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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