A treatment strategy for meeting life as it is. Patients' and therapists' experiences of brief therapy in a district psychiatric centre: A qualitative study

Abstract Background: Young adults increasingly seek help for mental health problems. In 2016, a district psychiatric centre in Norway started a brief treatment program to provide early and effective help for moderate depression and anxiety. Aim: Exploring patients' and therapists' experiences of brief therapy, especially how the time limitation influences the treatment process. Methods: Individual interviews with 12 patients and focus group interviews with eight therapists analyzed using systematic text condensation. Results: The results constitute five themes: (1) Time-limit as a frame for targeted change, (2) Clarifying expectations and accountability, (3) Shared agreement on a defined treatment-project, (4) Providing tools instead of searching for causes, and (5) Learning to cope-not being cured. Conclusion: Time-limitation in brief therapy appeared to play a positive role, helping the therapists to structure the therapeutic process and strengthening patients' motivation. Shared understanding and activation during brief therapy may reinforce patients' responsibility and expectations to achieve individual goals. Brief therapy can be viewed as the start of a personal process towards "mastering life as it is". More research is needed to investigate the patients' long-term outcomes after treatment and to shed light on the potential for, and limitations of, mastering everyday-life.publishedVersio

Return to Work after Surgery for Cervical Radiculopathy: A Nationwide Registry-based Observational Study

Study Design - An observational multicenter study. Summary of Background Data - Return to work (RTW) is increasingly used to assess the standard, benefit, and quality of health care. Objective - The aim of this study was to evaluate sick leave patterns among patients undergoing surgery for cervical radiculopathy and identify predictors of successful RTW using two nationwide databases. Materials and Methods - Data from the Norwegian Registry for Spine Surgery (NORspine) and the Norwegian Labour and Welfare Administration were linked on an individual level. We included patients between 18 and 60 years of age registered in NORspine from June 2012 through December 2019 that were temporarily out of the labor force for medical reasons at the time of surgery. We assessed types and grades of sickness benefits before and after surgery and conducted logistic regression analyses. Results - Among 3387 patients included in the study, 851 (25.1%) received temporary benefits one year before surgery. The proportion of recipients increased steadily towards surgery. Postoperatively the medical benefit payment decreased rapidly, and half of the patients had already returned to work by four months. The rate of RTW reached a plateau at one year. By the end of the third year, 2429 patients (71.7%) had returned to work. The number of sick days, categorized as 90 or less, during the year before surgery had the most powerful association with RTW at two years (odds ratio: 4.54, 95% CI: 3.42–6.03, P Conclusion - RTW after cervical radiculopathy surgery occurs primarily during the first year. The strongest predictor of RTW was fewer sick days before surgery. The clinical improvement after surgery had a lesser impact

Effectiveness of a resistance training program on physical function, muscle strength, and body composition in community-dwelling older adults receiving home care: A cluster-randomized controlled trial

Background: Aging is associated with reduced muscle mass and strength leading to impaired physical function. Resistance training programs incorporated into older adults’ real-life settings may have the potential to counteract these changes. We evaluated the effectiveness of 8 months resistance training using easily available, low cost equipment compared to physical activity counselling on physical function, muscle strength, and body composition in community-dwelling older adults receiving home care. Methods: This open label, two-armed, parallel group, cluster randomized trial recruited older adults above 70 years (median age 86.0 (Interquartile range 80–90) years) receiving home care. Participants were randomized at cluster level to the resistance training group (RTG) or the control group (CG). The RTG trained twice a week while the CG were informed about the national recommendations for physical activity and received a motivational talk every 6th week. Outcomes were assessed at participant level at baseline, after four, and 8 months and included tests of physical function (chair rise, 8 ft-up-and-go, preferred- and maximal gait speed, and stair climb), maximal strength, rate of force development, and body composition. Results: Twelve clusters were allocated to RTG (7 clusters, 60 participants) or CG (5 clusters, 44 participants). The number of participants analyzed was 56–64 (6–7 clusters) in RTG and 20–42 (5 clusters) in CG. After 8 months, multilevel linear mixed models showed that RTG improved in all tests of physical function and maximal leg strength (9–24%, p = 0.01–0.03) compared to CG. No effects were seen for rate of force development or body composition. Conclusion: This study show that resistance training using easily available, low cost equipment is more effective than physical activity counselling for improving physical function and maximal strength in community-dwelling older adults receiving home care.publishedVersio

Effectiveness of 'motivational interviewing' on sick leave: a randomized controlled trial in a social insurance setting

Objective This study aimed to evaluate the effectiveness of motivational interviewing (MI) – a counselling approach offered by caseworkers at the Norwegian Labor and Welfare Administration (NAV) – on return to work (RTW) for individuals sick-listed for ≥8 weeks due to any diagnoses. MI was compared to usual case management and an active control during 12 months of follow-up. Methods In a randomized clinical trial with three parallel arms, participants were randomized to MI (N=257), usual case management (N=266), or an active control group (N=252). MI consisted of two MI sessions while the active control involved two sessions without MI, both were offered in addition to usual case management. The primary outcome was number of sickness absence days based on registry data. Secondary outcomes included time to sustainable RTW, defined as four consecutive weeks without medical benefits. Results The median number of sickness absence days for the MI group was 73 days [interquartile range (IQR) 31–147], 76 days (35–134) for usual care, and 75 days (34–155) for active control. In total 89%, 88% and 86% of the participants, respectively, achieved sustainable RTW. The adjusted hazard ratio (HR) for time to sustainable RTW was 1.12 (95% CI 0.90–1.40) for MI compared to usual case management and HR 1.16 (95% CI 0.93–1.44) compared to the active control. Conclusions This study did not provide evidence that MI offered by NAV caseworkers to sick-listed individuals was more effective on RTW than usual case management or an active control. Providing MI in this context could be challenging as only half of the MI group received the intervention.publishedVersio

Occupational rehabilitation and readiness for return to work in individuals with musculoskeletal complaints and mental health disorders: A randomized clinical trial

Background Musculoskeletal complaints and mental health disorders are the two leading causes of sickness absence in Norway. Despite increasing documentation of overlap in symptoms between these diagnoses groups, most occupational rehabilitation programs described in the scientific literature are diagnosis-specific. In Norway, inpatient occupational rehabilitation programs including different diagnostic groups in the same groups has been done for decades, but such programs have never been evaluated with a rigorous study design. Aims The main aim of this thesis was to assess the effects of a 4+4 days multicomponent inpatient occupational rehabilitation program compared to a less comprehensive outpatient program on sickness absence and somatic and mental health in persons with musculoskeletal- or mental health disorders. A secondary aim was to explore the usefulness of the Readiness for Return to work scale, a questionnaire developed to evaluate where sick listed individuals are in their return to work (RTW) process, by assessing the association between the scale and RTW, and comparing the scale to a single question assessing participants` expectations about length of sick leave. Methods In a randomized trial with parallel groups, individuals on sick leave with musculoskeletal complaints or common mental health disorders were randomized to the inpatient program or the outpatient program. The inpatient program consisted of Acceptance and Commitment Therapy (ACT), physical training and work-related problem-solving including creating a RTW plan and a workplace visit if considered relevant. The outpatient program consisted primarily of ACT (6 sessions during 6 weeks). The primary outcome was cumulated number of sickness absence days at 6 and 12 months follow-up based on registry data. Secondary outcomes were time until sustainable RTW and different somatic and mental health outcomes measured by questionnaires up to 12 months follow-up (paper 1 and 2). In a prospective cohort study with 9 months follow-up participants on sick leave with musculoskeletal complaints or common mental health disorders who took part in two randomized clinical trials were included. Associations between the Readiness for RTW scale and RTW was analysed using linear and logistic regression. The Readiness for RTW scale was compared to a self-reported question assessing participants` expectations about length of sick leave using adjusted/pseudo R2. Questionnaires were answered at the start and the end of rehabilitation programs and sick leave was measured using registry data (paper 3). Results 168 individuals were randomized to the 4+4 days multicomponent inpatient program (n=92) or the outpatient program (n=76) (paper 1 and 2). There was no statistical difference between the programs in median number of sickness absence days at 6 and 12 months follow-up. The hazard ratio for sustainable RTW was 0.74 (95% CI 0.48-1.32, p=0.165), in favor of the outpatient program. There were no statistically significant differences between the programs in health outcomes, except for slightly more reduced pain after the outpatient program. For participants not working at the end of rehabilitation (n=96), high scores on two dimensions (Prepared for action-self-evaluative and Prepared for action-behavioral) were associated with a higher probability of RTW and more working days (paper 3). For those working (n=121), high scores on the Uncertain maintenance dimension was associated with a lower probability of RTW and less working days. Stage allocation, allocating participants to the dimension with the highest score, was problematic due to several tied scores between (not necessarily adjacent) dimensions. Generally, models including the Readiness for RTW dimensions were not as good at explaining work outcomes as models including a single expectation question. Conclusions There was no difference between the inpatient program and the outpatient program on sick leave or sustainable RTW. There was no difference in self-reported health measures between the programs, except for slightly more reduced pain after the outpatient program. Therefore, this study presents no support that a 4+4 days inpatient multicomponent occupational rehabilitation program is superior to a less comprehensive outpatient program. Three of the Readiness for RTW dimensions were associated with RTW, but only to a lesser or similar extent than a single expectation question. Furthermore, several weaknesses with the Readiness for RTW scale were established and particularly the stage allocation approach cannot be recommended for clinical use in its current form

Is there really a “golden hour” for work disability interventions? a narrative review

The subacute phase of low back pain has been termed as the “golden hour” to intervene to prevent work disability. This notion is based on the literature up to 2001 and is limited to back pain. In this narrative review, we examined whether the current literature indicate an optimal time for return to work (RTW) interventions. We considered randomized controlled trials published from 1997 to April 2018 assessing effects of occupational rehabilitation interventions for musculoskeletal complaints (15 included), mental health disorders (9 included) or a combination of the two (1 included). We examined participants’ sick leave duration at inclusion and the interventions’ effects on RTW. Most studies reporting an effect on RTW included participants with musculoskeletal complaints in the subacute phase, supporting that this phase could be a beneficial time to start RTW-interventions. However, recent studies suggest that RTW-interventions also can be effective for workers with longer sick leave durations. Our interpretation is that there might not be a limited time window or “golden hour” for work disability interventions, but rather a question about what type of intervention is right at what time and for whom. However, more research is needed. Particularly, we need more high-quality studies on the effects of RTW-interventions for sick listed individuals with mental health disorders

The Readiness for Return to Work Scale; Does it Help in Evaluation of Return to Work?

Purpose The Readiness for Return to Work (RRTW) scale is used to evaluate workers’ readiness to resume work after sick leave. Previous research has questioned the RRTW scale’s constructs and stages. The aim of this study was to assess the unidimensionality of the RRTW scale and its six subscales by evaluating its fit to the Rasch model, and furthermore to assess if Rasch-based scaling would improve its predictive value, compared with the conventional use of the scale. Methods A prospective cohort study with 12 months of follow-up. Individuals (n = 397) sick-listed due to musculoskeletal, unspecified, or common mental health disorders undergoing rehabilitation were included: 191 were full-time sick-listed (not working), and 206 were part-time sick-listed (working). A Rasch analysis was applied to evaluate the measurement properties of the RRTW scale in the working and not working participants at baseline. Linear and logistic regressions were used to assess how well Rasch-based scaling predicted future work participation during the 12 months of follow-up. Results The RRTW subscales had too few items to represent underlying dimensions properly, and the items fitted poorly within the subscales. A constructed variable based on the items that fit together for not working individuals poorly predicted future work participation. The individuals’ scores across stages were disordered, indicating a lack of ordered stages. Conclusions This study reveals poor measurement properties of the Norwegian version of the RRTW scale in individuals with musculoskeletal and common mental disorders, with neither the subscales nor the stages closely associated with return to work