Background
Objectives
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Are the multicomponent rehabilitation programs more effective in reducing sickness absence compared to the single component Acceptance and Commitment Therapy (ACT) program (i.e. Short vs. ACT; Long vs. ACT), and are there differences between the Long and Short programs?
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Are the multicomponent rehabilitation programs cost effective compared to the single component ACT program (i.e. Short vs. ACT; Long vs. ACT)?
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Are the patients’ and service providers’ expectations before participation in the multicomponent rehabilitation programs, in accordance with their experiences afterwards?
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According to the patients’ and service providers’ experiences; have the multicomponent rehabilitation program been implemented as planned?
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Are the multicomponent programs more effective in improving secondary outcomes (e.g. mental or physical health, or motivation for return to work) than the single component Acceptance and Commitment Therapy (ACT) program?
Methods/design
Project context
Design
Study population
Recruitment procedure
The three occupational rehabilitation interventions
Long multicomponent program | Short multicomponent program | ACT comparative arm | |
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Setting
| Inpatient rehabilitation center | Inpatient rehabilitation center | Outpatient Hospital clinic |
Duration
| 3.5 weeks | 4 + 4 days, separated by 2 weeks living at home | 6 weeks |
Contents and quantities
| -group discussions (×8, total 16 h; ACT based) | -group discussions (×6, total 12 h; ACT based) | -ACT group discussions (×6, total 15 h) |
-psychoeducational sessions (×4, total 6.5 h) | -psychoeducational session on stress (×1, 2 h) | -group discussion on physical activity (×1, 1 h) | |
-individual meetings with coordinator (×5, total 5 h) | -individual meetings with coordinator (×2, total 2 h) | -individual sessions with social worker (×2, total 2 h) | |
-individual meeting with physician (×1, 0.5 h) | -individual meeting with physician (×1, 0.5 h) | -individual session with social worker and ACT group moderator (×1, 0.5 h) | |
-mindfulness sessions (×7, total 3.5 h) | -mindfulness sessions (×4, total 2 h) | -home practice, including daily mindfulness | |
-individual/group based supervised training sessions (×10, total 12 h) | -individual/group based supervised training sessions (×8, total 10.5 h) | ||
-“walking to work” (×6, total 3 h) | -Create RTW-plan | ||
-Create RTW-plan | In the 2 weeks between the stays at the rehab: | ||
-outdoor activities day (×1, 5 h) | -Meeting with employer, if relevant and permitted | ||
-“network day” with 2 group sessions (total 4 h) | -At least 2 contacts with team coordinator (telephone or personal) |
Outcomes
Primary outcome
Secondary outcomes and additional measures
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Time until full sustainable RTW (i.e. for at least 4 weeks without relapse).
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The proportion of workers at work will be obtained by national registers and a self-report of social security benefits received from NAV (The Social Security Office).
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One, three and five-year follow-up of total registered days of physician referred sick leave by national registers.
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Readiness, beliefs and motivation for Return to Work, measured by Readiness for Return to Work Scale [28] and the questions: “How long do you think you will be on sick leave from today” (Not at all, less than 1 month, 1–2 months, 2–4 months, 4–10 months, more than 10 months), “Do you want to return to work” (yes/no), “How strongly do you want to return to work” (not at all-very much, 1, 2…-10).
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Health-related quality of life by 15D (15 dimensions) [29].
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Perceived general health with the question: How is your health now?
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Pain intensity and pain sites by a body pain chart; and question 3–5 from the Brief Pain Inventory [30].
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Catastrophizing thoughts regarding pain by two questions from the Coping Strategies Questionnaire [31].
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Symptoms of depression and anxiety by the Hospital Anxiety and Depression Scale [32].
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Subjective health complaints by the SHC Inventory [33].
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Physical, social and emotional functional status measured by the first four charts of COOP/WONKA [36].
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Four subscales (Job Demands, Control at work, Mastery of work and Social interactions at work) from The general Nordic questionnaire for psychological and social factors at work (QPSnordic) [37].
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Duration and intensity of complaints and interruption with work tasks. The original questions referred to pain only [38], but we modified them so they would apply to all complaints.
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Fear of movement in relation to work and physical activity, with the Fear Avoidance Beliefs Questionnaire [39].
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Psychological flexibility and acceptance by the Acceptance and Action Questionnaire-II [40].