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Original research
Mechanisms of vocational interventions for return to work from musculoskeletal conditions: a mediation analysis of the MI-NAV trial
  1. Aidan G Cashin1,2,
  2. Britt Elin Øiestad3,
  3. Fiona Aanesen4,
  4. Kjersti Storheim5,
  5. Alexander Tingulstad3,
  6. Tarjei Langseth Rysstad3,
  7. Hopin Lee6,
  8. James H McAuley1,2,
  9. Gail Sowden7,8,
  10. Gwenllian Wynne-Jones8,
  11. Anne Therese Tveter3,9,
  12. Margreth Grotle5,10
  1. 1 Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, Sydney, Australia
  2. 2 School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
  4. 4 National Institute of Occupational Health, Oslo, Norway
  5. 5 Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
  6. 6 Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
  7. 7 Connect Health Ltd, Newcastle upon Tyne, UK
  8. 8 School of Medicine, Keele University, Keele, UK
  9. 9 Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  10. 10 Centre for Intelligent Musculoskeletal Health, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
  1. Correspondence to Dr Aidan G Cashin, Neuroscience Research Australia, Randwick, NSW 2031, Australia; a.cashin{at}neura.edu.au

Abstract

Objectives To investigate whether and to what extent, return to work (RTW) expectancy and workability mediate the effect of two vocational interventions on reducing sickness absence in workers on sick leave from a musculoskeletal condition.

Methods This is a preplanned mediation analysis of a three-arm parallel randomised controlled trial which included 514 employed working adults with musculoskeletal conditions on sick leave for at least 50% of their contracted work hours for ≥7 weeks. Participants were randomly allocated (1:1:1) to one of three treatment arms; usual case management (UC) (n=174), UC plus motivational interviewing (MI) (n=170) and UC plus a stratified vocational advice intervention (SVAI) (n=170). The primary outcome was the number of sickness absence days over 6 months from randomisation. Hypothesised mediators included RTW expectancy and workability assessed 12 weeks after randomisation.

Results The mediated effect of the MI arm compared with UC on sickness absence days through RTW expectancy was −4.98 days (−8.89 to −1.04), and workability was −3.17 days (−8.55 to 2.32). The mediated effect of the SVAI arm compared with UC on sickness absence days through RTW expectancy was −4.39 days (−7.60 to −1.47), and workability was −3.21 days (−7.90 to 1.50). The mediated effects for workability were not statistically significant.

Conclusions Our study provides new evidence for the mechanisms of vocational interventions to reduce sickness absence related to sick leave due to musculoskeletal conditions. Changing an individual’s expectation that RTW is likely may result in meaningful reductions in sickness absence days.

Trial registration number NCT03871712.

  • occupational health
  • clinical trial
  • musculoskeletal system

Data availability statement

Data are available on reasonable request. Anonymised individual participant data (including data dictionary) will be available on reasonable request from January 2023 to December 2028 to researchers who provide a methodologically sound scientific proposal that has been approved by an ethics committee and by the scientific board of the MI-NAV study. Requests to access data should be addressed to brielo@oslomet.no.

https://doi.org/10.1136/oemed-2022-108716

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    Data availability statement

    Data are available on reasonable request. Anonymised individual participant data (including data dictionary) will be available on reasonable request from January 2023 to December 2028 to researchers who provide a methodologically sound scientific proposal that has been approved by an ethics committee and by the scientific board of the MI-NAV study. Requests to access data should be addressed to brielo@oslomet.no.

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    Footnotes

    • Twitter @AidanCashin

    • Contributors AGC, BEØ and MG conceptualised the study and devised the methodology. All authors contributed to and approved the study protocol. BEØ was principal investigator of the MI-NAV trial, whereas MG was responsible for the larger MI-NAV project with three work packages, including receiving funding for the project. FA and AT recruited the trial participants. ATT oversaw data storage. TLR and FA prepared the data for analysis. AGC designed and conducted the formal analysis. AGC interpreted analyses and wrote the original manuscript draft. All authors contributed to reviewing and editing the original manuscript draft. All authors read and approved the final draft of the manuscript. AGC is the corresponding author and full access to the data and had final responsibility for the decision to submit for publication. AGC is the guarantor for the study and accepts full responsibility for the finished work and conduct of the study.

    • Funding The Research Council of Norway was the main funder of the trial (grant no. 280431). The Norwegian Labour and Welfare Administration (NAV) and Oslo Metropolitan University contributed with personal, infrastructure and coordination of the trial.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.