Comparing with results from other researchers

Section 8.1.2 referred to other studies that used assessment in a multidisciplinary team like our brief intervention. The content of brief intervention is not clear, but some may be similar in scope to our extra intervention. Return to work has been self-reported in many studies and is difficult to compare with our NAV registry data and our focus on the workforce.

In 1997 Bruusgaard and Eriksen investigated the effects of an intervention The study included 397 patients with low back pain and a control group and concluded that there was no significant difference between the intervention and control groups in health status and sick leave one year after the intervention (27). The intervention consisted of interdisciplinary counselling with a specialist in neurology, a specialist in general medicine, a psychologist, a physiotherapist and occupational therapists. Patients received 7 hours of a daily, structured program for one month. There was no significant difference between the study and the control group vis a vis sick leave one year after the intervention. The study group had some improved quality of sleep and some practical skills, but there were no differences in coping with

everyday tasks between the two groups.

Molde-Hagen et al. (28) presented a study in 2003 wherein 457 patients sick listed for 8 to 12 weeks for low back pain were randomized into two groups: an intervention group (n = 237) and a control group (n = 220). The intervention group was examined at a spinal clinic and given information and advice to stay active. This intervention could be compared with the brief intervention in our setting. The control group was not examined at the clinic but was treated within primary health care. After three years of observation, the intervention group had significantly fewer days of sickness compensation than the control group. This difference was mainly caused by a more rapid return to work during the first year. There was no

significant difference for the second or third year.

In a randomized study in 2015, Brendbekken et al. studied 284 adults with

musculoskeletal pain who were referred to a specialist clinic for physical rehabilitation (122).

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A multidisciplinary intervention, including the use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), was compared with a brief intervention, including the assessment to somatisation (p < 0.01)) and functioning ability (p < 0.01) after 12 months. The multidisciplinary intervention group reported a better self-evaluated capability for coping with complaints (p < 0.001) and took better care of their own health (p < 0.001) as compared to the brief intervention group. The degree of return to work is unclear, but the multidisciplinary intervention may represent an important supplement in the treatment of musculoskeletal pain.

Thorlacius and Guetmundsson in Iceland (61) investigated 109 individuals with musculoskeletal and psychiatric disorders, referred by physicians to a multidisciplinary team for assessment of rehabilitation potentials and advice on the appropriate type of rehabilitation.

As a result, 46 individuals received additional treatment and education over time in three different settings. In a telephone survey, 72 % said their fitness for work had improved, but only 47 % had returned to work.

The following refers to other studies where multidisciplinary or brief intervention was performed. In 2001 Bratberg (123) reviewed randomized trials on return to work for

individuals on long term sick leave with musculoskeletal and psychiatric complaints and concluded that no effects were found for a four-week multidisciplinary intervention. The sick leave period was shortened for a small group believed to have less possibility of return to work. This was an extensive intervention as in our extra intervention group( Chapter 5, especially Table 5.3) and NAV Groups 5.3.1–5.

Haldorsen and Grasdal (124) in Norway, 2002, published a randomised study of prognostic groups on the outcome of long-lasting multidisciplinary treatment. They concluded that patients with poor prognosis receiving extensive multidisciplinary treatment returned to work at a higher rate than patients with poor prognosis receiving ordinary treatment, 55 vs. 37

% (p<0.05) at 14 months. Date of return to work was from official registers. They assessed that multidisciplinary treatment was effective concerning return to work when given to patients who, after their selection, were most likely to benefit from that treatment. That was different from our clinically selected groups, but underscores the importance of extensive and prolonged treatment.

Carlsson et al. (125) found that in Sweden an early multidisciplinary assessment was associated with longer periods of sick leave and more individuals on part-time sick leave. In Carlsson’s study, the observation time was from the first to the fourth month of sick leave.

Degree of sick-listing was the measure for “work”. Unlike our study, the actual follow-up

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period in that journal article was where the sick leave curve had the steepest decline (compare Figure 2.1).

If the brief intervention influenced the course, we would expect some changes the first year after assessment. Molde Hagen et al. (in Norway) performed a randomized clinical trial with a three-year follow-up. They examined individuals with low back pain, giving

information, reassurance, and encouragement to engage in physical activity, and demonstrated an effect for the first year on return to work. There was little or no effect on sick leave or fear-avoidance beliefs when a physical exercise programme for low-back-pain patients was given in addition to a multidisciplinary brief intervention at a spinal clinic, but the intervention—

examining for low back pain—was assumed to have a brief intervention effect according to the author (28, 126).

The eight examples above illustrate some possible effects of extra intervention in addition to the brief intervention, but RTW was only registered to a limited extent.

Ahlgren, Bergroth et al. (127) in 2007 studied 815 clients who had taken part in vocational rehabilitation. Of these clients, 52.4 % had attained full working capacity, but the proportion had decreased to 37.4 % two years later. Those who returned to work had shorter sick leave, had jobs to return to and had received job training as a vocational rehabilitation measure. Being 16–29 years of age and employed in industry improved the chance of being at work.

In 2014 in Norway, Reme et al (128) performed a randomised controlled multicentre trial with work-focused cognitive-behavioural therapy and individual job support to increase work participation. The patients suffered from common mental disorders. They found that a work-focused cognitive-behavioural therapy and individual job support was more effective than usual care in increasing or maintaining work participation for people with common mental disorders. The effects were profound for people on long-term benefits, and the effects remained significant after 18 months. In our study, extensive intervention was performed late in the course. Motivation and support could have been reduced at that time.

Braathen et al. (85) applied a multidisciplinary rehabilitation programme to an intervention group of 183 patients on long-term sick leave, and the effects of the treatment were compared with a control group (n = 96) recruited from the national sickness insurance record of patients on a sick leave of 6–12 months duration (mean 11.5 months). They found that the work or tendency to work in the intervention group improved significantly after four months as compared to the control group (p < 0.01). In the intervention group, 80 % had returned to work as compared with 66 % (p = 0.06) of the control group. To be working at a

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baseline predicted return to work. Patients with high motivation and good support from a rehabilitation team demonstrated good results. They concluded that a multidisciplinary rehabilitation programme with focus on work significantly improved perceived work ability as compared with treatment as usual. In our study, the intervention was short and the focus on work insufficient.

A recent study performed by Brendbekken et al on “Multidisciplinary Intervention in Patients with Musculoskeletal Pain: A Randomized Clinical Trial” (129) should be

considered. The purpose of this study was to compare a multidisciplinary intervention—

including the use of the novel Interdisciplinary Structured Interview with a Visual

Educational Tool (ISIVET), with a brief intervention—on the effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain. After 12 months, the results were: the multidisciplinary group reported better self-evaluated capability of coping with complaints (p < 0.001) and better self care (p <

0.001) as compared to the brief intervention group. The results indicated that the

multidisciplinary intervention can represent an important supplement in the treatment of musculoskeletal pain. Our patients’ attitudes to the intervention given in chapter 7 contain opinions and attitudes from the responders similar to these (Table 7.7). The connection to work was not mentioned by Brendbekken.

The multidisciplinary intervention to our extra intervention group could be compared with what was done at “Senter for Jobbmestring” (Coping with job centres) in six different counties in Norway (130). To begin, 1193 individuals were randomized into two groups: one group was sent to the job centre and a few weeks’ advice on health and work, and the other group was given treatment as usual from NAV and the family doctor. The follow-up was at 12–18 months. The intervention group had a slightly better return to work. A cost-benefit analysis concluded that using the job-centres were economically useful for society, especially for returning to work among those who are more than 30 years old who have been sick-listed for several months. This “coping with a job” has a future job in focus and a social identity to the “Senter” that seemed to be beneficial as compared with our focus more on health and individuals.