Early multidisciplinary assessment was associated with longer periods of sick leave: A randomized controlled trial in a primary health care centre

Abstract

ObjectiveTo study the effects on sick leave from an early multidisciplinary assessment at a primary health care centre.DesignRandomized controlled trial.SettingPatients who saw GPs at a primary health care centre in mid-Sweden and asked for a sickness certificate for psychiatric or musculoskeletal diagnoses were invited to participate. Patients included were sick-listed for less than four weeks; 33 patients were randomized either to an assessment within a week by a physiotherapist, a psychotherapist, and an occupational therapist or to “standard care”. The therapists used methods and tools they normally use in their clinical work.Main outcome measureProportion of patients still sick-listed three months after randomization, total and net days on sick leave, and proportion who were on part-time sick leave.ResultsAt follow-up after three months, in contrast to the pre-trial hypothesis, there was a trend toward a higher proportion of patients still sick-listed in the intervention group (7/18) as compared with the control group (3/15). The intervention group also had significantly longer sick-listing periods (mean 58 days) than the control group (mean 36 days) (p = 0.038). The proportion of patients who were part time sick-listed was significantly higher in the intervention group (10/18) than in the control group (2/15) (p = 0.027).ConclusionsIn this study an early multidisciplinary assessment was associated with longer periods on sick leave and more individuals on part-time sick leave.

Effects of a vocational rehabilitation programme on return to work among sick-listed primary health care patients: a population-based matched, case-control study

“…A further limitation might be that the analyses and results are based on data collected in 2004-2007. However, despite changes in business cycles, and financial initiatives from the Swedish government to improve rehabilitation and sick leave management promoting return to work, the results from recent rehabilitation and vocational intervention studies show results similar to the present one [16,24,25,27,28].…”

“…However, several previous studies, with interventions similar to the present one, have evaluated the effects of rehabilitation on sick leave conclusion in sickness-certified patients. We found six randomised controlled trials (RCT) [16,[23][24][25][26][27], one study with a matched two-cohort design [21], and one review [28]. Johansson et al [16] concluded that the intervention prolonged sickness absence spells, as we did.…”

“…We found no effect of prognosis (measured as propensity score). Carlsson et al [24] and Jensen et al [25] found no significant difference between the intervention and control groups. Anema et al [26] found a positive effect of workplace intervention in subjects with low back pain but no effect of graded activity.…”

“…However, this recommendation does not appear to be supported by scientific evidence. As pointed out by Johansson et al [16] and Carlsson et al [24] the rehabilitation team may focus more on rehabilitation than on encouraging the sick-listed individual to return to work, and the early intervention programme may therefore have a locking-in effect, i.e., actually preventing the sicklisted from concluding sick leave and returning to work. The results from the present study may be due to such an effect.…”

Effects of a vocational rehabilitation programme on return to work among sick-listed primary health care patients A population-based matched, case-control study

“…We found no effect of prognosis (measured as propensity score). Carlsson et al [24] and Jensen et al [25] found no significant difference between the intervention and control groups.…”