Effect of Inpatient Multicomponent Occupational Rehabilitation Versus Less Comprehensive Outpatient Rehabilitation on Sickness Absence in Persons with Musculoskeletal- or Mental Health Disorders: A Randomized Clinical Trial
Effect of Inpatient Multicomponent Occupational Rehabilitation Versus Less Comprehensive Outpatient Rehabilitation on Sickness Absence in Persons with Musculoskeletal- or Mental Health Disorders: A Randomized Clinical Trial
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DOI：
10.1007/s10926-017-9708-z
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发表时间：
2018-03-01
影响因子：
3.3
通讯作者：
Fimland, Marius Steiro
中科院分区：
文献类型：
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作者：
Aasdahl, Lene;Pape, Kristine;Fimland, Marius Steiro
目的：评估与不太全面的门诊康复相比，住院多组分职业康复计划对肌肉骨骼或精神健康障碍患者因病缺勤的影响。方法采用随机、平行对照的临床试验。参加者是18-60岁的个人，请病假2-12个月，病假诊断符合国家登记册中确定的《国际预防犯罪公约第二版》肌肉骨骼、心理或一般和未具体说明的章节。住院计划（4 + 4天）包括接受和承诺疗法（ACT）、体能训练和解决工作相关问题，包括制定重返工作计划和工作场所访视（如果认为相关）。门诊计划主要包括ACT（6周内6次）。这两个方案都是以小组为基础的。主要结局为6个月和12个月随访时累计病假天数。次要结局是持续重返工作岗位的时间。结果168例患者随机分为住院组（n = 92）和门诊组（n = 76）。我们发现，在6个月和12个月的随访中，两个项目之间的病假天数中位数没有统计学显著差异。在门诊计划中，57%的参与者实现了可持续的恢复工作（中位时间7个月），在住院计划中，49%（对数秩，p = 0.167）。可持续恢复工作的风险比为0.74（95% CI 0.48-1.32，p = 0.165），有利于门诊计划。结论这项研究没有提供更全面的4 + 4天住院多组分职业康复计划减少病假相比，门诊康复计划的支持。
Purpose To assess effects of an inpatient multicomponent occupational rehabilitation program compared to less comprehensive outpatient rehabilitation on sickness absence in persons with musculoskeletal- or mental health disorders. Methods Randomized clinical trial with parallel groups. Participants were individuals 18-60 years old on sick-leave for 2-12 months with a sick-leave diagnosis within the musculoskeletal, psychological or general and unspecified chapters of ICPC-2, identified in a national register. The inpatient program (4 + 4 days) consisted of Acceptance and Commitment Therapy (ACT), physical training and work-related problem-solving including creating a return to work plan and a workplace visit if considered relevant. The outpatient program consisted primarily of ACT (6 sessions during 6 weeks). Both programs were group based. Primary outcome was cumulated number of sickness absence days at 6 and 12 months follow-up. Secondary outcome was time until sustainable return to work. Results 168 individuals were randomized to the inpatient program (n = 92) or the outpatient program (n = 76). We found no statistically significant difference between the programs in median number of sickness absence days at 6 and 12 months follow-up. In the outpatient program 57% of the participants achieved sustainable return to work (median time 7 months), in the inpatient program 49% (log rank, p = 0.167). The hazard ratio for sustainable return to work was 0.74 (95% CI 0.48-1.32, p = 0.165), in favor of the outpatient program. Conclusions This study provided no support that the more comprehensive 4 + 4 days inpatient multicomponent occupational rehabilitation program reduced sickness absence compared to the outpatient rehabilitation program.