Effects of a short-term occupational therapy intervention in an acute geriatric unit. A randomized clinical trial. Effect of an intervention to enhance guideline adherence of occupational physicians on return-to-work self-efficacy in workers sick-listed with common mental disorders Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial Observation-to-Imitate Plus Practice Could Add Little to Physical Therapy Benefits Within 31 Days of Stroke Evaluation of a motivational interview for substance use within psychiatric in-patient services. Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands Effectiveness of a Blended Web-Based Intervention on Return to Work for Sick-Listed Employees With Common Mental Disorders: Results of a Cluster Randomized Controlled Trial Faster return to work after psychiatric consultation for sicklisted employees with common mental disorders compared to care as usual. A randomized clinical trial Collaborative care for sick-listed workers with major depressive disorder: a randomised controlled trial from the Netherlands Depression Initiative aimed at return to work and depressive symptoms Adjuvant occupational therapy improves long-term depression recovery and return-to-work in good health in sick-listed employees with major depression: results of a randomised controlled trial Predictive tests for non-return to work in patients with chronic low back pain Design of a multicentre randomized controlled trial to evaluate the effectiveness of a tailored clinical support intervention to enhance return to work for gastrointestinal cancer patients Effectiveness and cost-effectiveness of an exposure-based return-to-work programme for patients on sick leave due to common mental disorders: design of a cluster-randomized controlled trial Effectiveness of an exposure-based return-to-work program for workers on sick leave due to common mental disorders: a cluster-randomized controlled trial. 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 Effectiveness of an Intervention to Enhance Occupational Physicians’ Guideline Adherence on Sickness Absence Duration in Workers with Common Mental Disorders: A Cluster-Randomized Controlled Trial Thoughts and feelings of future working life as a predictor of return to work: a combined qualitative and quantitative study of sick-listed persons with musculoskeletal disorders Predictors of return to work in employees sick-listed with mental health problems: findings from a longitudinal study. Municipal return to work management in cancer survivors undergoing cancer treatment: a protocol on a controlled intervention study Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol The effectiveness of graded activity for low back pain in occupational healthcare Multidisciplinary Collaborative Care for Depressive Disorder in the Occupational Health Setting: design of a randomised controlled trial and cost-effectiveness study Subgroup analyses on return to work in sick-listed employees with low back pain in a randomised trial comparing brief and multidisciplinary intervention
OBJECTIVES To compare the benefits of a short-term occupational therapy intervention ( OTI ) when added to the conventional treatment model ( CTM ) in the functional recovery of patients admitted to an acute geriatric unit ( AGU ) . STUDY DESIGN Non-pharmacological r and omized clinical trial . 400 patients were r and omized to OTI ( n = 198 ) or CTM ( n = 202 ) group . Mean age 83.5 . Interventions included needs assessment , iatrogenic prevention , retraining in activities of daily living , and instructions for caregivers in three groups of patients defined a priori ( cardiopulmonary disease , stroke , other conditions ) 5 days a week , 30 - 45 min a day . MAIN OUTCOME MEASURE Recovery of ≥ 10 Barthel index points by discharge . Secondary outcome was the reduction in confusional episodes . RESULTS The adjusted relative risk ( RR ) of functional recovery in the OTI group was 1.16 ( 95%CI 0.91 - 1.47 ) . In participants with cardiopulmonary disease was 1.57 ( 95%CI 1.06 - 2.32 ) , number needed to treat ( NNT ) 5 . Participants with other conditions assigned to OTI had a reduction in acute confusional episodes ; RR 0.48 ( 95 % CI 0.26 - 0.87 ) , NNT 7 . CONCLUSIONS Although overall there were no significant differences , patients with cardiopulmonary disease or non-stroke pathologies admitted to an AGU , may benefit from a short-term OTI Background Since a higher level of self-efficacy in common mental disorders is associated with earlier return-to-work ( RTW ) , it is important to know if work related self-efficacy can be increased by occupational health care . The primary aim of this study was to evaluate whether an intervention to enhance guideline adherence of occupational physicians lead to an increase in RTW self-efficacy in workers three months later . The secondary aim was to evaluate whether the intervention modified the association between RTW self-efficacy and return-to-work three months later . Methods A total of 66 occupational physicians participated in the study . They were r and omized into two groups ; the intervention group received a training , the control group did not . The training aim ed to enhance adherence to a mental health guideline that contained strategies that are supposed to enhance RTW self-efficacy . In 128 sick-listed workers guided by these occupational physicians , RTW self-efficacy , RTW , and personal , health-related and work-related variables were measured at baseline and three months later . Generalized linear mixed models analysis and linear mixed models analysis were used for the evaluations . Results In workers whose occupational physicians had received the training RTW self-efficacy increased significantly more than in workers whose occupational physicians had participated in the control group ( t = −2.626 , p ≤ .05 ) . Higher baseline RTW self-efficacy scores were significantly more often associated with full RTW than with no RTW three months later ( OR 2.20 , 95 % CI 1.18–4.07 ) , but the intervention did not affect this association . Conclusions This study showed that a training to enhance guideline adherence of occupational physicians leads to increased RTW self-efficacy in workers sick-listed with common mental disorders during the first months of sickness absence in a real-life occupational health care setting . This insight is helpful for optimizing the recovery and RTW process , and for underst and ing the role of RTW self-efficacy in this process . Trial registration IS RCT Background Common mental disorders ( CMD ) have a major impact on both society and individual workers , so return to work ( RTW ) is an important issue . In The Netherl and s , the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW . Evidence -based guidelines are available , but seem not to be effective in improving RTW in people with CMD . An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed . A blended E-health module embedded in collaborative occupational health care is now available , and comprises a decision aid supporting the occupational physician and an E-health module , Return@Work , to support sick-listed workers in the RTW process . The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual . Methods This study is a two-armed cluster r and omized controlled trial , with r and omization done at the level of occupational physicians . Two hundred workers with CMD on sickness absence for 4–26 weeks will be included in the study . Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention . Occupational physicians allocated to the care as usual group will give conventional sickness guidance . Follow-up assessment s will be done at 3 , 6 , 9 , and 12 months after baseline . The primary outcome is duration until RTW . The secondary outcome is severity of symptoms of CMD . An economic evaluation will be performed as part of this trial . Conclusion It is hypothesized that collaborative occupational health care intervention will be more (cost)-effective than care as usual . This intervention is innovative in its combination of a decision aid by email sent to the occupational physician and an E-health module aim ed at RTW for the sick-listed worker Background and Purpose . Observation of action with intention-to-imitate ( OTI ) might enhance motor recovery . This early phase trial investigated whether OTI followed by physical practice ( OTI + PP ) enhanced the benefits of conventional physical therapy ( CPT ) on upper limb recovery early after stroke . Methods . Participants were 3 to 31 days poststroke . They had substantial paresis and ability to imitate action with their ipsilesional arm . After baseline measures , participants were r and omized to either OTI + PP in addition to CPT or to CPT only . Outcome measures were made after 15 days of treatment . The measurement battery was the Motricity Index ( MI ) and the Action Research Arm Test ( ARAT ) . Change , baseline to outcome , was examined using the Wilcoxon test for within group and Mann – Whitney U test for between groups . Results . Sixty-five of 570 stroke survivors were eligible , 55 were able to imitate , 37 gave informed consent , 7 were transferred out of area before baseline , and 29 were r and omized . Outcome measures were completed with 13 CPT participants and 9 OTI + PP participants . Both groups showed statistically significant improvements for the MI  ( CPT median change 8 , P = .003 ; OTI + PP median change 10 , P = .012 ) but the median ( 95 % confidence interval [ CI ] ) between-group difference was 0.0 ( −11 , 16 ) , P = 1.000 . For the ARAT , only the CPT group showed a statistically significant improvement ( median 9 , P = .006 ) . The median ( 95 % CI ) between-group difference of 1.0 ( −18 , 23 ) was not statistically significant ( P = .815 ) . Conclusions . These findings suggest that OTI + PP might add little to the benefits of CPT early after stroke AIMS To assess the effectiveness of a motivational interview among hospitalized psychiatric patients with comorbid substance use disorder in reducing alcohol and other drug ( AOD ) use . DESIGN Subjects were assigned r and omly to receive an individual motivational interview ( n=79 ) or a self-help booklet ( control condition ; n=81 ) . SETTING Subjects were volunteers recruited from a major public psychiatric hospital . PARTICIPANTS Subjects met abuse or dependence criteria on the structured clinical interview for diagnosis ( SCID ) for alcohol , cannabis or amphetamine or they reported hazardous use during the last month of one or more of these drug types on the opiate treatment index ( OTI ) . INTERVENTION Either one 30 - 45-minute motivational interview or brief advice . MEASUREMENTS The SCID and OTI were the main measures . FINDINGS There was a modest short-term effect of the motivational interview on an aggregate index of alcohol and other drug use ( polydrug use on the OTI ) . Cannabis use remained high among the sample over the 12-month follow-up period . CONCLUSION Although motivational interviewing appears feasible among in- patients in psychiatric hospital with comorbid substance use disorders , more extensive interventions are recommended , continuing on an out-patient basis , particularly for cannabis use Objectives To support return to work ( RTW ) among cancer patients , a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy . The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes . Design Longitudinal prospect i ve intervention study using a one-group design . Setting Two hospitals in the Netherl and s. Participants Of the eligible patients , 56 % participated ; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included . Patients completed question naires on RTW , the importance of work , work ability ( WAI ) , RTW self-efficacy , fatigue ( MFI ) , and quality of life ( EORTC QLQ C-30 ) at baseline and 6 , 12 and 18 months follow-up . Before and after the exercise programme 1-repetition maximum ( 1RM ) muscle strength and cardiorespiratory fitness ( VO2 peak ) were assessed . Results Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme , 59 % of the cancer patients returned to work , 86 % at 12 months and 83 % at 18 months . In addition , significant improvements ( p<0.05 ) in the importance of work , work ability , RTW self-efficacy , and quality of life were observed , whereas fatigue levels were significantly reduced . After completing the exercise programme , 1RM muscle strength was significantly increased but there was no improvement in VO2 peak level . Conclusions RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme . A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW , reduced fatigue and increased importance of work , work ability , and quality of life Background Common mental disorders are strongly associated with long-term sickness absence , which has negative consequences for the individual employee ’s quality of life and leads to substantial costs for society . It is important to focus on return to work ( RTW ) during treatment of sick-listed employees with common mental disorders . Factors such as self-efficacy and the intention to resume work despite having symptoms are important in the RTW process . We developed “ E-health module embedded in Collaborative Occupational health care ” ( ECO ) as a blended Web-based intervention with 2 parts : an eHealth module ( Return@Work ) for the employee aim ed at changing cognitions of the employee regarding RTW and a decision aid via email supporting the occupational physician with advice regarding treatment and referral options based on monitoring the employee ’s progress during treatment . Objective This study evaluated the effect of a blended eHealth intervention ( ECO ) versus care as usual on time to RTW of sick-listed employees with common mental disorders . Methods The study was a 2-armed cluster r and omized controlled trial . Employees sick-listed between 4 and 26 weeks with common mental disorder symptoms were recruited by their occupational health service or employer . The employees were followed up to 12 months . The primary outcome measures were time to first RTW ( partial or full ) and time to full RTW . Secondary outcomes were response and remission of the common mental disorder symptoms ( self-assessed ) . Results A total of 220 employees were included : 131 participants were r and omized to the ECO intervention and 89 to care as usual ( CAU ) . The duration until first RTW differed significantly between the groups . The median duration was 77.0 ( IQR 29.0 - 152.3 ) days in the CAU group and 50.0 ( IQR 20.8 - 99.0 ) days in the ECO group ( hazard ratio [ HR ] 1.390 , 95 % CI 1.034 - 1.870 , P=.03 ) . No significant difference was found for duration until full RTW . Treatment response of common mental disorder symptoms did not differ significantly between the groups , but at 9 months after baseline significantly more participants in the ECO group achieved remission than in the CAU group ( OR 2.228 , 95 % CI 1.115 - 4.453 , P=.02 ) . Conclusions The results of this study showed that in a group of sick-listed employees with common mental disorders , applying the blended eHealth ECO intervention led to faster first RTW and more remission of common mental disorder symptoms than CAU . Trial Registration Netherl and s Trial Register NTR2108 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2108 . ( Archived by WebCite at http://www.webcitation.org/6YBSnNx3P ) Introduction Return to work ( RTW ) of employees on sick leave for common mental disorders may require a multidisciplinary approach . This article aims to assess time to RTW after a psychiatric consultation providing treatment advice to the occupational physician ( OP ) for employees on sick leave for common mental disorders in the occupational health ( OH ) setting , compared to care as usual ( CAU ) . Methods Cluster r and omized clinical trial evaluating patients of 12 OPs receiving consultation by a psychiatrist , compared to CAU delivered by 12 OPs in the control group . 60 patients suffering from common mental disorders and ≥ six weeks sicklisted were included . Follow up three and six months after inclusion . Primary outcome measure was time to RTW . Intention- to-treat multilevel analysis and a survival analysis were performed to evaluate time to RTW in both groups . Results In CAU , referral was the main intervention . Both groups improved in terms of symptom severity and quality of life , but time to RTW was significantly shorter in the psychiatric consultation group . At three months follow up , 58 % of the psychiatric consultation group had full RTW versus 44 % of the control group , a significant finding ( P = 0.0093 ) . Survival analysis showed 68 days earlier RTW after intervention in the psychiatric consultation group ( P = 0.078 ) compared to CAU . Conclusion Psychiatric consultation for employees on sick leave in the OH setting improves time to RTW in patients with common mental disorders as compared to CAU . In further research , focus should be on early intervention in patients with common mental disorders on short sick leave duration  . Psychiatric consultation might be particularly promising for improvement of RTW in those patients . Trial registration number IS RCT N : Objectives Major depressive disorder ( MDD ) is associated with absenteeism . In this study , the effectiveness of collaborative care , with a focus on return to work ( RTW ) , was evaluated in its effect on depressive symptoms and the duration until RTW in sick-listed workers with MDD in the occupational health setting . Methods In this r and omised controlled trial , 126 sick-listed workers with MDD were r and omised to usual care  ( N=61 ) or  collaborative care  ( N=65 ) . Collaborative care was applied by the occupational physician care manager , supported by a web-based tracking system and a consultant psychiatrist . Primary outcome measure was time to response . Secondary outcome measures were time to remission , depressive symptoms as continuous measure and the duration until full RTW . Results Collaborative care participants had a shorter time to response , with a difference of 2.8 months . However , no difference was found on time to remission or depressive symptoms as continuous measure . With a mean of 190 days in the collaborative care group , and 210 days in the usual care group , the groups did not differ significantly from each other in the duration until full RTW . Adherence to the collaborative care intervention was low . Conclusions These results do not justify a widespread implementation of collaborative care in occupational healthcare , as it was operationalised in this study . However , since the study might have been underpowered for RTW and because treatment integrity was low , further research , with larger sample sizes , is needed to develop the best fitting ( collaborative care ) model for addressing RTW in depressed sick-listed workers . Trial registration : IS RCT Objectives To evaluate whether adjuvant occupational therapy ( OT ) can improve the effectiveness of treatment-as-usual ( TAU ) in sick-listed employees with major depression . Methods In total , 117 employees sick-listed for a median duration of 4.8 months ( IQR=2.6 to 10.1 months ) because of major depression were r and omised to TAU  ( n=39 ) or adjuvant OT ( TAU+OT ; n=78 ) . OT ( 18 sessions ) focussed on a fast return to work ( RTW ) and improving work-related coping and self-efficacy . The primary outcome was work participation ( hours of absenteeism+ duration until partial/full RTW ) . Secondary outcomes were depression , at-work functioning , and health-related functioning . Intermediate outcomes were work-related , coping and self-efficacy . Blinded assessment s occurred at baseline and 6 , 12 and 18 months follow-up . Results The groups did not significantly differ in their overall work participation ( adjusted group difference=−1.9 , 95 % CI −19.9 to + 16.2 ) . However , those in TAU+OT did show greater improvement in depression symptoms ( −2.8 , −5.5 to −0.2 ) , an increased probability of long-term symptom remission ( + 18 % , + 7 % to + 30 % ) , and increased probability of long-term RTW in good health ( GH ) ( + 24 % , 12 % to 36 % ) . There were no significant group differences in the remaining secondary /intermediate outcomes . Conclusions In a highly impaired population , we could not demonstrate significant benefit of adjuvant OT for improving overall work participation . However , adjuvant OT did increase long-term depression recovery and long-term RTW in GH ( ie , full RTW while being remitted , and with better work and role functioning ) . Trial Registration Dutch Trial Register NTR2057 Abstract . Return to work ( RTW ) is the primary goal in the rehabilitation of patients with chronic low back pain . In spite of expensive rehabilitative efforts , many patients do not RTW . To increase cost effectiveness , predictive tests for non-RTW are needed to select patients for rehabilitation . The reliability of these tests must be high , to prevent exclusion of patients who might improve . This study evaluates the reliability and predictive validity of four tests and the following psychosocial factors for non-RTW : nationality , off-work duration , unemployment and work load . It was design ed as a prospect i ve cohort study of 99 patients with chronic low back pain . Upon entry , physical work load , time off work , unemployment and nationality were recorded . The study investigated four tests with an anticipated prognostic value for non-RTW : the  Numeric Pain Rating Scale ( NRS , 9–10 of a maximum of 10 ) , the  Step Test and Pseudo Strength Test ( precipitous cessation ) and  Behavioural Signs .  After 12 months , the RTW rate was obtained from the physicians responsible for sick-listing by postal survey . The response rate regarding RTW was 91 % at 1 year . The RTW rate at 1 year was 20 % . All investigated tests significantly correlated with non-RTW . Regression analysis showed that the best prediction of non-RTW was obtained when at least two out of the four tests were positive ( positive predictive value 0.97 , sensitivity 0.45 ) . Unemployment , time off work , nationality and physical work load were less predictive . The results show that the combination of the four prognostic tests allows a very reliable prognosis of non-RTW . The cost effectiveness of rehabilitation aim ing at RTW will , therefore , be increased by excluding patients with two or more positive tests Background Gastrointestinal ( GI ) cancer is frequently diagnosed in people of working age , and many GI cancer patients experience work-related problems . Although these patients often experience difficulties returning to work , supportive work-related interventions are lacking . We have therefore developed a tailored work-related support intervention for GI cancer patients , and we aim to evaluate its cost-effectiveness compared with the usual care provided . If this intervention proves effective , it can be implemented in practice to support GI cancer patients after diagnosis and to help them return to work . Methods / Design We design ed a multicentre r and omized controlled trial with a follow-up of twelve months . The study population ( N = 310 ) will include individuals aged 18–63 years diagnosed with a primary GI cancer and employed at the time of diagnosis . The participants will be r and omized to the intervention or to usual care . ‘ Usual care ’ is defined as psychosocial care in which work-related issues are not discussed . The intervention group will receive tailored work-related support consisting of three face-to-face meetings of approximately 30 min each . Based on the severity of their work-related problems , the intervention group will be divided into groups receiving three types of support ( A , B or C ) . A different supportive healthcare professional will be available for each group : an oncological nurse ( A ) , an oncological occupational physician ( B ) and a multidisciplinary team ( C ) that includes an oncological nurse , oncological occupational physician and treating oncologist/physician . The primary outcome measure is return to work ( RTW ) , defined as the time to a partial or full RTW . The secondary outcomes are work ability , work limitations , quality of life , and direct and indirect costs . Discussion The hypothesis is that tailored work-related support for GI cancer patients is more effective than usual care in terms of the RTW . The intervention is innovative in that it combines oncological and occupational care in a clinical setting , early in the cancer treatment process . Trial registration METC protocol number NL51444.018.14/Netherl and s Trial Register number NTR5022 . Registered 6 March 2015 Background To reduce the duration of sick leave and loss of productivity due to common mental disorders ( CMDs ) , we developed a return-to-work programme to be provided by occupational physicians ( OPs ) based on the principles of exposure in vivo ( RTW-E programme ) . This study evaluates this programme 's effectiveness and cost-effectiveness by comparing it with care as usual ( CAU ) . The three research questions we have are : 1 ) Is an RTW-E programme more effective in reducing the sick leave of employees with common mental disorders , compared with care as usual ? 2 ) Is an RTW-E programme more effective in reducing sick leave for employees with anxiety disorders compared with employees with other common mental disorders ? 3 ) From a societal perspective , is an RTW-E programme cost-effective compared with care as usual ? Methods / design This study was design ed as a pragmatic cluster-r and omized controlled trial with a one-year follow-up and r and omization on the level of OPs . We aim ed for 60 OPs in order to include 200 patients . Patients in the intervention group received the RTW-E programme .  Patients in the control group received care as usual .  Eligible patients had been on sick leave due to common mental disorders for at least two weeks and no longer than eight weeks . As primary outcome measures , we calculated the time until full return to work and the duration of sick leave . Secondary outcome measures were time until partial return to work , prevalence rate of sick leave at 3 , 6 , 9 , and 12 months ' follow-up , and scores of symptoms of distress , anxiety , depression , somatization , and fatigue ; work capacity ; perceived working conditions ; self-efficacy for return to work ; coping behaviour ; avoidance behaviour ; patient satisfaction ; and work adaptations . As process measures , we used indices of compliance with the intervention in the intervention group and employee-supervisor communication in both groups . Economic costs were calculated from a societal perspective . The total costs consisted of the costs of consuming health care , costs of production loss due to sick leave and reduced productivity , and out-of-pocket costs of patients for travelling to their OP . Discussion The results will be published in 2009 . The strengths and weaknesses of the study protocol are discussed . Trial registration IS RCT OBJECTIVES In case of long-term sick leave , gradually increasing workload appears to be an effective component of work-directed interventions to reduce sick leave due to common mental disorders ( CMD ) . CMD are defined as stress-related , adjustment , anxiety , or depressive disorders . We developed an exposure-based return-to-work ( RTW-E ) intervention and evaluated the effect on time-to-full return to work ( RTW ) among workers who were on sick leave due to CMD in comparison to those treated with care-as-usual ( CAU ) . CAU is guideline -directed and consists of problem-solving strategies and grade d activities . METHODS Using a two-armed cluster-r and omized trial , we r and omized 56 occupational physicians ( OP ) . Of these , 35 OP treated 160 workers at the start of their sick leave ; 75 workers received RTW-E and 85 workers received CAU .  These workers were followed over a 12-month follow-up period . The time-to-full RTW lasting ≥28 days without recurrence was the primary outcome measure . To evaluate differences between groups , we used intention-to-treat and multilevel Cox 's regression analysis . RESULTS The median time-to-full RTW differed significantly between groups [ hazard ratio ( HR ) 0.55 ; 95 % confidence interval ( 95 % CI ) 0.33 - 0.89 ] . The workers receiving RTW-E ( 209 days ; 95 % CI 62 - 256 ) had a prolonged time-to-full RTW compared to workers receiving CAU ( 153 days ; 95 % CI 128 - 178 ) . CONCLUSIONS Workers on sick leave due to CMD treated with RTW-E showed a prolonged time-to-full RTW compared to those treated with CAU . We recommend that OP do not apply RTW-E but continue counseling workers on sick leave due to CMD according to CAU 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 r and omly allocated to the participatory return-to-work program ( n = 79 ) or to usual care ( n = 84 ) . The new program is a stepwise procedure aim ed 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 result ed 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 Purpose Evidence -based guidelines in occupational health care improve the quality of care and may reduce sickness absence duration . Notwithst and ing that , guideline adherence of occupational physicians ( OPs ) is limited . Based on the literature on guideline implementation , an intervention was developed that was shown to effectively improve self-reported adherence in OPs . The aim of present study was to evaluate whether this intervention leads to earlier return to work ( RTW ) in workers with common mental disorders ( CMD ) . Methods In a two-armed cluster r and omized controlled trial , 66 OPs were r and omized . The trial included 3379 workers , with 1493 in the intervention group and 1886 in the control group . The outcome measures were : time to full RTW , time to first RTW , and total hours of sickness absence . Cox regression analyses and generalized linear mixed model analyses were used for the evaluations . Results The median time to RTW was 154 days among the 3228 workers with CMD . No significant differences occurred in ( time to ) full RTW between intervention and control group HR 0.96 ( 95 % CI 0.81–1.15 ) nor for first RTW HR 0.96 ( 95 % CI 0.80–1.15 ) . The mean total hours of sickness absence was 478 h in the intervention group and 483 h in the control group . Conclusions The intervention to enhance OPs ’ guideline adherence did not lead to earlier RTW in workers with CMD guided by the OPs . Possible explanations are the remaining external barriers for guideline use , and that perceived guideline adherence might not represent actual guideline adherence and improved care . Trail registration : IS RCT N86605310 Purpose . The main aim of this study was to describe the thoughts and feelings of future working life related to return to work ( RTW ) in sick-listed persons due to musculoskeletal disorders ( MSD ) . Further aim was to compare these descriptions with the person 's actual working situation 1 , 5 and 10 years after a rehabilitation period . Methods . This study consisted of two parts . The first part had an explorative design , and qualitative content analysis was chosen in order to analyse the response to an open question regarding future working life answered before , persons sick-listed due to MSD ( n = = 320 ) , took part in a rehabilitation programme 10 years ago . The second part had a prospect i ve design and quantitative analysis was used to compare the results of the qualitative analysis with RTW and the working situation 1 , 5 and 10 years after baseline . Results . Three categories emerged from the data with a total of nine subcategories . In the categories Motivation and optimism and Limitations to overcome , there were significantly more persons who had RTW 1 year after baseline when compared with the category Hindrance and hesitation . There were also some significant differences between the subcategories . Conclusions . The question , regarding thoughts and feelings of future working life , may be a simple screening method to predict RTW in persons sick-listed with MSD . This will guide the rehabilitation team to adjust the rehabilitation to each person 's needs and facilitating RTW BACKGROUND Sickness absence due to mental health problems ( MHPs ) is increasing in several European countries . However , little is known about return to work ( RTW ) for employees with MHPs . This prospect i ve study aim ed to identify predictors for RTW in employees sick-listed with MHPs . METHODS Employees were recruited when applying for sickness benefit due to MHPs from the Municipality of Copenhagen ( n = 644 ) . Information about age , gender , occupation , self-reported RTW expectancy , self-reported reason for absence and prior absence with MHPs was retrieved from application forms for sickness benefit . Each participant was followed-up in the National Register for Social Transfer Payments for a maximum period of 52 weeks to estimate time to RTW . Hazard ratios for RTW with 95 % confidence intervals were calculated using Cox proportional regression analyses . RESULTS Employees sick-listed with self-reported stress/burnout  returned to work faster than those with self-reported depression ( HR = 0.76 ) , and other MHPs ( HR = 0.56 ) . A positive RTW expectancy of the sick-listed person ( HR = 1.27 ) and no prior absence with MHPs ( HR = 1.29 ) were associated with a shorter time to RTW . CONCLUSION Sickness absence due to self-reported stress/burnout , a positive RTW expectancy and no prior absence with MHPs predicted a shorter time to RTW among Danish employees sick listed with MHPs . Findings could help social insurance officers and other rehabilitation professionals to identify groups at high risk for prolonged absence Background Cancer survivors are often left on their own to deal with the challenges of resuming work during or after cancer treatment , mainly due to unclear agreements between stakeholders responsible for occupational rehabilitation . Social ine quality exists in cancer risk , survival probability and continues with regard to the chance of being able to return to work . The aim is to apply an early , individually tailored occupational rehabilitation intervention to cancer survivors in two municipalities parallel with cancer treatment focusing on enhancing readiness for return to work . Methods / Design In a controlled trial municipal job consultants use acceptance and commitment therapy dialogue and individual-placement- and -support-inspired tools with cancer survivors to engage them in behaviour changes toward readiness for return to work . The workplace is involved in the return to work process . Patients referred to surgery , radiotherapy or chemotherapy at the Oncology Department , Aarhus University Hospital , Denmark for the diagnoses ; breast , colon-rectal , head and neck , thyroid gl and , testicular , ovarian or cervix cancer are eligible for the study . Patients must be residents in the municipalities of Silkeborg or R and ers , 18–60 years of age and have a permanent or temporary employment ( with at least 6 months left of their contract ) at inclusion . Patients , for whom the treating physician considers occupational rehabilitation to be unethical , or who are not reading or talking Danish are excluded . The  control group  has identical inclusion and exclusion criteria except for municipality of residence . Return to work is the primary outcome and is indentified in a social transfer payment register . Effect is assessed as relative cumulative incidences within 52 weeks and will be analysed in generalised linear regression models using the pseudo values method . As a secondary outcome ; co-morbidity and socio-economic status is analysed as effect modifiers of the intervention effect on return to work . Discussion The innovative element of this intervention is the timing of the occupational rehabilitation which is much earlier initiated than usual and the active involvement of the workplace . We anticipate that vulnerable cancer survivors will benefit from this approach and reduce the effects of social ine quality on workability . Trial registration Current Controlled Trials IS RCT N50753764 . Registered August 21st , 2014 Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 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 grade d activity as part of a multistage RTW programme . Design : R and omised controlled trial . Setting : Occupational healthcare . Subjects : 112 workers absent from work for more than eight weeks due to low back pain were r and omised to either grade d activity ( n = 55 ) or usual care ( n = 57 ) . Intervention : Grade d activity , a physical exercise programme aim ed 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 : Grade d 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 grade d 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 grade d activity , together with a delay in the start of the grade d 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 ) . Grade d activity did not improve pain or functional status clinical ly significantly . Conclusions : Grade d activity was not effective for any of the outcome measures . Different interventions combined can lead to a delay in RTW . Delay in referral to grade d activity delays RTW . In implementing grade d activity special attention should be paid to the structure and process of care Background Major depressive disorder ( MDD ) has major consequences for both patients and society , particularly in terms of needlessly long sick leave and reduced functioning . Although evidence -based treatments for MDD are available , they show disappointing results when implemented in daily practice . A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners ( GPs ) and other health care professionals with occupational physicians ( OPs ) . The OP may play a more important role in the recovery of patients with MDD . Purpose of the present study is to tackle these obstacles by applying a collaborative care model , which has proven to be effective in the USA , with a focus on return to work ( RTW ) . From a societal perspective , the (cost)effectiveness of this collaborative care treatment , as a way of transmural care , will be evaluated in depressed patients on sick leave in the occupational health setting . Methods / Design A r and omised controlled trial in which the treatment of MDD in the occupational health setting will be evaluated in the Netherl and s. A transmural collaborative care model , including Problem Solving Treatment ( PST ) , a workplace intervention , antidepressant medication and manual guided self-help will be compared with care as usual ( CAU ) .  126 Patients with MDD on sick leave between 4 and 12 weeks will be included in the study .  Care in the intervention group will be provided by a multidisciplinary team of a trained OP-care manager and a consultant psychiatrist . The treatment is separated from the sickness certification . Data will be collected by means of question naires at baseline and at 3 , 6 , 9 and 12 months after baseline . Primary outcome measure is reduction of depressive symptoms , secondary outcome measure is time to RTW , tertiary outcome measure is the cost effectiveness . Discussion The high burden of MDD and the high level of sickness absence among people with MDD contribute to the relevance of this study . The intervention is an innovative approach , with trained OPs in a new role as care managers in the treatment of MDD . If this intervention proves to be cost-effective , implementation will be very relevant for individual patients as well as for society . Trial registration IS RCT Background Multidisciplinary intervention is recommended for rehabilitation of employees sick-listed for 4 - 12 weeks due to low back pain ( LBP ) . However , comparison of a brief and a multidisciplinary intervention in a r and omised comparative trial of sick-listed employees showed similar return to work ( RTW ) rates in the two groups . The aim of the present study was to identify subgroups , primarily defined by work-related baseline factors that would benefit more from the multidisciplinary intervention than from the brief intervention . Methods A total of 351 employees sick-listed for 3 - 16 weeks due to LBP were recruited from their general practitioners . They received a brief or a multidisciplinary intervention . Both interventions comprised clinical examination and advice by a rehabilitation doctor and a physiotherapist . The multidisciplinary intervention also comprised assignment of a case manager , who made a rehabilitation plan in collaboration with the patient and a multidisciplinary team . Using data from a national data base , we defined RTW as no sickness compensation benefit disbursement for four consecutive weeks within the first year after the intervention . At the first interview in the clinic , it was ensured that sick leave was primarily due to low back problems . Question naires were used to obtain data on health , disability , demographic and workplace-related factors . Cox hazard regression analyses were used with RTW as outcome measure and hazard rate ratios ( HRR = HRmultidisciplinary/HRbrief ) were adjusted for demographic and health-related variables . An interaction term consisting of a baseline variable*intervention group was added to the multivariable regression model to analyse whether the effects of the interventions were moderated by the baseline factor . Subsequently , a new study was performed that included 120 patients who followed the same protocol . This group was analyzed in the same way to verify the findings from the original study group . Results The multidisciplinary intervention group ensured a quicker RTW than the brief intervention group in a subgroup with low job satisfaction , notably when cl aim ants were excluded . The opposite effect was seen in the subgroup with high job satisfaction . When cl aim ants were excluded , the effect was also in favour of the multidisciplinary intervention in subgroups characterised by no influence on work planning and groups at risk of losing their job . Inversely , the effect was in favour of the brief intervention in the subgroups who were able to influence the planning of their work and who had no risk of losing their job due to current sick leave . Interaction analysis of the data in the new study displayed similar or even more pronounced differences between subgroups in relation to intervention type . Conclusions Multidisciplinary intervention seemed more  effective than brief intervention in subgroups of patients with low job satisfaction , no influence on work planning and feeling at risk of losing their jobs due to their sick leave as compared with subgroups not fulfilling these criteria
Results show systematic review ing of OTIs on RTW was challenging due to varying population s , different outcome measures , and poor descriptions of methodology .
There is evidence that OTIs as part of rehabilitation programs , increase RTW rates , although the method ological evidence of most studies is weak .
Background The primary aim of this review study was to gather evidence on the effectiveness in terms of return to work ( RTW ) of occupational therapy interventions ( OTIs ) in rehabilitation patients with non-congenital disorders .
A secondary aim was to be able to select the most efficient OTI .