Return to work following a multimodal work hardening: A cluster randomised trial

Background: Systematic reviews have confirmed the effectiveness of work-related rehabilitation programmes with significant cognitive-behavioural components for patients with musculoskeletal disorders. However, in Germany work-related rehabilitation for patients with musculoskeletal disorders is mainly focussed on evaluating functional capacity and on enhancing it by appropriate modules of exercise therapy while psychosocial work demands have been less considered in the rehabilitation process so far. The aim of our study was the efficacy evaluation of a multimodal work hardening following a cognitive-behavioural approach. Methods: Participants were patients with musculoskeletal disorders and substantial work-related problems that were allocated to an inpatient rehabilitation centre. Included patients were randomised in groups either to a multimodal work hardening or to a common orthopaedic rehabilitation (cluster randomisation). Primary outcome was return to work. Analyses were based on data obtained 6 and 12 months after treatment. Results: 236 (86.8%) patients consented to participate. Response rates after 6 and 12 months were 71.6% (n=169) and 61.9% (n=146). After 6 months participants of the intervention group had a 2.4fold (OR=2.363; 95% CI: 1.266 to 4.410; p=0.007) higher chance of return to work, after 12 months the chance of return to work was 1.9fold (OR=1,914; 95% CI: 0.849 to 4.317; p=0.118) higher than for the control group. Furthermore, participants of the multimodal work hardening reported less depression and anxiety, better mental and physically health-related quality of life and better pain management. Conclusions: Results of the trial confirmed that an intensified work-related programme with a well-defined multimodal structure is able to enhance the chances of return to work for patients with substantial work-related problems.