of a broad set of demographic, work, LBP and psychosocial related factors on lasting return to work was studied using Cox regression analysis with backward selection. The most relevant factors were used to derive a clinical prediction rule to determine the risk of sick-leave of more than 6 months. Variable and model selection and clinical model performance were performed with bootstrapping techniques. Also the test characteristics of the clinical model were considered. Results Longer work absence is related to “moderate” to “poor” job satisfaction, a higher score of fear avoidance beliefs, higher pain intensity at baseline, a longer duration of complaints and being of female gender. Calibration and discrimination of the clinical prediction rule were 0.90 (slope) and 0.63 (c-index), respectively. The explained variance of 6% of the prediction rule was low and the clinical performance in terms of sensitivity, specificity, positive and negative predictive values at specific cut-off points was moderate. Conclusions Our study confirmed the importance of demographic, work, LBP and psychosocial related factors on the prediction of long-term sick-leave. When these factors were used to derive a clinical prediction rule the performance was moderate. As a consequence, prudence has to be taken when using the prediction rule in practice.     

Reducing Sickness Absence from Work due to Low Back Pain: How Well do Intervention Strategies Match Modifiable Risk Factors?

Objective: To assess, from the review literature, the extent to which effective strategies for reducing work absence after acute low back pain (LBP) match empirical risk factors. Methods: From 17 recent review articles (2000–2005), disability risk factors and interventions were cross-tabulated to assess levels of relative concordance. Results: Potentially modifiable risk factors included 23 variables describing 3 workplace and 3 personal domains. Effective interventions included 25 strategies that were personal (physical or behavioral), engineering, or administrative in nature. There was a strong risk factor concordance for workplace technical and organizational interventions, graded activity exposure, and cognitive restructuring of pain beliefs. There was less risk factor concordance for exercise, back education, and RTW coordination. Few interventions focused on relieving emotional distress or improving job dissatisfaction, two well-supported risk factors. Discussion: Gaps between the epidemiological and intervention research of back disability prevention could be reduced by testing mediators of intervention effects or by stratifying outcomes according to pre-intervention risk factors.     

Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651]

Background  

Chronic low back pain (LBP) is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW) is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW.     

The effectiveness of graded activity for low back pain in occupational healthcare

Background

Low back pain is a common medical and social problem associated with disability and absence from work. Knowledge on effective return to work (RTW) interventions is scarce.

Objective

To determine the effectiveness of graded activity as part of a multistage RTW programme.

Design

Randomised controlled trial.

Setting

Occupational healthcare.

Subjects

112 workers absent from work for more than eight weeks due to low back pain were randomised to either graded activity (n = 55) or usual care (n = 57).

Intervention

Graded activity, a physical exercise programme aimed at RTW based on operant‐conditioning behavioural principles.

Main outcome measures

The number of days off work until first RTW for more then 28 days, total number of days on sick leave during follow up, functional status, and severity of pain. Follow up was 26 weeks.

Results

Graded activity prolonged RTW. Median time until RTW was equal to the total number of days on sick leave and was 139 (IQR = 69) days in the graded activity group and 111 (IQR = 76) days in the usual care group (hazard ratio = 0.52, 95% CI 0.32 to 0.86). An interaction between a prior workplace intervention and graded activity, together with a delay in the start of the graded activity intervention, explained most of the delay in RTW (hazard ratio = 0.86, 95% CI 0.40 to 1.84 without prior intervention and 0.39, 95% CI 0.19 to 0.81 with prior intervention). Graded activity did not improve pain or functional status clinically significantly.

Conclusions

Graded activity was not effective for any of the outcome measures. Different interventions combined can lead to a delay in RTW. Delay in referral to graded activity delays RTW. In implementing graded activity special attention should be paid to the structure and process of care.     

Prediction of return to work outcomes under an injured worker case management program

Introduction Many factors affect worker return to work (RTW) after occupational injury, among which effective case management strategies play a particularly vital role in prompting workers for a successful RTW. Objectives This study aimed at predicting the RTW outcome and optimizing the intervention scheme of a case management program initiated in China. Methods A retrospective cohort was formed with 523 injured workers treated at a rehabilitation center for work injuries in southern China. The social demographic information, medical data and intervention process were extracted from the medical records of the rehabilitation center. A Cox Regression Model was used to examine the predictors of RTW case management. Results 261 patients (77.9%) out of the 335 valid subjects successfully returned to work after median absence duration of 36.0 days. A computer skills training program was a positive factor for RTW outcomes (hazard ratio 1.5, P < 0.001). Psychological counseling was possibly an important measure to improve RTW with a hazard ratio of 3.4 (95% CI 0.94–16, P > 0.05). Disability adjustment accommodations did not specifically benefit RTW. Education level, family’s attitude to RTW, personal perceptions about social support for RTW, and injury severity were significantly associated with outcomes of RTW. Conclusions It was implied that RTW intervention should be focused on a specific skill reconstruction and training which was presumably related with labor market needs. However, tailored psychological counseling and disability adjustment activity should not be ignored in RTW.     

Family members' experiences of the return to work of cancer survivors

Although family members play an important role in various aspects of coping with cancer and are significantly affected by it, little is known about their perspectives regarding return to work (RTW). This study explored attitudes and experiences of cancer survivors' family members related to cancer survivors' RTW. The present study consists of a qualitative research design, employing in-depth semistructured interviews with first-degree family members (N = 21) of cancer survivors who were approached through online social networks: spouses, children, parents and siblings. Grounded theory techniques were used for data analysis. Four themes emerged from the interviews: (a) the family's cautious voice in return-to-work decision making; (b) work–home imbalance; (c) inhibiting or promoting the effect of work on the recovery process and (d) expectations and appreciation of unconditional workplace support. The findings suggest that psychosocial and health care professionals should help family members play an active role in the decision of RTW. Professionals should also prepare family members for potential costs of RTW for the family and help them develop realistic expectations regarding workplace support of the cancer survivor.     

A Developmental Conceptualization of Return to Work

Introduction: Although return to work (RTW) is a phenomenon that has been researched for many years, our ability to understand and improve outcomes is still limited. As an avenue for advancing the field, this paper presents an alternative way of thinking about RTW. Method: The conceptualization was constructed based on a review of the literature and the comments of RTW and workers' compensation researchers. Results: RTW is presented as an evolving process, comprising four key phases: i.e., “off work,” “work re-entry,” “retention,” and “advancement.” In addition, multiple phase-specific outcomes that may be used to evaluate RTW success are advanced. Conclusion: Broadening thinking about RTW to take into consideration the complexities of its developmental nature holds promise for understanding and improving RTW, as it not only clarifies the importance of incremental milestones, but also facilitates intervention choice and evaluation.     

A Literature Review Describing the Role of Return-to-Work Coordinators in Trial Programs and Interventions Designed to Prevent Workplace Disability

Objective Return-to-work (RTW) coordination has been suggested as an effective strategy for preventing workplace disability, but the scope of these services is not well described. The objective of this study was to describe the activities of RTW coordinators in published trials to provide a basis for establishing necessary competencies. Methods A keyword search of MEDLINE and CINAHL databases was conducted to identify intervention studies with a RTW coordinator providing direct, on-site workplace liaison to reduce work absences associated with physical health ailments. This search yielded 2,383 titles that were inspected by two examiners. Using a stepwise process that allowed for assessment of inter-observer agreement, 90 full articles were selected and reviewed, and 40 articles (22 studies) met criteria for inclusion. Results All but two studies (of traumatic brain injury) focused on musculoskeletal conditions or work injuries. Twenty-nine RTW coordinator activities were identified, but there was variation in the training background, workplace activities, and contextual setting of RTW coordinators. Based on reported RTW coordinator activities, six preliminary competency domains were identified: (1) ergonomic and workplace assessment; (2) clinical interviewing; (3) social problem solving; (4) workplace mediation; (5) knowledge of business and legal aspects; and (6) knowledge of medical conditions. Discussion Principal activities of RTW coordination involve workplace assessment, planning for transitional duty, and facilitating communication and agreement among stakeholders. Successful RTW coordination may depend more on competencies in ergonomic job accommodation, communication, and conflict resolution than on medical training.     

The “Toxic Dose” of System Problems: Why Some Injured Workers Don’t Return to Work as Expected

Introduction Most workers who incur an injury on the job follow a relatively straightforward path through a workers’ compensation claim, recovery and return to work. However, a minority of compensation claims is prolonged and can be disproportionately costly. We conducted this qualitative study in order to gain an understanding of systemic, process-related problems affecting injured workers who had failed to return to work as expected. Method A total of 69 in-depth interviews were conducted with injured workers with complex and extended workers’ compensation claims and with return-to-work (RTW) providers such as health care providers, insurers, legal advisors, and workplaces. The study was based in Ontario, Canada. A modified grounded theory analysis led to the identification of common mechanisms in RTW problems. Results We identify problems with return to work and extended workers’ compensation claims in dysfunctions in organizational dynamics across RTW systems including the workplace, healthcare, vocational rehabilitation and workers’ compensation. These system problems are difficult to identify because they appear as relatively mundane and bureaucratic. These appeared to have damaging effects on workers in the form of a ‘toxic dose’ affecting the worker beyond the initial injury. Conclusions Worker’s problems with extended claims were linked to RTW policies that did not easily accommodate conflict or power imbalances among RTW parties and by social relations and processes that impeded communication about RTW situations and problems. Avenues for intervention are located in a shift to a critical lens to RTW process that addresses differences of knowledge, resources, and interests among different parties.     

Determinants of Return to Work After Occupational Injury

Introduction The promotion of return to work (RTW) following occupational injury benefits injured workers, their families, enterprises and the society. The identification of the potential determinants would be helpful in improving RTW rate and minimizing the duration of absenteeism following injury. Objectives The aim of the study was to identify the potential determinants of RTW following work-related injury. Methods A historical cohort of workers with occupational injury in a state-owned locomotive vehicles company in central China was followed up on the outcomes of RTW. Demographic, employment and medical information was retrieved from the company archival documents; and post-injury information was interviewed by structured questionnaires. Univariate analysis and Cox Regression Model were used to examine the associations between potential determinants and outcomes of RTW. Results Three hundred of the 323 cases (92.9%) eventually returned to work after the median absence of 43 days. Factors from socio-demographic, clinical, economic, and psychological domains affected RTW in the univariate analyses. The multivariate analysis indicated that age, injury severity, injury locus, injury nature, pain in the injury locus, self-report health status and pre-injury monthly salary were significant determinants of RTW. Conclusions There were multidimensional factors affecting RTW after occupational injury. Proper clinical treatment and rehabilitation, as well as economic and social support to facilitate workers’ RTW would be the priorities upon intervention. Future studies should be conducted in larger representative samples to confirm the findings and to develop a multidisciplinary intervention strategy towards promoting RTW.     

Validation of a Risk Factor-Based Intervention Strategy Model Using Data from the Readiness for Return to Work Cohort Study

Background Low back pain (LBP) is a common and in some cases disabling condition. Until recently, workers presenting with non-specific LBP have generally been regarded as a homogeneous population. If this population is not homogeneous, different interventions might be appropriate for different subgroups. We hypothesized that (1) Clusters of individuals could be identified based on risk factors, (2) These clusters would predict duration and recurrences 6 months post-injury. Methods The study focuses on the 442 LBP claimants in the Readiness for Return-to-Work Cohort Study. Claimants (n = 259) who had already returned to work, approximately 1 month post-injury were categorized as the low risk group. A latent class analysis was performed on 183 workers absent from work, categorized as the high risk group. Groups were classified based on: pain, disability, fear avoidance beliefs, physical demands, people-oriented culture and disability management practice at the workplace, and depressive symptoms. Results Three classes were identified; (1) workers with ‘workplace issues’, (2) workers with a ‘no workplace issues, but back pain’, and (3) workers having ‘multiple issues’ (the most negative values on every scale, notably depressive symptoms). Classes 2 and 3 had a similar rate of return to work, both worse than the rate of class 1. Return-to-work status and recurrences at 6 months were similar in all 3 groups. Conclusion This study largely confirms that several subgroups could be identified based on previously defined risk factors as suggested by an earlier theoretical model by Shaw et al. (J Occup Rehab 16(4):591–605, 2006). Different groups of workers might be identified and might benefit from different interventions.     

Can Cross Country Differences in Return-to-Work After Chronic Occupational Back Pain be Explained? An Exploratory Analysis on Disability Policies in a Six Country Cohort Study

Introduction There are substantial differences in the number of disability benefits for occupational low back pain (LBP) among countries. There are also large cross country differences in disability policies. According to the Organization for Economic Cooperation and Development (OECD) there are two principal policy approaches: countries which have an emphasis on a compensation policy approach or countries with an emphasis on an reintegration policy approach. The International Social Security Association initiated this study to explain differences in return-to-work (RTW) among claimants with long term sick leave due to LBP between countries with a special focus on the effect of different disability policies. Methods A multinational cohort of 2,825 compensation claimants off work for 3–4 months due to LBP was recruited in Denmark, Germany, Israel, the Netherlands, Sweden, and the United States. Relevant predictors and interventions were measured at 3 months, one and 2 years after the start of sick leave. The main outcome measure was duration until sustainable RTW (i.e. working after 2 years). Multivariate analyses were conducted to explain differences in sustainable RTW between countries and to explore the effect of different disability policies. Results Medical and work interventions varied considerably between countries. Sustainable RTW ranged from 22% in the German cohort up to 62% in the Dutch cohort after 2 years of follow-up. Work interventions and job characteristics contributed most to these differences. Patient health, medical interventions and patient characteristics were less important. In addition, cross-country differences in eligibility criteria for entitlement to long-term and/or partial disability benefits contributed to the observed differences in sustainable RTW rates: less strict criteria are more effective. The model including various compensation policy variables explained 48% of the variance. Conclusions Large cross-country differences in sustainable RTW after chronic LBP are mainly explained by cross-country differences in applied work interventions. Differences in eligibility criteria for long term disability benefits contributed also to the differences in RTW. This study supports OECD policy recommendations: Individual packages of work interventions and flexible (partial) disability benefits adapted to the individual needs and capacities are important for preventing work disability due to LBP.     

Integrating Psychosocial and Behavioral Interventions to Achieve Optimal Rehabilitation Outcomes

Introduction: Psychosocial factors are important contributors to work disability associated with musculoskeletal conditions. The primary objectives of this paper were 1) to describe different psychosocial interventions that have been developed to prevent prolonged work disability, and 2) to identify future research directions that might enhance the impact of programs targeting psychosocial risk factors for work disability. Methods: Selective review of scientific literature on psychosocial and behavioral interventions and work disability. Results: Most prior interventions focused on psychosocial risk factors that exist primarily within the individual (e.g., pain catastrophizing, beliefs, expectancies). Successful disability prevention will require methods to assess and target psychosocial risk factors “outside” of the individual (e.g., interpersonal conflict in the workplace, job stress, etc.) using cost-effective, multipronged approaches. Research to explore interactions among different domains of psychosocial risk factors in relation to RTW outcomes is needed. Challenges to effective secondary prevention of work disability include developing competencies to enable a range of providers to deliver interventions, standardization of psychosocial interventions, and maximizing adherence to intervention protocols. Conclusion: Effective secondary prevention of work disability will require research to develop cost-effective, multipronged approaches that concurrently target both worker-related and workplace psychosocial risk factors.     

Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: Prospective study with clinical implications

Study Design: Prospective cohort study with 18-month follow-up. Objective: To investigate if long-term sick listed persons’ own predictions of their future return to work (RTW) have an impact on their RTW when controlling for other established factors. Method: Postal questionnaires at baseline were sent to persons who had been on sick leave for more than 90 days, and were employed in five municipalities and four county councils in Sweden. A follow-up regarding their RTW was performed 18 months later. Results: After 18 months 135 out of 508 persons (27%) had returned to work, full or part-time. In a multivariate logistic regression, the sick listed persons’ own prediction of their RTW proved to be highly significant (OR=8.28, 95% CI: 3.31–20.69). Only six out of 132 persons with a negative view of their RTW did return to wok. Other predictive factors that were found for RTW were: being on sick leave for a period of less than 1 year (OR=2.09, 95% CI: 1.19–3.67), having less pain than persons in the quartile with most pain (OR=2.65, 95% CI: 1.21–5.81), perceiving that one was welcome back to work (OR=1.98, 95% CI: 1.10–3.58), and being under 55 years of age (OR=2.37, 95% CI: 1.07–5.23 for age between 45 and 54 years and the same trend for age below 45 years OR=1.85, 95% CI: 0.82–4.20). Conclusion: Persons with a positive prediction should get help to realise their potential for RTW. Offering traditional rehabilitation measures to a person with a negative prediction of his/her RTW, could be a waste of resources if done ahead of improving self-confidence and view of what is possible. The problems in this group might decrease or be easier to handle if decisions about the future are taken within a year.     

Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up

Objective: To determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints. Methods: A randomized controlled trial with a 1-year follow-up was carried out. Thirty-eight subjects were allocated to multidisciplinary treatment (intervention, n=23), or to usual care provided by occupational health services (n=15). The intervention consisted of psychological and physical sessions provided by a medical specialist, a psychologist, a physiotherapist and an occupational therapist. It aims at reconditioning, “de-medicalizing”, unrestrained moving and return-to-work. The intervention process was evaluated on compliance to the protocol and the effectiveness of its components. The individual outcome variable was the severity of complaints. The societal outcomes included return-to-work and costs. Measurements were performed at baseline and after 2, 6 and 12 months. Mixed model analyses were used for analysis. Results: The intervention achieves its aims: physical disabilities (P=0.039), kinesiophobia (P<0.001) and physical functioning (P=0.016) improved significantly as compared to usual care. In addition, the intervention was significantly more effective in reducing the severity of complaints than usual care. The intervention was equally effective compared to usual care in terms of return-to-work (86% in the intervention group vs. 73% in the usual care group). The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months. Conclusion: Multidisciplinary treatment affects individuals positively, but shows no significant difference in (cost-) effectiveness on the societal level as compared to usual care.