Explore the vast range of titles available.

This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling. Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication. The IPS-WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS-WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS-WFM intervention (45 v. 26 weeks, p < 0.004). The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.

ObjectivesCommon mental disorders (CMDs) are among the main causes of sickness absence and can lead to suffering and high costs for individuals, employers and the society. The occupational health service (OHS) can offer work-directed interventions to support employers and employees. The aim of this study was to evaluate the effect on sickness absence and health of a work-directed intervention given by the OHS to employees with CMDs or stress-related symptoms.MethodsRandomisation was conducted at the OHS consultant level and each consultant was allocated into either giving a brief problem-solving intervention (PSI) or care as usual (CAU). The study group consisted of 100 employees with stress symptoms or CMDs. PSI was highly structured and used a participatory approach, involving both the employee and the employee’s manager. CAU was also work-directed but not based on the same theoretical concepts as PSI. Outcomes were assessed at baseline, at 6 and at 12 months. Primary outcome was registered sickness absence during the 1-year follow-up period. Among the secondary outcomes were self-registered sickness absence, return to work (RTW) and mental health.ResultsA statistical interaction for group × time was found on the primary outcome (p=0.033) and PSI had almost 15 days less sickness absence during follow-up compared with CAU. Concerning the secondary outcomes, PSI showed an earlier partial RTW and the mental health improved in both groups without significant group differences.ConclusionPSI was effective in reducing sickness absence which was the primary outcome in this study.

Background Common mental disorders (CMDs) are highly prevalent in workplace settings, and have become a significant public health challenge. This study aims to assess the effectiveness of PRATICA dr , a web application facilitated by a Return-to-Work Coordinator (RTW-C), with a focus on reducing sick leave duration and preventing relapse in individuals with CMDs. Methods PRATICA dr , designed to enhance collaboration among Return-to-Work (RTW) stakeholders and provide systematic support throughout the RTW process, was evaluated in a quasi-experimental study. Survival analyses were used to compare sick leave durations and relapses between the experimental group (PRATICA dr with RTW-C), and control groups (RTW-C only). Both conditions had equal distribution of 50% from large public health organizations ( n  = 35) and 50% from a large private financial organization ( n  = 35). Mixed linear models were used to observe changes in clinical symptoms over time, especially for the experimental group. Results The experimental group demonstrated significantly shorter sick leave durations and fewer relapses compared to the control group. Notably, the average absence duration was close to 3 months shorter in the experimental group. This difference was found when the RTW-C intervention (rehabilitation care) began 2 months after the onset of sick leave. Relapses occurred only in the control group (13.2%). The absence of relapses in the experimental group is noteworthy, along with the significant decrease in depressive and anxious symptoms over time. Conclusions The findings suggest that incorporating PRATICA dr into RTW-C intervention can lead to substantial cost savings by facilitating coordination among stakeholders and guiding the RTW process with validated tools. Initiation of RTW-C intervention alongside PRATICA dr within the first month of absence is recommended for optimal health and work outcomes.

Background Problem-solving interventions with workplace involvement (PSI-WPI) have been shown to reduce sick leave and increase return to work in an occupational health services context. However, many employees struggle with reduced work functioning, anxiety-, and depressive symptoms up to 12 months after a sick leave episode, and it is unclear if the intervention affects outcomes other than sick leave. The aim of this study is to investigate if a PSI-WPI added to care as usual (CAU) is superior to CAU with respect to self-reported sick leave, psychological symptoms, work ability, work performance, and health after RTW when provided in primary care. Methods Employed individuals aged 18–59 years on sick leave (2 to 12 weeks) diagnosed by a physician at a primary care center with mild to moderate depression, anxiety, or adjustment disorder were enrolled in a two-armed cluster-randomised trial evaluating the effectiveness of a PSI-WPI. Multiple outcomes were recorded at baseline, six months, 12 months, and every fourth week during the study period. Outcomes were categorised into psychological symptoms, health, work ability, work performance, and self-reported sick leave. Data were analysed using MANOVA, GEE (Generalized Estimating Equations), and cox regression. Results One hundred ninety-nine individuals responded to the invitation to participate; one participant withdrew, one was excluded as the employment ended, nine did not answer the baseline survey, and three were removed from the analysis due to missing data. The analysis included 81 subjects who received the intervention and 104 subjects who received the control. Baseline characteristics were similar across both groups. No differences between the groups were found among either variables except one. There was a significant difference between the groups in self-rated health (EQ5D) in favour of the CAU group from baseline to six-month follow-up, with a mean difference of -8.44 (-14.84, -2.04). Conclusions A problem-solving intervention with workplace involvement added to CAU did not result in statistically significant reductions in outcomes. Further research is needed to understand why problem-solving interventions appear to have an effect on sick leave in an occupational health services context and not in a primary care context. Trial registration NCT3346395, registration date 2017–11-17.

Background Musculoskeletal disorders are an extensive burden to society, yet few studies have explored and replicated modifiable prognostic factors associated with high societal costs. This study aimed to replicate previously identified associations between nine modifiable prognostic factors and high societal costs among people on sick leave due to musculoskeletal disorders. Methods Pooled data from a three-arm randomised controlled trial with 6 months of follow-up were used, including 509 participants on sick leave due to musculoskeletal disorders in Norway. Consistent with the identification study, the primary outcome was societal costs dichotomised as high (top 25th percentile) or low. Societal costs included healthcare utilization (primary, secondary, and tertiary care) and productivity loss (absenteeism, work assessment allowance and disability benefits) collected from public records. Binary unadjusted and adjusted logistic regression analyses were used to replicate previously identified associations between each modifiable prognostic factor and having high costs. Results Adjusted for selected covariates, a lower degree of return-to-work expectancy was associated with high societal costs in both the identification and replication sample. Depressive symptoms and health literacy showed no prognostic value in both the identification and replication sample. There were inconsistent results with regards to statistical significance across the identification and replication sample for pain severity, self-perceived health, sleep quality, work satisfaction, disability, and long-lasting disorder expectation. Similar results were found when high costs were related to separately healthcare utilization and productivity loss. Conclusion This study successfully replicated the association between return-to-work expectancy and high societal costs among people on sick leave due to musculoskeletal disorders. Other factors showed no prognostic value or inconsistent results. Trial registration ClinicalTrials.gov NCT03871712, 12th of March 2019.

ObjectiveThe aim of this study was to investigate an integrated mental healthcare and vocational rehabilitation intervention to improve and hasten the process of return-to-work of people on sick leave with anxiety and depression.MethodsIn this three-arm, randomised trial, participants were assigned to (1) integrated intervention (INT), (2) improved mental healthcare (MHC) or (3) service as usual (SAU). The primary outcome was time to return-to-work measured at 12-month follow-up. The secondary outcomes were time to return-to-work measured at 6-month follow-up; levels of anxiety, depression, stress symptoms, and social and occupational functioning at 6 months; and return-to-work measured as proportion in work at 12 months.Results631 individuals were randomised. INT yielded a higher proportion in work compared with both MHC (56.2% vs 43.7%, p=0.012) and SAU (56.2% vs 45%, p=0.029) at 12-month follow-up. We found no differences in return-to-work in terms of sick leave duration at either 6-month or 12-month follow-up, with the latter being the primary outcome. No differences in anxiety, depression or functioning between INT, MHC and SAU were identified, but INT and MHC showed lower scores on Cohen’s Perceived Stress Scale compared with SAU at 6-month follow-up.ConclusionsAlthough INT did not hasten the process of return-to-work, it yielded better outcome with regard to proportion in work compared with MHC and SAU. The findings suggest that INT compared with SAU is associated with a few, minor health benefits. Overall, INT yielded slightly better vocational and health outcomes, but the clinical significance of the health advantage is questionable.Trial registration numberNCT02872051.

Objective: To determine the effect of a workplace intervention programme on the rate of return to work of previously employed stroke survivors in the Gauteng province of South Africa. Design: A randomised controlled trial. Setting: Participants’ workplaces and three hospitals with stroke rehabilitation facilities. Subjects: Eighty stroke survivors between the ages of 18 and 60 years who were employed at the time of stroke onset. Intervention: The workplace intervention programme was tailored according to functional ability and workplace challenges of each stroke survivor. The control group received usual stroke care which took into consideration job requirements but without workplace intervention. Main outcomes: The primary outcome was return to work rate. Secondary outcomes included activities of daily living (ADLs), mobility, basic cognitive function and perceived quality of life. Results: At six months follow-up 60% (n = 24) of stroke survivors in the intervention group returned to work compared to 20% (n = 8) in the control group (P <0.001). The odds ratio for return to work for stroke survivors in the intervention group was 5.2. For every unit increase in the ADLs and cognitive assessment score, the odds of return to work increased by 1.7 and 1.3 respectively; those who returned to work had better quality of life than those who did not return to work (P = 0.05). Conclusion: A workplace intervention consisting of workability assessments and workplace visits was effective in facilitating return to work for stroke survivors in the Gauteng province of South Africa.

Background The study aimed to explore which sociodemographic, health-related, and work-related factors were associated with the number of sickness absence days during 18 months among employees on sickness absence due to common mental disorders. Methods A longitudinal study with participants from a cluster-randomized controlled trial was conducted. Participants from both intervention and control groups were treated as one cohort. Factors included in the analysis were sociodemographic, health-related, and work-related variables collected through questionnaires at baseline. The outcome was cumulative net sickness absence days for sickness absence spells exceeding 14 days and was collected from a national register. Data was analyzed using generalized estimating equations. Results The sample consisted of 197 employees. Lower-rated work ability in relation to physical demands ([exp (B) 1.19], 95% CI 1.02–1.40) and higher-rated job demands ([exp (B) 1.28], 95% CI 1.01–1.61), were associated with increased number of sickness absence days during the 18 months follow-up. Higher certainty of return to work within three months ([exp (B) 0.63], 95% CI 0.48–0.83) was associated with a decreased number of sickness absence days during the 18 months follow-up. Conclusions Our study suggests that work-related factors, i.e., high job demands and impaired work ability, are associated with an increased number of days on sickness absence. Additionally, the certainty of returning to work within three months is associated with fewer days on sickness absence. The results highlight the importance of addressing specific workplace factors when designing interventions aimed at decreasing sickness absence for employees on sickness absence due to CMDs. The results could be used to inform a dialogue between healthcare personnel and employees on sickness absence due to CMDs, and to serve as basis for a structured inventory to assist healthcare personnel in addressing workplace factors.

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 (2-12 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 33-149] versus 117 [interquartile range 59-189)], P=0.034). The hazard ratio for sustainable return to work was 1.9 (95% confidence interval 1.2-3.0) 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.

IntroductionCommon mental disorders and musculoskeletal disorders are the leading causes of sickness absence and disability. There has been a rise in work-focused clinical interventions and studies investigating whether general clinical services can increase employment and reduce sickness absence. However, evidence supporting a clinical approach to preventing sickness absence and improving return to work remains limited. This is a protocol for a multicentre randomised controlled trial, the Norwegian Sickness Absence Clinic Nudge Study (NSAC Nudge Study), which aims to investigate the effect of including questionnaires on motivation for work, barriers for return to work and work environment to patients and the provision of a summary of responses to clinicians prior to consultation, on return to work, prevention of sickness absence and alleviation of symptoms.MethodsThe NSAC Nudge Study is a multicentre naturalistic randomised controlled trial conducted at five outpatient clinics admitting patients on—or at risk of sickness absence due to common mental—and/or musculoskeletal disorders in Northern Norway. The study commenced on 6 September 2021 and aimed to recruit 1100 patients. Recruitment concluded on 12 January 2023, at which point 1171 patients had been enrolled. The patients were randomised in equal proportions to receive either of two questionnaires prior to treatment; a questionnaire mapping health factors only, or a questionnaire mapping health factors and factors related to motivation for work, barriers for return to work and motivation for work. Data sources include survey data from both patients and clinicians, as well as 20 years of retrospective and prospective data from national registries on healthcare utilisation, sickness absence, employment and benefits.AnalysesIn this protocol, we describe a trial aiming to facilitate and improve return to work, prevention of sickness absence and alleviation of symptoms for patients with common mental health and/or musculoskeletal disorders through a nudge. The study findings will serve as validation of an implemented programme for this patient group and inform decisions on how the programme may be adapted to increase its efficacy.Ethics and disseminationThe study has been approved by the Regional Committee for Medical Research (REC North), grant number #285 489. Results from the study will be communicated to the participating HelseIArbeid outpatient clinics and other relevant stakeholders and disseminated through scientific publications and presentations.Trial registration number NCT05006976.