Effects of a randomized controlled intervention trial on return to work and health care utilization after long-term sickness absence

Abstract

BackgroundThe aim of the RCT study was to investigate if the effect of a multidisciplinary intervention on return to work (RTW) and health care utilization differed by participants’ self-reported health status at baseline, defined by a) level of somatic symptoms, b) health anxiety and c) self-reported general health.MethodsA total of 443 individuals were randomized to the intervention (n = 301) or the control group (n = 142) and responded to a questionnaire measuring health status at baseline. Participants were followed in registries measuring RTW and health care utilization. Relative risk (RR) and odds ratio (OR) were used as measures of associations. Results were adjusted for gender, age, educational level, work ability and previous sick leave.ResultsAmong all responders we found no effect of the intervention on RTW. Among participants with low health anxiety, the one-year probability of RTW was lower in the intervention than in the control group (RR = 0.79 95 % CI 0.68-0.93), but for those with high health anxiety there was no difference between the groups (RR = 1.15 95 % CI 0.84-1.57). Neither general health nor somatic symptoms modified the effect of the intervention on RTW. The intervention had no effect on health care utilization.ConclusionsThe multidisciplinary intervention did not facilitate RTW or decrease health care utilization compared to ordinary case management in subgroups with multiple somatic symptoms, health anxiety or low self-rated health. However, the intervention resulted in a reduced chance of RTW among participants with low health anxiety levels.Trial registration ISRCTN43004323, and ISRCTN51445682

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.…”

“…Anema et al [26] found a positive effect of workplace intervention in subjects with low back pain but no effect of graded activity. The Danish return-to-work programme [27] found that a multidisciplinary intervention did not facilitate return to work or decrease health care utilisation as compared to ordinary case management in patients with somatic symptoms, anxiety or low self-rated health. Suoyrjö et al [21] found that during 7 years of follow-up, the intervention group had more sick leave days than the controls, as in the present study.…”

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

“…Anema et al [26] found a positive effect of workplace intervention in subjects with low back pain but no effect of graded activity. The Danish return-to-work programme [27] found that a multidisciplinary intervention did not facilitate return to work or decrease health care utilisation as compared to ordinary case management in patients with somatic symptoms, anxiety or low self-rated health.…”

Primary care physicians’ concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden

“…The review revealed that the time to RTW, cumulative sickness absence, the proportion of RTW at short-term follow-up or ever did not differ from care as usual. In a more recent randomized controlled study a multidisciplinary intervention did not facilitate RTW or decrease health care utilization compared to ordinary case management and could even reduce the chance of RTW in some patients [27].…”