Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial
DOI:
https://doi.org/10.2340/jrm.v56.18385Keywords:
Occupational therapy, work, pain intensity, chronic pain, mental health, sick leaveAbstract
Objective: Studies suggest that symptom reduction is not necessary for improved return-to-work after occupational rehabilitation programmes. This secondary analysis of a randomized controlled trial examined whether pain intensity and mental distress mediate the effect of an inpatient programme on sustainable return-to-work.
Methods: The randomized controlled trial compared inpatient multimodal occupational rehabilitation (n = 82) with outpatient acceptance and commitment therapy (n = 79) in patients sick-listed due to musculoskeletal and mental health complaints. Pain and mental distress were measured at the end of each programme, and patients were followed up on sick-leave for 12 months. Cox regression with an inverse odds weighted approach was used to assess causal mediation.
Results: The total effect on return-to-work was in favour of the inpatient programme compared with the control (hazard ratio (HR) 1.96; 95% confidence interval (95% CI) 1.15–3.35). There was no evidence of mediation by pain intensity (indirect effect HR, 0.98; 95% CI, 0.61–1.57, direct effect HR, 2.00; 95% CI, 1.02–3.90), but mental distress had a weak suppression effect (indirect effect HR, 0.89; 95% CI, 0.59–1.36, direct effect HR, 2.19; 95% CI, 1.13–4.26).
Conclusion: These data suggest that symptom reduction is not necessary for sustainable return-to-work after an inpatient multimodal occupational rehabilitation intervention.
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References
Loisel P, Durand MJ, Berthelette D, Vezina N, Baril R, Gagnon D, et al. Disability prevention: new paradigm for the management of occupational back pain. Dis Manag Health Out 2001; 9: 351-360.
https://doi.org/10.2165/00115677-200109070-00001 DOI: https://doi.org/10.2165/00115677-200109070-00001
Cullen KL, Irvin E, Collie A, Clay F, Gensby U, Jennings PA, et al. Effectiveness of Workplace interventions in return-to-work for musculoskeletal, pain-related and mental health conditions: an update of the evidence and messages for practitioners. J Occup Rehabil 2018; 28: 1-15. DOI: 10.1007/s10926-016-9690-x
https://doi.org/10.1007/s10926-016-9690-x DOI: https://doi.org/10.1007/s10926-016-9690-x
Blonk RWB, Brenninkmeijer V, Lagerveld SE, Houtman ILD. Return to work: a comparison of two cognitive behavioural interventions in cases of work-related psychological complaints among the self-employed. Work Stress 2006; 20: 129-144. DOI: 10.1080/02678370600856615
https://doi.org/10.1080/02678370600856615 DOI: https://doi.org/10.1080/02678370600856615
Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR. Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ 2010; 340: c1035. DOI: 10.1136/bmj.c1035
https://doi.org/10.1136/bmj.c1035 DOI: https://doi.org/10.1136/bmj.c1035
Gismervik S, Aasdahl L, Vasseljen O, Fors EA, Rise MB, Johnsen R, et al. Inpatient multimodal occupational rehabilitation reduces sickness absence among individuals with musculoskeletal and common mental health disorders: a randomized clinical trial. Scand J Work Environ Health 2020; 46: 364-372. DOI: 10.5271/sjweh.3882
https://doi.org/10.5271/sjweh.3882 DOI: https://doi.org/10.5271/sjweh.3882
WONCA Classification Committee, Committee WC. International Classification of Primary Care, Second Edition (ICPC-2). Oxford University Press, 1998.
Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994; 23: 129-138.
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52: 69-77. DOI: 10.1016/S0022-3999(01)00296-3
https://doi.org/10.1016/S0022-3999(01)00296-3 DOI: https://doi.org/10.1016/S0022-3999(01)00296-3
Nguyen QC, Osypuk TL, Schmidt NM, Glymour MM, Tchetgen Tchetgen EJ. Practical guidance for conducting mediation analysis with multiple mediators using inverse odds ratio weighting. Am J Epidemiol 2015; 181: 349-356. DOI: 10.1093/aje/kwu278.
https://doi.org/10.1093/aje/kwu278 DOI: https://doi.org/10.1093/aje/kwu278
Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008; 40: 879-891. DOI: 10.3758/brm.40.3.879
https://doi.org/10.3758/BRM.40.3.879 DOI: https://doi.org/10.3758/BRM.40.3.879
van Vilsteren M, van Oostrom SH, de Vet HC, Franche RL, Boot CR, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev 2015; 10: CD006955. DOI: 10.1002/14651858.CD006955.pub3
https://doi.org/10.1002/14651858.CD006955.pub3 DOI: https://doi.org/10.1002/14651858.CD006955.pub3
Venning A, Oswald TK, Stevenson J, Tepper N, Azadi L, Lawn S, et al. Determining what constitutes an effective psychosocial 'return to work' intervention: a systematic review and narrative synthesis. BMC Public Health 2021; 21: 2164. DOI: 10.1186/s12889-021-11898-z.
https://doi.org/10.1186/s12889-021-11898-z DOI: https://doi.org/10.1186/s12889-021-11898-z
Verhoef JA, Bal MI, Roelofs PD, Borghouts JA, Roebroeck ME, Miedema HS. Effectiveness and characteristics of interventions to improve work participation in adults with chronic physical conditions: a systematic review. Disabil Rehabil 2022; 44: 1007-1022.
https://doi.org/10.1080/09638288.2020.1788180 DOI: https://doi.org/10.1080/09638288.2020.1788180
Staal JB, Hlobil H, van Tulder MW, Köke A, Smid T, van Mechelen W. Return-to-work interventions for low back pain: a descriptive review of contents and concepts of working mechanisms. Sports Medicine (Auckland, NZ) 2002; 32: 251-267.
https://doi.org/10.2165/00007256-200232040-00004 DOI: https://doi.org/10.2165/00007256-200232040-00004
Øverland S, Grasdal AL, Reme SE. Long-term effects on income and sickness benefits after work-focused cognitive-behavioural therapy and individual job support: a pragmatic, multicentre, randomised controlled trial. Occup Environ Med 2018; 75: 703-708.
https://doi.org/10.1136/oemed-2018-105137 DOI: https://doi.org/10.1136/oemed-2018-105137
Valeri L, Coull BA. Estimating causal contrasts involving intermediate variables in the presence of selection bias. Stat Med 2016; 35: 4779-4793.
https://doi.org/10.1002/sim.7025 DOI: https://doi.org/10.1002/sim.7025
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