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Lyby PS, Johansen T, Aslaksen PM. Comparison of Two Multidisciplinary Occupational Rehabilitation Programs Based on Multimodal Cognitive Behavior Therapy on Self-Rated Health and Work Ability. Front Psychol 2021; 12:669770. [PMID: 34497553 PMCID: PMC8419222 DOI: 10.3389/fpsyg.2021.669770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: Musculoskeletal pain and common mental disorders constitute the largest proportion of people who are on sick leave. This study investigated the efficacy of two multidisciplinary occupational rehabilitation programs on self-rated health and work-related outcomes. The interventions were identical in content but differed in length. It was hypothesized that a longer inpatient program would yield greater improvements than a shorter outpatient program. Methods: Patients were sick-listed workers referred to occupational rehabilitation by the Norwegian Labor and Welfare Administration. A non-randomized 2 Condition (20 days, n = 64 versus 12 days, n = 62) × 4 repeated measures (start, end, 3 months, 12 months) between-subject design was used. Both programs were based on multimodal cognitive behavior therapy with a return-to-work focus. Health-related questionnaires were the Subjective Health Complaints inventory, Hospital Anxiety and Depression Scale, and SF-36 Bodily Pain. Work-related questionnaires were the Work Ability Index, the Fear-Avoidance Beliefs Questionnaire, Return To Work Self-Efficacy, and Return To Work expectations. Intervention effects were estimated using linear mixed models and Cohen’s d. Results: The results revealed that both groups improved on the selected outcomes. Within-group contrasts and effect sizes showed that the inpatient group showed larger effect sizes at the end of rehabilitation and 12 months post-intervention for work-related outcomes than the outpatient group. Conclusion: Both programs were efficacious in improving health- and work-related outcomes during and after rehabilitation, but the inpatient group generally displayed stronger and more rapid improvements and was more stable at one-year postintervention.
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Affiliation(s)
| | - Thomas Johansen
- Norwegian National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
| | - Per M Aslaksen
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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Johansen T, Øyeflaten I, Eriksen HR, Lyby PS, Dittrich WH, Holsen I, Jakobsen H, Del Risco Kollerud R, Jensen C. Sustained Attention and Working Memory Predict the Number of Days on Health-Related Benefits in the Year Following Occupational Rehabilitation. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:592-603. [PMID: 33471320 PMCID: PMC8298247 DOI: 10.1007/s10926-020-09944-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
Purpose The objective of this study was to investigate the association between cognitive and emotional functioning and the number of days on health-related benefits such as sick leave, work assessment allowance and disability pension. We investigated whether cognitive and emotional functioning at the start of rehabilitation and the change from the start to the end of rehabilitation predicted the number of days on health-related benefits in the year after occupational rehabilitation. Methods A sample of 317 individuals (age 19-67 years), mainly diagnosed with a musculoskeletal or mental and behavioural ICD-10 disorder, participated. The sample was stratified depending on the benefit status in the year before rehabilitation. Those receiving health-related benefits for the full year comprised the work assessment allowance and disability pension (WAA) group and those receiving benefits for less than a year comprised the sick leave (SL) group. The participants were administered cognitive and emotional computerised tests and work and health questionnaires at the beginning and end of rehabilitation. The cumulative number of days on health-related benefits during 12 months after rehabilitation was the primary outcome variable and age, gender, educational level, subjective health complaints, anxiety, and depression were controlled for in multiple regression analyses. Results The WAA group (n = 179) was significantly impaired at baseline compared to the SL group (n = 135) in focused attention and executive function, and they also scored worse on work and health related variables. Higher baseline scores and change scores from the start to the end of rehabilitation, for sustained attention, were associated with fewer number of health-related benefit days in the WAA group, while higher baseline scores for working memory were associated with fewer number of health-related benefit days in the SL group. Conclusions New knowledge about attention and memory and return to work in individuals with different benefit status may pave the way for more targeted programme interventions. Rehabilitation programmes could benefit from designing interventions that respectively improve sustain attention and working memory related to working life in individuals on sick leave or work assessment allowance and disability pension.
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Affiliation(s)
- Thomas Johansen
- Norwegian National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864, Rauland, Norway.
| | - Irene Øyeflaten
- Norwegian National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864, Rauland, Norway
- NORCE, Norwegian Research Centre, Bergen, Norway
| | - Hege R Eriksen
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Winand H Dittrich
- FOM Hochschule, KCI Competence Center for Behavioral Economics, Frankfurt, Germany
| | - Inge Holsen
- Red Cross Haugland Rehabilitation Center, Flekke, Norway
| | | | - Ruby Del Risco Kollerud
- Norwegian National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864, Rauland, Norway
| | - Chris Jensen
- Norwegian National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864, Rauland, Norway
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Linge AD, Jensen C, Laake P, Bjørkly SK. Changes to body mass index, work self-efficacy, health-related quality of life, and work participation in people with obesity after vocational rehabilitation: a prospective observational study. BMC Public Health 2021; 21:936. [PMID: 34001067 PMCID: PMC8130265 DOI: 10.1186/s12889-021-10954-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People on or at risk of sick leave from work due to obesity or obesity-related problems participated in a new vocational rehabilitation (VR). The study aimed to examine the outcome changes in the participants' health-related quality of life (HRQoL), body mass index (BMI), return to work self-efficacy (RTWSE), work ability scale (WAS) and degree of work participation (DWP) after their participation in the 12-month VR programme. The secondary aim was to examine associations between the outcome changes and HRQoL at 12-month follow-up, measured with the HRQoL 15D instrument (15D). METHODS This prospective observational study included 95 participants. The one-year multidisciplinary VR programme with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by 5 meetings. A paired sample t-test was used to examine changes in HRQoL, BMI, RTWSE, WAS, and DWP between baseline and the 12-month follow-up. Multiple linear regression analyses explored associations between changes in HRQoL and the outcome variables. RESULTS The participants achieved statistically significant changes in HRQoL (2.57, 95% CI: 1.35 to 3.79), BMI (- 2.33, 95% CI: - 3.10 to - 1.56), RTWSE (15.89, 95% CI: 4.07 to 27.71), WAS (1.51, 95% CI: 0.83 to 2.20) and DWP (18.69, 95% CI: 8.35 to 29.02). At 12 months, a significant association was found between HRQoL and BMI (B = - 0.34, 95% CI: - 0.65 to - 0.04), RTWSE (B = 0.02, 95% CI: 0.004 to 0.04), WAS (B = 0.91, 95% CI: 0.55 to 1.28), DWP (B = - 0.02, 95% CI: - 0.04 to 0.001) and work absence (B = - 0.01, 95% CI: - 0.02 to - 0.002). The regression model explained 71.8% of the HRQoL variance. CONCLUSION The results indicated positive changes in HRQoL, BMI, RTWSE, WAS and DWP from baseline to the 12-month follow-up. Factors associated with HRQoL at the 12-month follow-up were decreased BMI, increased RTWSE, improved WAS and reduced work absence. Future studies examining VR programmes with lifestyle interventions for people with obesity are recommended. TRIAL REGISTRATION Norwegian Regional Committee for Medical and Health Research Ethics (REC) 2017/573, Clinical Trials NCT03286374 , registered 18. September 2017. https://clinicaltrials.gov/ct2/results?cond=Obesity&term=Anita+Dyb+Linge&cntry=NO&state=&city=&dist=.
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Affiliation(s)
- Anita Dyb Linge
- Institute of Social Sciences, Volda University College, Mailbox 500, 6101, Volda, Norway.
| | - Chris Jensen
- Norwegian National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864, Rauland, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Håkon Jarls gate 11 and Mauritz Hanssens Gate 2, 7491, Trondheim, Norway
| | - Petter Laake
- Faculty of Health Sciences and Social Care, Molde University College, Britvegen 2, 6410, Molde, Norway
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Sognsvannsveien 9, 0372, Oslo, Norway
| | - Stål Kapstø Bjørkly
- Faculty of Health Sciences and Social Care, Molde University College, Britvegen 2, 6410, Molde, Norway
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Eftedal M, Tveito TH, Gensby U, Islam MK, Lie SA, Aasland G, Kostveit S, Jensen C. Comparing two interdisciplinary occupational rehabilitation programs for employees on sick leave: a mixed-method design study protocol. BMC Musculoskelet Disord 2021; 22:158. [PMID: 33563250 PMCID: PMC7871619 DOI: 10.1186/s12891-021-03994-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/19/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) and common mental disorders (CMDs) are the most frequent reasons for long-term sick leave and work disability. Occupational rehabilitation programs are used to help employees return to work (RTW). However, knowledge regarding the effect of these programs is scarce, and even less is known about which programs are best suited for which patients. This study aims to compare the RTW results of two interdisciplinary occupational rehabilitation programs in Norway, as well as to examine the delivery and reception of the two programs and explore the active mechanisms of the participants' RTW processes. METHODS/DESIGN We will use a mixed-method convergent design to study the main outcome. Approximately 600 participants will be included in the study. Eligible study participants will be aged 18-60 years old and have been on sick leave due to MSDs, CMDs, or both for at least 6 weeks. Interdisciplinary teams at both participating clinics will deliver complex occupational rehabilitation programs. The inpatient rehabilitation program has a duration of 4 weeks and is full time. The outpatient program has a duration of 3 months and involves weekly sessions. The primary outcome is RTW. Secondary outcomes are differences in the incremental cost for an averted sick leave day, cost utility/benefit, and differences between the programs regarding improvements in known modifiable obstacles to RTW. Subgroup analyses are planned. The researchers will be blinded to the intervention groups when analyzing the quantitative RTW data. DISCUSSION This study aims to provide new insights regarding occupational rehabilitation interventions, treatment targets, and outcomes for different subgroups of sick-listed employees and to inform discussions on the active working mechanisms of occupational rehabilitation and the influence of context in the return-to-work process. TRIAL REGISTRATION Current controlled trials ISRCTN12033424 , 15.10.2014, retrospectively registered.
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Affiliation(s)
- Monica Eftedal
- National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864 Rauland, Norway
| | - Torill H. Tveito
- NORCE Norwegian Research Centre, Bergen, Norway
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Horten, Norway
| | - Ulrik Gensby
- National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864 Rauland, Norway
- Team Working Life Aps, Copenhagen, Denmark
- Adjunct Scientist, Institute for Work and Health, Toronto, Canada
| | - M. Kamrul Islam
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Gro Aasland
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Chris Jensen
- National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864 Rauland, Norway
- NORCE Norwegian Research Centre, Bergen, Norway
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Linge AD, Jensen C, Laake P, Bjørkly SK. Lifestyle and Work-Related Factors Associated with Work Ability and Work Participation for People with Obesity: A Prospective Observational Study After Vocational Rehabilitation. Diabetes Metab Syndr Obes 2021; 14:2943-2954. [PMID: 34234492 PMCID: PMC8254537 DOI: 10.2147/dmso.s311462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We aimed to investigate which changes in the explanatory factors that were associated with positive change in the work ability score (WAS) and degree of work participation (DWP) for participants in a new 1-year vocational rehabilitation (VR) program for people on or at risk of sick leave due to obesity or obesity-related problems. PATIENTS AND METHODS This prospective observational study included 95 participants with a body mass index (BMI) above 30 kg/m2. The 1-year multidisciplinary VR program with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by five meetings. Differences between baseline and 12-month follow-up data were analyzed for the change in explanatory variables WAS, DWP, health-related quality of life (HRQoL), BMI, and return-to-work self-efficacy (RTWSE). The primary outcome was measured by multiple linear regression for predicting WAS and DWP. RESULTS We found significant changes in WAS (1.51, 95% CI: 0.83 to 2.20, p<0.001), DWP (18.69, 95% CI: 8.35 to 29.02, p<0.001), HRQoL (2.57, 95% CI: 1.35 to 3.79, p<0.001), BMI (-2.33, 95% CI: -3.10 to -1.56, p<0.001), and in RTWSE (15.89, 95% CI: 4.07 to 27.71, p = 0.009). Regression analysis yielded a strong association between WAS at 12-month follow-up with an increase in HRQoL (β=0.27, 95% CI: 0.16 to 0.38, p<0.001) and WAS baseline (β=0.49, 95% CI: 0.28 to 0.71, p<0.001). Further, regression analysis demonstrated a strong association between DWP at 12-month follow-up with return-to-work expectancy (RTWEXP) (β=-10.62, 95% CI: -15.25 to -6.03, p<0.001). CONCLUSION The results indicate positive changes in WAS, DWP, HRQoL, BMI, and RTWSE from baseline to 12-month follow-up. For people with BMI above 30 kg/m2, changes in HRQoL are important for an increase in WAS, and a high RTWEXP is essential to achieve work participation. Future studies examining VR programs with lifestyle interventions for people with obesity are recommended.
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Affiliation(s)
- Anita Dyb Linge
- Faculty of Social Science and History, Institute of Social Science, Volda University College, Volda, Norway
- Correspondence: Anita Dyb Linge Faculty of Social Science and History, Institute of Social Science, Volda University College, Postboks 500, 6101 Volda, Volda, NorwayTel +47 988 73 835 Email
| | - Chris Jensen
- Norwegian National Advisory Unit on Occupational Rehabilitation, Rauland, Norway and Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Petter Laake
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway and Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Stål Kapstø Bjørkly
- Faculty of Health Science and Social Care, Molde University College, Molde, Norway
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Johansen T, Jensen C, Eriksen HR, Lyby PS, Dittrich WH, Holsen IN, Jakobsen H, Øyeflaten I. Occupational Rehabilitation Is Associated With Improvements in Cognitive Functioning. Front Psychol 2019; 10:2233. [PMID: 31649584 PMCID: PMC6795755 DOI: 10.3389/fpsyg.2019.02233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/17/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Occupational rehabilitation may be offered to workers on long-term sick leave who often report problems with cognitive functioning, anxiety, depression, pain, and reduced work ability. The empirical knowledge is sparce on how occupational rehabilitation may influence cognitive and emotional functioning and patients have not previously been subjected to comprehensive objective testing. The main aim of this study was to assess possible changes in cognitive and emotional functioning such as memory, attention, executive function, and emotion recognition among patients in occupational rehabilitation. Methods A large sample of 280 sick-listed workers referred to inpatient and outpatient occupational rehabilitation was recruited. The rehabilitation programs had a mean duration of 28 days and comprised physical activity, cognitive behavior treatment components and collaboration with the workplace. A pre-post design was applied to investigate possible changes in cognitive and emotional functioning (primary outcomes) and work and health measures (secondary outcomes), comparing the rehabilitation group with a control group of 70 healthy workers. Individuals in the control group were tested at random time points with an approximately 28 day interval between pre- and post-test, thus coinciding with the duration of rehabilitation. Repeated measures analysis of variance was used for the main analyses. Results Compared to the control group, the rehabilitation group had greater gains from pre- to post-test in focused and sustained attention, as well as greater improvements in work ability and reduction in subjective health complaints (SHC), helplessness, pain, pain related to work, anxiety, and depression. In the rehabilitation group, exploratory correlational analysis indicated that improvements in focused and sustained attention were associated with improvements in return-to-work self-efficacy, work ability as well as a reduction in SHC. Conclusion The sick-listed workers improved in focused and sustained attention and work and health measures after participating in occupational rehabilitation. This study is one of the first to systematically investigate changes in cognitive and emotional functioning during occupational rehabilitation. Clinical practice should benefit from increased knowledge about all cognitive functions and should be specifically aware of the improvements in focused and sustained attention, while memory, executive function and emotion recognition remained unchanged. The results can be used as a motivation to tailor specific interventions to gain further improvements in all cognitive and emotional functions.
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Affiliation(s)
- Thomas Johansen
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
| | - Chris Jensen
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hege R Eriksen
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Winand H Dittrich
- FOM Hochschule, KCI Competence Center for Behavioral Economics, Frankfurt, Germany
| | - Inge N Holsen
- Red Cross Haugland Rehabilitation Center, Flekke, Norway
| | | | - Irene Øyeflaten
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway.,Norwegian Research Centre, Bergen, Norway
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