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Abstract

Objective:

To evaluate feasibility and potential effectiveness of work-directed rehabilitation in people with common mental disorders.

Design:

Pilot randomized controlled trial.

Setting:

Primary healthcare, Sweden.

Subjects:

Working adults (n = 42) of mean age 46.2 ± 11.1 years with depression or anxiety disorder.

Interventions:

Eight weeks of work-directed rehabilitation (n = 21) or physical activity (n = 21). Work-directed rehabilitation included sessions with a physiotherapist and/or an occupational therapist, to develop strategies to cope better at work. Physical activity included a planning session and access to a local gym.

Main measures:

Feasibility: attendance, discontinuation and adverse events. Measurements were the Work Ability Index, the Global Assessment of Functioning, the Montgomery–Asberg Depression Rating Scale, the Beck Anxiety Inventory and the World Health Organization—Five Well-Being Index.

Results:

Attendance to rehabilitation sessions was 88% (n = 147/167) and discontinuation rate was 14% (n = 3/21). No serious adverse events were reported. Within both groups, there was a significant improvement in Work Ability Index score (mean change: 3.6 (95% confidence interval (CI): 0.45, 6.7) in work-directed rehabilitation and 3.9 (95% CI: 0.9, 7.0) in physical activity) with no significant difference between groups. For the other outcomes, significant improvements were found within but not between groups. Per-protocol analysis showed a trend toward the antidepressant effect of work-directed rehabilitation compared to physical activity (mean difference in depression score −3.1 (95% CI: −6.8, 0.4), P = 0.075).

Conclusion:

Work-directed rehabilitation was feasible to persons with common mental disorders and improved their work ability and mental health. Comparable improvements were seen in the physical activity group. Suggested modifications for a larger trial include adding a treatment-as-usual control.

Keywords

Depression anxiety physiotherapy occupational therapy vocational rehabilitation

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References

The Organisation for Economic Co-operation and Development (OECD). Fit mind, fit job: from evidence to practice in mental health and work (Mental health and work). Paris: OECD, 2015.

Whiteford

Degenhardt

Rehm

, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 2013; ccclxxxii: 1575–1586.

Vos

Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; ccclxxxvi(9995): 743–800.

Sandqvist

Henriksson

CM.

Work functioning: a conceptual framework. Work 2004; 23(2): 147–157.

Salomonsson

Hedman-Lagerlof

Ost

LG.

Sickness absence: a systematic review and meta-analysis of psychological treatments for individuals on sick leave due to common mental disorders. Psychol Med 2018; 48(12): 1954–1965.

Overland

Grasdal

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(10): 703–708.

Nigatu

Liu

Uppal

, et al. Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials. Psychol Med 2016; 46(16): 3263–3274.

Mikkelsen

Rosholm

Systematic review and meta-analysis of interventions aimed at enhancing return to work for sick-listed workers with common mental disorders, stress-related disorders, somatoform disorders and personality disorders. Occup Environ Med 2018; 75(9): 675–686.

Alonso

Marco

Andani

Reducing the time until psychotherapy initiation reduces sick leave duration in participants diagnosed with anxiety and mood disorders. Clin Psychol Psychother 2018; 25(1): 138–143.

10.

Danielsson

Papoulias

Petersson

, et al. Exercise or basic body awareness therapy as add-on treatment for major depression: a controlled study. J Affect Disord 2014; 168: 98–106.

11.

Eklund

Wastberg

Erlandsson

LK.

Work outcomes and their predictors in the Redesigning Daily Occupations (ReDO) rehabilitation programme for women with stress-related disorders. Aust Occup Ther J 2013; 60(2): 85–92.

12.

Schene

Koeter

MWJ

Kikkert

, et al. Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation. Psychol Med 2007; 37(3): 351–362.

13.

Andersen

Nielsen

Brinkmann

How do workers with common mental disorders experience a multidisciplinary return-to-work intervention? A qualitative study. J Occup Rehabil 2014; 24(4): 709–724.

14.

Danielsson

Elf

Hensing

Strategies to keep working among workers with common mental disorders—a grounded theory study. Disabil Rehabil 2019; 41: 786–795.

15.

Sheehan

Lecrubier

Sheehan

, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59(suppl 20): 22–33; quiz 34–57.

16.

Ekman

Hedman

Swedberg

, et al. Commentary: Swedish initiative on person centred care. BMJ 2015; 350: h160.

17.

Leplege

Gzil

Cammelli

, et al. Person-centredness: conceptual and historical perspectives. Disabil Rehabil 2007; 29(20–21): 1555–1565.

18.

Yrkesföreningar för fysisk aktivitet (YFA). Fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling (FYSS) 2017 [Physical activity in the prevention and treatment of disease 2017], FYSS kapitel—del 2, diagnosspecifik del [FYSS chapter part 2: specific diagnoses], 2017, http://www.fyss.se/in-english/introduction/

19.

Kaur

Figueiredo

Bouchard

, et al. Where have all the pilot studies gone? A follow-up on 30 years of pilot studies in clinical rehabilitation. Clin Rehabil 2017; 31(9): 1238–1248.

20.

Ilmarinen

Tuomi

Klockars

Changes in the work ability of active employees over an 11-year period. Scand J Work Environ Health 1997; 23(suppl 1): 49–57.

21.

Ahlstrom

Grimby-Ekman

Hagberg

, et al. The work ability index and single-item question: associations with sick leave, symptoms, and health—a prospective study of women on long-term sick leave. Scand J Work Environ Health 2010; 36(5): 404–412.

22.

Montgomery

Asberg

A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382–389.

23.

Hall

RCW

. Global Assessment of Functioning. A modified scale. Psychosomatics 1995; 36: 267–275.

24.

Beck

Epstein

Brown

, et al. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56(6): 893–897.

25.

Beck

Steer

. Beck Anxiety Inventory manual. San Antonio, TX: Psychological Corporation, 1993.

26.

Topp

Østergaard

Søndergaard

, et al. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom 2015; 84(3): 167–176.

27.

Whitehead

Julious

Cooper

, et al. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res 2016; 25(3): 1057–1073.

28.

Malmberg Gavelin

Eskilsson

Boraxbekk

, et al. Rehabilitation for improved cognition in patients with stress-related exhaustion disorder: RECO—a randomized clinical trial. Stress 2018; 21(4): 279–291.

29.

Kaldo

Lundin

Hallgren

, et al. Effects of internet-based cognitive behavioural therapy and physical exercise on sick leave and employment in primary care patients with depression: two subgroup analyses. Occup Environ Med 2018; 75(1): 52–58.

30.

Salomonsson

Santoft

Lindsater

, et al. Cognitive-behavioural therapy and return-to-work intervention for patients on sick leave due to common mental disorders: a randomised controlled trial. Occup Environ Med 2017; 74(12): 905–912.

31.

Mander

Neubauer

Schlarb

, et al. The therapeutic alliance in different mental disorders: a comparison of patients with depression, somatoform, and eating disorders. Psychol Psychother 2017; 90(4): 649–667.

32.

Danielsson

Kihlbom

Rosberg

“Crawling out of the cocoon”: patients’ experiences of a physical therapy exercise intervention in the treatment of major depression. Phys Ther 2016; 96(8): 1241–1250.

33.

Bjork Bramberg

Holmgren

Bultmann

, et al. Increasing return-to-work among people on sick leave due to common mental disorders: design of a cluster-randomized controlled trial of a problem-solving intervention versus care-as-usual conducted in the Swedish primary health care system (PROSA). BMC Public Health 2018; 18(1): 889.

34.

Hallgren

Helgadóttir

Herring

, et al. Exercise and internet-based cognitive-behavioural therapy for depression: multicentre randomised controlled trial with 12-month follow-up. Br J Psychiatry 2016; 209: 414–420.

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Work-directed rehabilitation or physical activity to support work ability and mental health in common mental disorders: a pilot randomized controlled trial

Abstract

Objective:

Design:

Setting:

Subjects:

Interventions:

Main measures:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material