Less than one third of the intervention group was reached by the information elements that we expected to be most powerful (telephone calls and information meeting), and only 11.5% attended the solution-focused follow-up. Even if the information strategy might be improved, it is not likely that the uptake rate for the solution-focused follow-up could be increased to more than 20% to 25%. We therefore conclude that offering a voluntary solution-focused follow-up by the social security offices will not result in measurable reduction in length of sick leave at the population level for employees on long-term sick leave due to psychological problems or muscle skeletal pain.
The strength of this study is that it is a randomised comparison with 100% follow-up for the main outcome, days off work. An important weakness is that one of the three participating social security offices was not able to manage with the procedures and logistics and had to withdraw. The study was designed to measure the effects of offering a solution-focused-up on a population level and must be interpreted cautiously with respect to the possible effects of this approach for individual patients.
What factors can explain the low uptake rate of participants to the solution focused follow up? Introduction of new services is known to be slow when first introduced . The two most common reasons for not attending have been; "Returning to work soon" or "Are already receiving relevant/sufficient treatment". Offering this intervention by mail from the local social security offices might also have reduced the uptake; some might regard this as a means of saving money or as a control strategy. Maybe more persons would have used it if their physician offered it? Our target group is very heterogeneous and we have not done any pre-selection except by main diagnosis. This was done intentionally to encourage "self-recruitment", hopefully increasing motivation and avoiding resource demanding selection procedures. Promotion strategies through media or other information channels were not possible due to randomisation procedures. We believe that the quest for the "ultimate intervention" to reach most of the target population might be forfeit. A realistic aim for this type of wide scoped intervention might be 15–20% uptake rate. Considering a target population of at least 100000 sick listed employees per year in Norway still is a considerable group of people that might be helped through this relatively brief intervention.
The difference in lost workdays between groups was not significant, but never the less showed a tendency for the intervention group to have longer absences. If this tendency is related to the effects of the intervention, what could the reasons be? The "Road Ahead" program in itself might increase the length of sick leave at short term. All of the participants decided to make smaller or larger changes in their lives. For most people, change takes time, especially when it involves career change. If this is a valid explanation to the group difference, we might expect to see difference in future work status and "change behaviour" among our participants. Present status (work, treatment, future plans) and different types of change behaviour should therefore be considered as outcome measures in future studies. The program is aimed at those interested in or in need of making changes in their lives.
Twenty-one of the 41 persons we tried to contact for the telephone survey were reached. This contact resulted in five additional participants in the intervention. If these figures are representative, this might indicate room for increasing the recruitment rate by improving the use of telephone contact by the social security offices. It was surprisingly difficult to reach persons on sick leave by telephone. A 'practical' result of our study is that the registration of sick-listed employees at the social security offices ought to include a telephone number where clients can be reached. Utilisation of the telephone has shown great potential in various settings  and if our study is anywhere near representative, the possibilities for improvement seems apparent.
The difference we observed in outcome for men and women corresponds to both popular beliefs and research concerning sex differences in help-seeking behaviour . Could it be that most men experience this kind of offer as a kind of input that actually makes it harder for them to improve their health status and return to work? The approach might have been perceived as an "emphatic gesture" that actually reduced their expectation to get back to work. This phenomenon has been observed in other settings . We hope to pursue this line of investigation in our future work in this field.
Previous experimental studies in Norway in this area are few, but one study  shows that personal or telephone follow-up by social security officers was effective in reducing number of lost days absent from work. Another recent study looking at the efficacy of a group intervention for sick-listed employees with muscle skeletal disorders  reduced lost work days in the intervention group and also reduced help seeking behaviour. A recent systematic review showed a dramatic difference in effect between two distinctly different approaches to rehabilitation of persons with severe psychological problems. Supported employment return 34% of their users to regular employment after 12 months, while with the more traditional approaches of pre-employment training 12% are in ordinary jobs .
There is limited evidence showing specific effects of different psychotherapies . Some argue that "common factors" is the change engine of all approaches. We have chosen a solution-oriented approach partly because of the limited time perspective of our interventions. The project team developed the group intervention labelled "The Road Ahead Course". We think it is important to have a 'none treatment profile' in this setting, hopefully preventing the "production" of chronic patients. We considered the participants as normal people facing normal troubles of modern life. The aim is to turn a negative circle of failing health into positive circles of change. It remains too bee seen if this will have any effect on number of days absent or on perceived health.