Table 3 Specific Intervention Characteristics & Overall Results from Included RCTs (n = 18)
Study | Interventions | Duration (Total Hours) | Frequency of sessions | Early Timing | Multi-Disciplinary | RTW Focus | Exposure | Cognitive Restructuring | Behavioural Activation | Goal Setting | Values Clarification | Problem Solving | Psychoeducation | Results |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Aasdahl, Pape [25] | Outpatient group-based ACT | High (18) | High (Weekly) | ✕ | ✓ | ✓ | ✓ | ✕ | ✓ | ✓ | ✓ | ✕ | ✓ | • NSSD between groups in sickness absence days 6 or 12 months following the programs. • NSSD between groups in sustainable RTW (1 month without benefits) at 12 months follow-up (OP = 57%; IP = 49%). |
Inpatient multi-component intervention | High (56) | High (4 days over 2 weeks) | ✕ | ✓ | ✓ | ✓ | ✕ | ✓ | ✓ | ✓ | ✓ | ✓ | ||
Andersen, Birgit [26] | Health guidance | Low (1.5) | Low (One-off) | ✓ | ✕ | ✕ | ✕ | ✕ | ✓ | ✕ | ✕ | ✕ | ✕ | • NSSD’s between intervention types in RTW after 11 months (HG = 64%; TPA = 61%; CPSM = 60%). • Pain, BMI, aerobic capacity, work ability and kinesiophobia improved, and non-significant changes were found between groups. |
Tailored physical activity + Health guidance OR Chronic pain self-management + Health guidance | High (> 30) | Highly (weekly) | ✓ | ✓ | ✕ | ✕ | ✕ | ✓ | ✕ | ✕ | ✕ | ✕ | ||
High (16.5) | High (weekly) | ✓ | ✓ | ✕ | ✕ | ✕ | ✓ | ✕ | ✕ | ✓ | ✕ | |||
Bitsch, Nielsen [27] | Standard cardiac rehabilitation alone involving structured deductive teaching without rationale and 3 exercise sessions per week | High (48) | High (4 per week) | ✓ | ✓ | ✕ | ✕ | ✕ | ✓ | ✕ | ✕ | ✕ | ✓ | • NSSD between groups in successful RTW at 1-year follow-up (SCR = 69%; LC = 65%). • NSSD in relapse rates between the groups. |
Learning and coping education program in addition to standard cardiac rehabilitation | High (50) | High (4 weekly + 2 interviews) | ✓ | ✓ | ✕ | ✕ | ✕ | ✓ | ✕ | ✕ | ✕ | ✓ | ||
Brendbekken, Eriksen [28] | Brief intervention focusing on education | Low (3.5) | Moderate (Fortnightly) | ✕ | ✓ | ✕ | ✕ | ✕ | ✓ | ✕ | ✕ | ✕ | ✓ | • NSSD between groups in full RTW at 12- (45% for both) and 24- (BI = 37%; MI = 43%) months follow-up. • In three of the first 7 months, significantly more patients were partly RTW in the MI-group compared to the BI-group (RR = 2.31 (95% CI 1.19–4.51, p = 0.01)). |
Multi-disciplinary comprehensive intervention | Moderate (5.5) | Moderate (Fortnightly + 3-month follow-up) | ✕ | ✓ | ✓ | ✕ | ✕ | ✓ | ✕ | ✕ | ✓ | ✓ | ||
De Weerd, Van Dijk [29] | Work-focused CBT | Moderate (6) | High (Weekly) | ✓ | ✕ | ✓ | ✓ | ✓ | ✓ | ✕ | ✕ | ✕ | ✓ | • NSSD between groups in first RTW at the end of treatment (CBT = 26 participants; CA = 29 participants). • NSSD between groups in full RTW at the end of treatment (17 participants in each). • NSSD between groups on the Symptom Checklist-90 items after treatment. • Some effect modification by gender. |
Work-focused CBT plus a 1.5 h meeting with employer | Moderate (7.5) | High (Weekly) | ✓ | ✕ | ✓ | ✓ | ✓ | ✓ | ✕ | ✕ | ✕ | ✓ | ||
Du Bois and Donceel [30] | Rehabilitation-oriented coaching | ? | Low (Monthly) | ✕ | ✕ | ✓ | ✕ | ✕ | ✓ | ✕ | ✕ | ✕ | ✓ | • At 1-year follow-up, 8% of participants in the brief disability evaluation group had not returned to work, compared with 4% in the coaching group (p = 0.03). • At 1-year follow-up recurrent sick leave was higher in the no medical advice group (23.3%) compared to the coaching group (15.3%) (p = 0.02). • NSSD between the groups regarding subsequent surgery for lower back pain or duration of sick leave. |
Brief disability evaluation without medical advice | Low (1) | Low (once-off) | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ||
Finnes, Ghaderi [31] | ACT | Moderate (6) | Moderate (Fortnightly) | ✕ | ✕ | ✓ | ✓ | ✕ | ✓ | ✓ | ✓ | ✕ | ✓ | • Overall, net sickness absence days decreased by approximately 16 days from pre- to post-treatment, but there was NSSD between groups (some group differences during follow-up when stratified by diagnostic group). • All groups improved in self-assessed work ability (WAI) from pre- to post-measurement, but there was NSSD between groups (some group differences during follow-up when stratified by diagnostic group). • For general functioning (WSAS), there was NSSD between groups for pre- to post-measurement or during follow-up. • For satisfaction with life (SWLS), there was a significant Group x Time effect from pre- to post-measurement. The participants randomized to ACT and WDI improved significantly more than TAU. The ACT + WDI condition did not differ from TAU. For the follow-up period, there were no differences between groups. • There were some differences in symptom reduction between groups at post-treatment, favouring mostly ACT and ACT + WDI, but there were no differences in overall estimated average linear change between groups during the follow-up period for any of the secondary outcome measures. These results indicate that up until 9-month follow-up, self-reported symptoms of depression, anxiety, and exhaustion disorder decreased, whereas daily functioning and satisfaction with life increased over time, but changes were similar across conditions. |
WDI OR | Low (2) | Low (2 interviews / meetings) | ✕ | ✕ | ✓ | ✕ | ✕ | ✕ | ✕ | ✕ | ✓ | ✕ | ||
WDI + ACT OR | Moderate (9) | Moderate (fortnightly) | ✕ | ✓ | ✓ | ✓ | ✕ | ✓ | ✓ | ✓ | ✓ | ✓ | ||
TAU involving rehabilitation in standard care facilities with a range of health professionals | ? | ? | ✕ | ? | ? | ? | ? | ? | ? | ? | ? | ? | ||
Glasscock, Carstensen [32] | Work-focused CBT with option of workplace meeting | Moderate (6) | High (Weekly) | ✕ | ✕ | ✓ | ✓ | ✓ | ✓ | ✓ | ✕ | ✕ | ✓ | • NSSD between groups for sick-leave duration or lasting RTW. • At 10-month follow up, both groups reported less perceived stress and improved mental health, but there were NSSDs. |
No-treatment control group | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ||
Lytsy, Carlsson [33] | ACT | High (no limit) | High (Weekly) | ✕ | ✕ | ✕ | ✓ | ✕ | ✓ | ✓ | ✓ | ✕ | ✓ | • NSSD’s between groups for returning to health insurance system (CAU = 51.5%; ACT = 43.5%; MD = 39%) or number of reimbursed days from the healthcare system (12-month follow up). • Compared to the “usual care” group (30%), participants in the multidisciplinary intervention (51%, p = 0.015) were more likely to self-report increased work-related degree of engagement, but ACT (40%, p = 0.21) participants were not. • Compared to the “usual care” group, participants in the multidisciplinary intervention were more likely to report increased working hours (OR 2.20 (95% CI 1.09–4.44, p = 0.028)), but ACT participants were not (OR of 0.95 (95% CI 0.46–1.95, p = 0.90)). |
Multidisciplinary assessments and individual rehabilitation interventions OR | High (no limit) | Moderate (approx. weekly) | ✕ | ✓ | ✓ | ? | ? | ? | ? | ? | ? | ? | ||
“Usual care” provided by regular health contacts | ? | ? | ? | ? | ? | ? | ? | ? | ? | ? | ? | ? | ||
Myhre, Marchand [34] | Pain-related coaching | High (20) | High (Weekly) | ✕ | ✓ | ✓ | ✕ | ✓ | ✓ | ✕ | ✕ | ✕ | ✓ | • NSSD’s between groups for RTW within 12 months (pain-related coaching only = 75%; pain-related coaching + work-focus = 70%) and median time before RTW (pain-related coaching only = 158 days; pain-related coaching + work-focus = 161 days). • In subgroup analyses, the median time before RTW was significantly briefer in the pain-related coaching only group than in the work-focus group, for participants aged > 41 years (132 vs. 177 days, p = 0.03). |
Pain-related coaching plus caseworker focusing on RTW and opportunity for a meeting with employer | High (appx. 20) | High (Weekly) | ✕ | ✓ | ✓ | ✕ | ✓ | ✓ | ✕ | ✕ | ✕ | ✓ | ||
Nieuwenhuijsen, Antonius [35] | RTW and mental health coaching only | Moderate (6) | Moderate (Fortnightly) | ? | ✕ | ✓ | ✕ | ✓ | ✕ | ✕ | ✓ | ✓ | ✓ | • NSSD’s between groups on all outcome measures. • Over time, participants in all groups increased their working hours to approximately two-thirds of their contract hours on average. • Emotional exhaustion complaints and stress complaints significantly decreased after treatment in all groups. • Work-related fatigue levels decreased significantly after treatment in all groups, to about half the level it was when the study started. • Significant improvements in QOL were observed over time for all groups. |
Light therapy / electromagnetic field therapy plus RTW and mental health coaching OR | Moderate (6) | Moderate (Fortnightly) | ? | ✕ | ✓ | ✕ | ✓ | ✕ | ✕ | ✓ | ✓ | ✓ | The results from the box above can be incorporated with this blank box, as they apply to the one study - Nieuwenhuijsen, Antonius | |
RTW and mental health coaching plus placebo light / electromagnetic therapy | Moderate (6) | Moderate (Fortnightly) | ? | ✕ | ✓ | ✕ | ✓ | ✕ | ✕ | ✓ | ✓ | ✓ | ||
Park, Esmail [36] | Functional restoration plus motivational interviewing | ? | ? | ✕ | ✓ | ✓ | ✓ | ✕ | ✓ | ✓ | ✓ | ✕ | ✕ | • Successful RTW at program discharge was 12.1% higher for unemployed claimants in the MI group overall (21.6%) vs. the CAU group (9.5%) (p = 0.03). • Successful RTW was also 3% higher for job attached claimants in the MI group (97.1%) compared to the CAU group (94.1%) (p = 0.10). • The proportion of claimants with successful RTW in the MI adherent intervention group was 33.3%, higher than the non-adherent intervention group (18.0%) and control group (9.5%) (p < 0.01). • Successful RTW increased to 47.4% when the MI adherent intervention included RTW as the target behaviour. • RTW among those who were job attached was higher in the MI adherent group (100%) compared to the non-adherent MI group (96.3%) and the control group (94.1%) (p – 0.03). |
CAU involving functional restoration | ? | ? | ✕ | ✓ | ✓ | ✓ | ? | ✓ | ? | ? | ? | ? | ||
Rolving, Nielsen [37] | Preoperative CBT in addition to CAU | High (18) | High (Weekly) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✕ | ✕ | ✓ | ✓ | • NSSD between the groups RTW rate during the first year after surgery (CBT = 42%; CAU = 42%) or sick leave (mean weeks) during the first year after surgery (CBT = 31; CAU = 39). • NSSD between the groups’ disability (ODI) scores at 12-month follow-up. At 3-months follow-up the CBT group achieved better. • NSSD between the groups for measures of catastrophizing or fear avoidance belief at 12-month follow up. However, at 6-months follow up the CBT group achieved better. • NSSD between the groups in terms of reduction in back / leg pain during the first year after surgery. |
CAU involving standard preoperative surgery-related information and postoperative physical rehabilitation | Moderate (appx 8) | High (Weekly) | ✕ | ✓ | ✕ | ✕ | ✕ | ✓ | ✕ | ✕ | ✕ | ✕ | ||
Salomonsson, Santoft [38] | Psychological disorder focused CBT (non-work focused) | High (maximum of 20 sessions) | High (Weekly) | ✕ | ✕ | ✕ | ✓ | ✓ | ✓ | ✕ | ✕ | ✕ | ✓ | • NSSD between groups for days of sick-leave at 12-months follow-up. • NSSD between groups for proportion of patients on full-time sick leave, part-time sick leave, or without sick-leave at 6- and 12-month follow up (no longer on sick leave at 12 months follow-up: CBT = 77%, RTW-I = 79%; COMBO = 80%). • Pre- to post-treatment, there were significant differences between groups on the clinician’s severity rating (CSR) outcome. Results indicated superior reduction of psychiatric symptoms after CBT compared with RTW-I. There was NSSD between COMBO and the other treatments pre to post. From post-treatment to 12-months follow up, RTW-I led to a larger improvement on the CSR compared with CBT. COMBO did not differ from CBT or RTW-I post-treatment to 12-months follow up. Within-group effect sizes (d’s) were large pre- to post-treatment for all groups; CBT 2.5 (95% CI 1.8 to 3.2), COMBO 2.0 (95% CI 1.5 to 2.4) and RTW-I 1.6 (95% CI 1.2 to 2.1). • 67% of the total sample did not fulfil criteria for principal disorder at post-treatment. At 12-months follow up, 26% of patients reported an increase in psychotropic medication or additional psychological treatment (NSSDs between groups). |
RTW-focused CBT only OR | Moderate (10) | Moderate (fortnightly) | ✕ | ✕ | ✓ | ✓ | ✕ | ✓ | ✓ | ✕ | ✓ | ✓ | ||
Psychological disorder and RTW-focused CBT combined | High (maximum of 25 sessions) | High(Weekly) | ✕ | ✕ | ✓ | ✓ | ✓ | ✓ | ✓ | ✕ | ✓ | ✓ | ||
Salzwedel, Wegscheider [39] | Social counselling and therapy in addition to usual care (cardiac rehabilitation) | Moderate (6) | High (Twice weekly) | ✓ | ✕ | ✓ | ✓ | ✕ | ✓ | ✓ | ✕ | ✓ | ✕ | • NSSD between the groups for employment 12 months after cardiac rehabilitation (social counselling / therapy group = 42.1%; CAU = 45.1%). • NSSD’s between the groups in sick leave, disability pension, or change in occupational situation. • NSSD between groups on measures of work ability (WAI) or mental quality of life. |
CAU involving cardiac rehabilitation and as-needed counselling | ? | ? | ✓ | ✕ | ? | ? | ? | ? | ? | ? | ? | ? | ||
Vlasveld, van der Feltz-Cornelis [40] | Collaborative care involving problem-solving, manual-guided self-help, workplace intervention, possible anti-depressants | High (max 12 sessions) | ? | ✓ | ✓ | ✓ | ✕ | ✓ | ✕ | ✕ | ✕ | ✓ | ✓ | • At 12-months follow up, 65% of the collaborative care and 59% of the CAU participants achieved lasting, full RTW. • NSSD in groups on duration until lasting, full RTW (collaborative care group = 190 (SD 120) days; CAU = 210 (SD 124) days (p > 0.05). • NSSD between groups on mean number of sick days in the entire follow up period (collaborative care group = 198 (SD 120) days; CAU = 215 (SD 118) days) (p > 0.05). • NSSD between groups on the PHQ-9 at all follow-up points. • Compared with the collaborative care group, more participants in CAU group had received treatment for mental health problems (14.5% vs 1.8%). |
CAU involving contact with a range of health professionals and treatment for mental health problems in some cases | ? | ? | ✓ | ? | ? | ? | ? | ? | ? | ? | ? | ? | ||
Volker, Zijlstra-Vlasveld [41] | Blended eHealth individually tailored involving CBT and problem-solving; access to face-to-face meetings with occupational physician | ? | ? | ✕ | ✕ | ✓ | ✕ | ✓ | ✓ | ✕ | ✕ | ✓ | ✓ | • By 1-year follow-up, 84% (72/86) of the CAU participants and 87.7% (114/130) of the e-Health participants had achieved partial or full RTW. • Duration until first RTW differed between groups. The median duration was 77 (CAU group) and 50 days (eHealth group) (p = .03). NSSD was found between the groups for duration until full RTW. • NSSD in the median total number of sick days in the 1-year follow-up period (CAU = 228.0 days (IQR 111.0–365.0); e-Health = 174.0 days (IQR 100.0–321.0)). • NSSD between groups for common mental disorder symptoms, but at 9 months follow up significantly more participants in the eHealth group (n = 41; 56%) achieved remission than in the CAU group (n = 23; 37%) (p = .02). |
CAU involving access to various health professionals; regular consultations with occupational physician | ? | ? | ✕ | ? | ? | ? | ? | ? | ? | ? | ? | ? | ||
Vonk Noordegraaf, Anema [42] | Web-based tailored eHealth focused on recovery and RTW | Low (maximum 3 h) | ? | ✓ | ✕ | ✓ | ✕ | ✕ | ✓ | ✕ | ✕ | ✕ | ✕ | • There was a statistically significant difference in RTW, favoring the treatment group focusing on recovery and RTW (HR = 1.54, 95%CI 1.07–.22, p = 0.02). • Participants in the treatment group were 1.84 times more likely to be included in a lower pain intensity category compared with participants in the generic information treatment group (cum OR = 1.84, 95%CI 1.04–3.25, p = 0.035). • Both physical and mental quality of life improved more in the treatment group than in the generic information treatment group (p’s < 0.05). • NSSD between groups on the recovery index (RI-10). |
Web-based generic information related to the surgery | Low | Low | ✓ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ | ✕ |