Work-Focused Versus Generic Internet-Based Interventions for Employees With Stress-Related Disorders: Randomized Controlled Trial

Background In recent decades, stress-related disorders have received more attention, with an increasing prevalence, especially within the working population. The internet provides new options for broad dissemination, and a growing body of evidence suggests that web-based interventions for stress might be effective. However, few studies have examined the efficacy of interventions in clinical samples and work-related outcomes. Objective The aim of this study was to evaluate the efficacy of an internet-based cognitive behavioral intervention for stress-related disorders integrating work-related aspects (work-focused and internet-based cognitive behavioral therapy [W-iCBT]), compared with a generic internet-based cognitive behavioral therapy (iCBT) group and a waitlist control (WLC) group. Methods In this trial, 182 employees, mainly employed in the health care, IT, or educational sector, who fulfilled the criteria for a stress-related disorder, were randomized to a 10-week W-iCBT (n=61, 33.5%), generic iCBT (n=61, 33.5%), or WLC (n=60, 33%). Self-rated questionnaires on perceived stress, burnout, exhaustion, and other mental health– and work-related outcomes were administered before and after the treatment and at 6- and 12-month follow-ups. Results Compared with the WLC group, participants of the W-iCBT and iCBT groups showed an equal and significant reduction in the primary outcome (Shirom-Melamed Burnout Questionnaire [SMBQ]) from pretreatment to posttreatment assessment (Cohen d=1.00 and 0.83, respectively) and at the 6-month follow-up (Cohen d=0.74 and 0.74, respectively). Significant moderate-to-large effect sizes were also found in the secondary health- and work-related outcomes. The W-iCBT was the only group that exhibited significant effects on work ability and short-term sickness absence. Short-term sickness absence was 445 days lower than the WLC group and 324 days lower than the iCBT intervention group. However, no significant differences were found in terms of work experience or long-term sick leave. Conclusions The work-focused and generic iCBT interventions proved to be superior compared with the control condition in reducing chronic stress and several other mental health–related symptoms. Interestingly, effects on work ability and short-term sickness absence were only seen between the W-iCBT intervention and the WLC groups. These preliminary results are promising, indicating that treatments that include work aspects may have the potential to accelerate recovery and reduce short-term sickness absence because of stress-related disorders. Trial Registration ClinicalTrials.gov NCT05240495; https://clinicaltrials.gov/ct2/show/NCT05240495 (retrospectively registered)

Is this a full powered effectiveness trial or a pilot/feasibility trial? * Manuscript tracking number * If this is a JMIR submission, please provide the manuscript tracking number under "other" (The ms tracking number can be found in the submission acknowledgement email, or when you login as author in JMIR. If the paper is already published in JMIR, then the ms tracking number is the four-digit number at the end of the DOI, to be found at the bottom of each published article in JMIR) (

1a-i) Identify the mode of delivery in the title
Identify the mode of delivery. Preferably use "web-based" and/or "mobile" and/or "electronic game" in the title. Avoid ambiguous terms like "online", "virtual", "interactive". Use "Internet-based" only if Intervention includes non-web-based Internet components (e.g. email), use "computer-based" or "electronic" only if o ine products are used. Use "virtual" only in the context of "virtual reality" (3-D worlds). Use "online" only in the context of "online support groups". Complement or substitute product names with broader terms for the class of products (such as "mobile" or "smart phone" instead of "iphone"), especially if the application runs on different platforms. Does your paper address subitem 1a-i? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes, we have adressed this criteria.

1a-ii) Non-web-based components or important co-interventions in title
Mention non-web-based components or important co-interventions in title, if any (e.g., "with telephone support").
C l e a r s e l e c t i o n Does your paper address subitem 1a-ii?
Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant for our study 2023-03- 1a-iii) Primary condition or target group in the title Mention primary condition or target group in the title, if any (e.g., "for children with Type I Diabetes") Example: A Web-based and Mobile Intervention with Telephone Support for Children with Type I Diabetes: Randomized Controlled Trial C l e a r s e l e c t i o n Does your paper address subitem 1a-iii? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Term stress-related disorders is included in the title and manuscript. Does your paper address subitem 1b-i? * Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant for our study 2023-03- subitem not at all important 1 2 3 4 5 essential 1b-ii) Level of human involvement in the METHODS section of the ABSTRACT Clarify the level of human involvement in the abstract, e.g., use phrases like "fully automated" vs. "therapist/nurse/care provider/physician-assisted" (mention number and expertise of providers involved, if any). (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) C l e a r s e l e c t i o n Does your paper address subitem 1b-ii?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study We have provided information in the manuscript (not abstract) regering provider support/guidence. subitem not at all important 1 2 3 4 5 essential 1b-iii) Open vs. closed, web-based (self-assessment) vs. face-to-face assessments in the METHODS section of the ABSTRACT Mention how participants were recruited (online vs. o ine), e.g., from an open access website or from a clinic or a closed online user group (closed usergroup trial), and clarify if this was a purely web-based trial, or there were face-to-face components (as part of the intervention or for assessment). Clearly say if outcomes were self-assessed through questionnaires (as common in web-based trials). Note: In traditional o ine trials, an open trial (open-label trial) is a type of clinical trial in which both the researchers and participants know which treatment is being administered. To avoid confusion, use "blinded" or "unblinded" to indicated the level of blinding instead of "open", as "open" in web-based trials usually refers to "open access" (i.e. participants can self-enrol). (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) C l e a r s e l e c t i o n Does your paper address subitem 1b-iii?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Methods: In this trial, 182 employees, mainly employed in the health care, IT, or educational sector, who fulfilled the criteria for a stress-related disorder, were randomized to a 10-week W-iCBT (n=61, 33.5%), generic iCBT (n=61, 33.5%), or WLC (n=60, 33%). Self-rated questionnaires on perceived stress, burnout, exhaustion, and other mental health-and work-related outcomes were administered before and after the treatment and at 6-and 12month follow-ups. subitem not at all important 1 2 3 4 5 essential 1b-iv) RESULTS section in abstract must contain use data Report number of participants enrolled/assessed in each group, the use/uptake of the intervention (e.g., attrition/adherence metrics, use over time, number of logins etc.), in addition to primary/secondary outcomes. (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) C l e a r s e l e c t i o n Does your paper address subitem 1b-iv?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Methods: In this trial, 182 employees, mainly employed in the health care, IT, or educational sector, who fulfilled the criteria for a stress-related disorder, were randomized to a 10-week W-iCBT (n=61, 33.5%), generic iCBT (n=61, 33.5%), or WLC (n=60, 33%). Self-rated questionnaires on perceived stress, burnout, exhaustion, and other mental health-and work-related outcomes were administered before and after the treatment and at 6-and 12month follow-ups.  METHODS 3a) Description of trial design (such as parallel, factorial) including allocation ratio 3b) Important changes to methods after trial commencement (such as eligibility criteria), with reasons Does your paper address CONSORT subitem 2b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study The aim of this study was to evaluate the efficacy of a work-focused iCBT (W-iCBT) intervention compared with generic iCBT and a waitlist control (WLC) group in a self-referred sample of employees with stress-related disorders. We hypothesized that W-iCBT and iCBT would be superior in reducing perceived stress, burnout, and exhaustion and improving recovery from work and quality of life compared with a WLC group. In secondary explorative analyses, we examined whether the W-iCBT group would differ from the iCBT and WLC groups in terms of important work-related outcomes, including work experience, work ability, SA, and long-term sick leave. We also hypothesized that the initially achieved changes would remain stable at the 12-month follow-up period.
Does your paper address CONSORT subitem 3a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Design This study was a 3-armed controlled superiority trial with 182 participants, and two internetbased interventions for stress-related disorders, namely, (1) iCBT (n=61, 33.5%) and (2) W-iCBT (n=61, 33.5%) that integrated work aspects early into the treatment, were compared against a WLC group (n=60, 33%). In addition to an adjustment disorder, participants must (1) be aged ≥18 years; (2) have Swedish proficiency; (3) have access to a computer or tablet computer with internet access; (4) be currently employed; and (5) have scored ≥4.4 points on SMBQ, ≤34 points on the Montgomery-Åsberg Depression Scale-Self-rating version (MADRS-S), ≤21 points on the Insomnia Severity Index (ISI), and ≤14 points on the Alcohol Use Disorders Identification Test (AUDIT). Mild to moderate forms of DSM-5 axis-I diagnosis [40] were accepted as comorbid conditions, as long as these were considered secondary to the primary adjustment disorder. Participants on full-or part-time sick leave, for ≤1 year, were also included.
Participants were excluded from the study if they (1) were currently in treatment for a stress-related disorder; (2) were currently experiencing bipolar disorder, psychosis, posttraumatic stress disorder, eating disorder, substance abuse, severe forms of depression, anxiety disorder, or personality disorders; or (3) had suicidal ideation based on item 9 of the MADRS-S. Participants on medication (eg, antidepressants or sleep medication) were not excluded from the study but were requested to keep their medication constant during the study period. In total, 489 individuals were screened and 307 (62.8%) were excluded according to the inclusion and exclusion criteria specified above.
subitem not at all important 1 2 3 4 5 essential 4a-i) Computer / Internet literacy Computer / Internet literacy is often an implicit "de facto" eligibility criterion -this should be explicitly clari ed.
C l e a r s e l e c t i o n Does your paper address subitem 4a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study "In addition to an adjustment disorder, participants must (1) be aged ≥18 years; (2) have Swedish proficiency; (3) have access to a computer or tablet computer with internet access" subitem not at all important 1 2 3 4 5 essential 4a-ii) Open vs. closed, web-based vs. face-to-face assessments: Open vs. closed, web-based vs. face-to-face assessments: Mention how participants were recruited (online vs. o ine), e.g., from an open access website or from a clinic, and clarify if this was a purely web-based trial, or there were face-to-face components (as part of the intervention or for assessment), i.e., to what degree got the study team to know the participant. In online-only trials, clarify if participants were quasi-anonymous and whether having multiple identities was possible or whether technical or logistical measures (e.g., cookies, email con rmation, phone calls) were used to detect/prevent these.
C l e a r s e l e c t i o n Does your paper address subitem 4a-ii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study After initial registration using a personal email address, potential participants received an ID number and were asked to (1) provide written informed consent, (2) complete web-based screening questionnaires (Measures section), and (3) participate in a diagnostic interview via telephone. Diagnostic interviews were conducted by licensed psychologists or master'slevel psychology students under supervision. The master's-level psychology students underwent diagnostic training, and all diagnostic interviews were reviewed by a licensed psychologist. Following the interviews, the included participants were randomized. Participants in the iCBT and W-iCBT groups received access to the programs immediately after randomization, and participants in the WLC group received access to the W-iCBT program after the 6-month follow-up period. subitem not at all important 1 2 3 4 5 essential 4b) Settings and locations where the data were collected 4a-iii) Information giving during recruitment Information given during recruitment. Specify how participants were briefed for recruitment and in the informed consent procedures (e.g., publish the informed consent documentation as appendix, see also item X26), as this information may have an effect on user self-selection, user expectation and may also bias results.
C l e a r s e l e c t i o n Does your paper address subitem 4a-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Detailed information and application to the study were presented on the project's home page. After initial registration using a personal email address, potential participants received an ID number and were asked to (1) provide written informed consent Does your paper address CONSORT subitem 4b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study The study was conducted in a university setting, with researchers and the treatment platform hosted by the university. Participants were recruited from the public through advertisements, articles in regional and national newspapers, and labor organization magazines. Detailed information and application to the study were presented on the project's home page.

4b-i) Report if outcomes were (self-)assessed through online questionnaires
Clearly report if outcomes were (self-)assessed through online questionnaires (as common in web-based trials) or otherwise.
C l e a r s e l e c t i o n Does your paper address subitem 4b-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Outcomes were self-assessed through online questionnaires, "After initial registration using a personal email address, potential participants received an ID number and were asked to (1) provide written informed consent, (2) complete web-based screening questionnaires (Measures section), and (3) participate in a diagnostic interview via telephone." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant. subitem not at all important 1 2 3 4 5 essential 5-i) Mention names, credential, affiliations of the developers, sponsors, and owners Mention names, credential, a liations of the developers, sponsors, and owners [6] (if authors/evaluators are owners or developer of the software, this needs to be declared in a "Con ict of interest" section or mentioned elsewhere in the manuscript).
C l e a r s e l e c t i o n

Does your paper address subitem 5-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study No conflict of interest was declared.

5-ii) Describe the history/development process
Describe the history/development process of the application and previous formative evaluations (e.g., focus groups, usability testing), as these will have an impact on adoption/use rates and help with interpreting results.
C l e a r s e l e c t i o n

Does your paper address subitem 5-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study The content of the programs was based on and previous studies, focus groups, usability testing.

5-iii) Revisions and updating
Revisions and updating. Clearly mention the date and/or version number of the application/intervention (and comparator, if applicable) evaluated, or describe whether the intervention underwent major changes during the evaluation process, or whether the development and/or content was "frozen" during the trial. Describe dynamic components such as news feeds or changing content which may have an impact on the replicability of the intervention (for unexpected events see item 3b).
C l e a r s e l e c t i o n Does your paper address subitem 5-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant.

5-iv) Quality assurance methods
Provide information on quality assurance methods to ensure accuracy and quality of information provided [1], if applicable.
C l e a r s e l e c t i o n Does your paper address subitem 5-iv?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant. subitem not at all important 1 2 3 4 5 essential 5-v) Ensure replicability by publishing the source code, and/or providing screenshots/screen-capture video, and/or providing flowcharts of the algorithms used Ensure replicability by publishing the source code, and/or providing screenshots/screencapture video, and/or providing owcharts of the algorithms used. Replicability (i.e., other researchers should in principle be able to replicate the study) is a hallmark of scienti c reporting.
C l e a r s e l e c t i o n

Does your paper address subitem 5-v?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant.

5-vi) Digital preservation
Digital preservation: Provide the URL of the application, but as the intervention is likely to change or disappear over the course of the years; also make sure the intervention is archived (Internet Archive, webcitation.org, and/or publishing the source code or screenshots/videos alongside the article). As pages behind login screens cannot be archived, consider creating demo pages which are accessible without login.
C l e a r s e l e c t i o n

Does your paper address subitem 5-vi?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant.

5-vii) Access
Access: Describe how participants accessed the application, in what setting/context, if they had to pay (or were paid) or not, whether they had to be a member of speci c group. If known, describe how participants obtained "access to the platform and Internet" [1]. To ensure access for editors/reviewers/readers, consider to provide a "backdoor" login account or demo mode for reviewers/readers to explore the application (also important for archiving purposes, see vi).
C l e a r s e l e c t i o n Does your paper address subitem 5-vii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Participation was free of charge. Eligible participants obtained access to the platform via web/Internet and two factor authentication. subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 5-viii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study The generic iCBT program, represented in the iCBT and W-iCBT groups, was based on contemporary CBT techniques adapted for stress-related disorders and recovery from work training inspired by Hahn et al [41]. Both the iCBT and W-iCBT programs consisted of 10 modules distributed over 10 weeks, with modules lasting 60-120 minute per week (Table 1). The W-iCBT was integrated and distributed over each module and compared with generic iCBT, adding correspondingly 1 to 3 regular pages of text, worksheets, and homework assignments. Each module contained information, exercises, worksheets, images, examples, audio and video files, and homework exercises. All participants were requested to complete each module and homework assignment before they were able to continue. Delayed participants were able to catch up during the last module of the program. All participants had access to the treatment 1 year after the posttreatment assessment.

5-ix) Describe use parameters
Describe use parameters (e.g., intended "doses" and optimal timing for use). Clarify what instructions or recommendations were given to the user, e.g., regarding timing, frequency, heaviness of use, if any, or was the intervention used ad libitum. Does your paper address subitem 5-ix?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Both the iCBT and W-iCBT programs consisted of 10 modules distributed over 10 weeks, with modules lasting 60-120 minute per week (Table 1). All participants were requested to complete each module (one module per week) and homework assignment before they were able to continue.

5-x) Clarify the level of human involvement
Clarify the level of human involvement (care providers or health professionals, also technical assistance) in the e-intervention or as co-intervention (detail number and expertise of professionals involved, if any, as well as "type of assistance offered, the timing and frequency of the support, how it is initiated, and the medium by which the assistance is delivered". It may be necessary to distinguish between the level of human involvement required for the trial, and the level of human involvement required for a routine application outside of a RCT setting (discuss under item 21 -generalizability). Does your paper address subitem 5-x?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Every week, participants in both interventions (W-iCBT and iCBT) received personalized written messages from a coach with feedback on the exercises. For the participants in the W-iCBT group, guidance was given on the CBT and work-focused modules simultaneously. The coaches, 8 in total, were master-level psychology students who were specifically trained to provide feedback according to a standardized manual. The feedback aimed to provide support and encouragement and to monitor homework assignments and adherence to the intervention. Treatment-as-usual was not only prohibited but also not encouraged during the trial. The coaches were requested to limit their support to 1 message and a maximum of 15 minutes of correspondence per week with 1 participant.

5-xi) Report any prompts/reminders used
Report any prompts/reminders used: Clarify if there were prompts (letters, emails, phone calls, SMS) to use the application, what triggered them, frequency etc. It may be necessary to distinguish between the level of prompts/reminders required for the trial, and the level of prompts/reminders for a routine application outside of a RCT setting (discuss under item 21 -generalizability). Does your paper address subitem 5-xi? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Prompts/reminders used, e.g. manual and automated emails and SMS triggered by non-response on weekly support, homework, exercises and/or questionnaires. 6a) Completely defined pre-specified primary and secondary outcome measures, including how and when they were assessed Does your paper address subitem 5-xii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study

5-xii) Describe any co-interventions (incl. training/support)
In the present trial we evalated a co-(work-focused) interventioner. The work-focused (W-iCBT) aimed to facilitate return to work among those participants who were on sick leave and increase work functioning among those participants who were experiencing an adjustment disorder but not disabled from work. Work-focused CBT is built on the same conceptual framework as regular CBT. For example, CBT principles are used to change the appraisal of work stressors (eg, "it is ok although the task is not 100% complete or perfect"), change dysfunctional behavior (eg, working late close to bedtime and accepting more work despite heavy workload), or increase health-promoting behaviors (eg, recreational activities, assertive behavior, and RTW activities). The CBT principle of exposure has received special attention. Gradual exposure can help individuals develop more effective coping skills when dealing with work-related stressors (eg, assertiveness) and stimulate a gradual RTW setting for individuals on long-term sick leave [21]. Does your paper address CONSORT subitem 6a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Primary and Secondary Outcome Measure was assessed pre, post and on a six and twelve month follow-up. Please see specifikation of the outcome measures below. . TiC-P has been used in several studies for economic evaluation of health care consumption and productivity loss in mental health [73]. Sickness absence (SA) was conceptualized as the self-rated number of days absent from work during the past 3 months while being physically or mentally ill. Long-term sick leave was operationalized as >15 days on sick leave and based on data from the Swedish Social Insurance Agency on the number of net days on sickness benefit between the pretreatment and 6-month follow-up assessments. In Sweden, sickness benefits from the Swedish Social Insurance Agency are due from day 15 on sick leave. Thus, absence during the first 14 days of illness was not included in the analysis of this outcome. Intervention Utility And Satisfaction The participants were asked to rate their utility and satisfaction after each module on a 5point scale (1=low utility/satisfaction to 5=high utility/satisfaction). Intervention Support Intervention support was operationalized and assessed as the number of minutes of support per week between the coaches and the participants during the intervention. On average, participants in the W-iCBT and iCBT groups completed 8.86 (SD 1.96) modules and 8.69 (SD 1.86) modules, respectively, which equals 88.6% and 86.9% of each intervention. completion was defined as the number of completed modules including all exercises and homework assignments. All exercises and homework assignments was logged in the platform. We also logged numer of logins and activities but this data was unreliable, incomplete and therefore unusable. Does your paper address CONSORT subitem 6b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant for our study. Does your paper address CONSORT subitem 7b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Statistical Analysis All analyses followed the CONSORT statement for randomized controlled trials [37]. Statistical analyses were conducted following the intention-to-treat (ITT) principle using SPSS (version 26; IBM Corp). We used the multiple imputation procedure to impute missing sum scores for participants who did not complete the posttreatment and 6-or 12-month follow-up assessments. Multiple imputation is considered a conservative approach for analyzing incomplete data sets, as it takes into account the uncertainty because of missing information [74]. We used all available data from the pretreatment, posttreatment, and 6month follow-up assessments, as well as age, gender, andeducational level as predictors. Means, SDs, and SEs of the effect sizes were pooled from 5 sets of imputations. The effects of group on primary and secondary outcome measures of the ITT and completers-only data sets were analyzed using repeated measures ANOVAs with time (pretreatment, posttreatment, and 6-month follow-up period) as a within-subject factor. Pooled F values were calculated using RStudio (RStudio Inc). Cohen d was reported for between-group effect sizes and the corresponding 95% CI. Internal consistency reliability for the primary and secondary outcomes was analyzed using Cronbach α. Outcomes at baseline and demographic variables between complete and missing data were analyzed using t and χ2 tests. The ITT principle was applied to the analysis of SA. The analysis of long-term sick leave was based on complete registry data with no attrition. Both SA and long-term sick leave were analyzed using the 8b) Type of randomisation; details of any restriction (such as blocking and block size) 9) Mechanism used to implement the random allocation sequence (such as sequentially numbered containers), describing any steps taken to conceal the sequence until interventions were assigned Does your paper address CONSORT subitem 8a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Participants who met the study criteria and provided informed consent were randomly allocated by an independent researcher by using an internet-based random generator (Randomizer). The independent researcher received a list of anonymous identification numbers of all participants (n=182) and coaches (n=8). This procedure ensured that blinding was implemented during randomization. All participants, coaches, and the participants reporting benefits because of long-term sick leave at baseline were randomized in a 1:1:1 proportion.
Does your paper address CONSORT subitem 8b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Participants who met the study criteria and provided informed consent were randomly allocated by an independent researcher by using an internet-based random generator (Randomizer). The independent researcher received a list of anonymous identification numbers of all participants (n=182) and coaches (n=8). This procedure ensured that blinding was implemented during randomization. All participants, coaches, and the participants reporting benefits because of long-term sick leave at baseline were randomized in a 1:1:1 proportion. 10) Who generated the random allocation sequence, who enrolled participants, and who assigned participants to interventions 11a) If done, who was blinded after assignment to interventions (for example, participants, care providers, those assessing outcomes) and how NPT: Whether or not administering co-interventions were blinded to group assignment Does your paper address CONSORT subitem 9? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study The independent researcher received a list of anonymous identification numbers of all participants (n=182) and coaches (n=8). This procedure ensured that blinding was implemented during randomization.
Does your paper address CONSORT subitem 10? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study The independent researcher received a list of anonymous identification numbers of all participants (n=182) and coaches (n=8). This procedure ensured that blinding was implemented during randomization. subitem not at all important 1 2 3 4 5 essential 11a-i) Specify who was blinded, and who wasn't Specify who was blinded, and who wasn't. Usually, in web-based trials it is not possible to blind the participants [1, 3] (this should be clearly acknowledged), but it may be possible to blind outcome assessors, those doing data analysis or those administering cointerventions (if any).
C l e a r s e l e c t i o n Does your paper address subitem 11a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Only participants was blinded to the assigned to intervention. Providers was blinded to assessment but not to intervention.

11b) If relevant, description of the similarity of interventions
(this item is usually not relevant for ehealth trials as it refers to similarity of a placebo or sham intervention to a active medication/intervention) 11a-ii) Discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator" Informed consent procedures (4a-ii) can create biases and certain expectations -discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator".
C l e a r s e l e c t i o n

Does your paper address subitem 11a-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Participants in the interventions group did not knew which intervention was the "intervention of interest". Waitlist controls did know that they were comparators. 12a) Statistical methods used to compare groups for primary and secondary outcomes NPT: When applicable, details of whether and how the clustering by care providers or centers was addressed Does your paper address CONSORT subitem 11b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study The generic iCBT and the work-focused iCBT were exact copies exept for the additional work-focused modules. Does your paper address CONSORT subitem 12a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Statistical Analysis All analyses followed the CONSORT statement for randomized controlled trials [37]. Statistical analyses were conducted following the intention-to-treat (ITT) principle using SPSS (version 26; IBM Corp). We used the multiple imputation procedure to impute missing sum scores for participants who did not complete the posttreatment and 6-or 12-month follow-up assessments. Multiple imputation is considered a conservative approach for analyzing incomplete data sets, as it takes into account the uncertainty because of missing information [74]. We used all available data from the pretreatment, posttreatment, and 6month follow-up assessments, as well as age, gender, andeducational level as predictors. Means, SDs, and SEs of the effect sizes were pooled from 5 sets of imputations. The effects of group on primary and secondary outcome measures of the ITT and completers-only data sets were analyzed using repeated measures ANOVAs with time (pretreatment, posttreatment, and 6-month follow-up period) as a within-subject factor. Pooled F values were calculated using RStudio (RStudio Inc). Cohen d was reported for between-group effect sizes and the corresponding 95% CI. Internal consistency reliability for the primary and secondary outcomes was analyzed using Cronbach α. Outcomes at baseline and demographic variables between complete and missing data were analyzed using t and χ2 tests. The ITT principle was applied to the analysis of SA. The analysis of long-term sick leave was based on complete registry data with no attrition. Both SA and long-term sick leave were analyzed using the subitem not at all important 1 2 3 4 5 essential 12b) Methods for additional analyses, such as subgroup analyses and adjusted analyses 12a-i) Imputation techniques to deal with attrition / missing values Imputation techniques to deal with attrition / missing values: Not all participants will use the intervention/comparator as intended and attrition is typically high in ehealth trials. Specify how participants who did not use the application or dropped out from the trial were treated in the statistical analysis (a complete case analysis is strongly discouraged, and simple imputation techniques such as LOCF may also be problematic [4]).
C l e a r s e l e c t i o n Does your paper address subitem 12a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study We used the multiple imputation procedure to impute missing sum scores for participants who did not complete the posttreatment and 6-or 12-month follow-up assessments. Multiple imputation is considered a conservative approach for analyzing incomplete data sets, as it takes into account the uncertainty because of missing information [74]. We used all available data from the pretreatment, posttreatment, and 6-month follow-up assessments, as well as age, gender, andeducational level as predictors. Means, SDs, and SEs of the effect sizes were pooled from 5 sets of imputations. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Informed consent was obtained on paper sent to each participant with returning mail.

RESULTS
13a) For each group, the numbers of participants who were randomly assigned, received intended treatment, and were analysed for the primary outcome NPT: The number of care providers or centers performing the intervention in each group and the number of patients treated by each care provider in each center

X26-iii) Safety and security procedures
Safety and security procedures, incl. privacy considerations, and any steps taken to reduce the likelihood or detection of harm (e.g., education and training, availability of a hotline) C l e a r s e l e c t i o n

Does your paper address subitem X26-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study All communication, assessment and requitement was conducted on an encrypted and two factor protected web platform, iTherapy. All participants received an anonymous ID number. ID and personal information were stored separately. Does your paper address CONSORT subitem 13b? (NOTE: Preferably, this is shown in a CONSORT flow diagram) * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study After screening 489 individuals, 307 participants were excluded, most (n=197) because of high or low scores on one or several of the outcome measures.
Copy and paste relevant sections from the manuscript or cite the gure number if applicable (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Overall, the study attrition rate was moderate: 19.2% (35/182) at posttreatment period (W-iCBT, n=18, 51%; iCBT, n=9, 26%; and WLC, n=8, 23%), 24.2% (44/182) at the 6 months followup (W-iCBT, n=22, 50%; iCBT, n=11, 25%; and WLC, n=11, 25%), and 34.4% (42/122) at the 12month follow-up questionnaires (W-iCBT=28 and iCBT=14). The analysis found no significant differences, χ23=.0645, n=182; P=.37, in the study attrition rate between any group or time point. No significant differences were found between demographic variables (presented in Table 2) or complete and missing data on the baseline outcome (Table 3). 14b) Why the trial ended or was stopped (early) Does your paper address CONSORT subitem 14a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study No, we did not provide any dates.

14a-i) Indicate if critical "secular events" fell into the study period
Indicate if critical "secular events" fell into the study period, e.g., signi cant changes in Internet resources available or "changes in computer hardware or Internet delivery resources" C l e a r s e l e c t i o n Does your paper address subitem 14a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study No, we avoided secular events, e.g. trial was conducted mid term, i.e. feb-may and sept-dec, not over longer vacations (summer/Christmas). Does your paper address CONSORT subitem 14b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant. The trial was not ended or stopped early.
Does your paper address CONSORT subitem 15? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes, we provided a table showing baseline demographic and clinical characteristics for each group. In ehealth trials it is particularly important to report demographics associated with digital divide issues, such as age, education, gender, social-economic status, computer/Internet/ehealth literacy of the participants, if known.
C l e a r s e l e c t i o n Does your paper address subitem 15-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes, we reported demographics associated with digital divide issues, age, education, gender, social-economic status. subitem not at all important 1 2 3 4 5 essential 16-i) Report multiple "denominators" and provide definitions Report multiple "denominators" and provide de nitions: Report N's (and effect sizes) "across a range of study participation [and use] thresholds" [1], e.g., N exposed, N consented, N used more than x times, N used more than y weeks, N participants "used" the intervention/comparator at speci c pre-de ned time points of interest (in absolute and relative numbers per group). Always clearly de ne "use" of the intervention.
C l e a r s e l e c t i o n Does your paper address subitem 16-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes, we reported multiple "denominators" and provide definitions. For example subitem not at all important 1 2 3 4 5 essential 17a) For each primary and secondary outcome, results for each group, and the estimated effect size and its precision (such as 95% confidence interval)

16-ii) Primary analysis should be intent-to-treat
Primary analysis should be intent-to-treat, secondary analyses could include comparing only "users", with the appropriate caveats that this is no longer a randomized sample (see 18-i).
C l e a r s e l e c t i o n

Does your paper address subitem 16-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study We provided both primary analysis on intent-to-treat sample and secondary analysis including completers only. Does your paper address CONSORT subitem 17a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study

Primary Outcome Analyses
The mean values) and SD for all groups for the primary outcomes are presented in Table 3. As depicted in Table 4, the repeated measures ANOVA for the primary outcome, the SMBQ, revealed a significant overall effect (F4,358=5.39; P<.001) between the interventions (W-iCBT and generic iCBT) and WLC. In the following separate ANOVA, both the W-iCBT and iCBT showed lower scores on the primary outcome SMBQ at posttest (T2; F2,179=14.9; P<.001) and at the 6 months follow-up (

Secondary Outcome Analysis
The mean values (M) and SD for all groups of secondary outcomes are presented in Table 3. Table 4 presents the results of the ITT analyses of the secondary outcomes. The repeated measures ANOVA found significant overall effects in favor of the two intervention groups for all outcomes at T2 and T3, apart from work experience (F4,358=1.40; P=.24) and work ability (F4,358=1.18; P=.32). In the following analyses of simple effects, we found significant improvement in the W-iCBT group, when compared with the WLC group, on work ability (T2; ). However, no significant differences were found in the net days of long-term sick leave between any groups (H(2)=−0.82; P=.66). The total net days on benefits owing to long-term sick leave were 1932 days in the W-iCBT group, 2328 days in the iCBT group, and 2435 days in the WLC group. Accordingly, 14 participants in the W-iCBT group were on long-term sick leave at T2 (6 ended and 3 started) and 9 participants at T3 (5 ended and 0 started). Corresponding figures for the iCBT and WLC groups at T2 were 17 and 15 participants, respectively (iCBT, 4 ended and 4 started; WLC, 5 ended and 3 started), and 11 and 10 participants at T3 (iCBT, 8 ended and 2 started; WLC, 10 ended and 5 started). subitem not at all important 1 2 3 4 5 essential 17b) For binary outcomes, presentation of both absolute and relative effect sizes is recommended 17a-i) Presentation of process outcomes such as metrics of use and intensity of use In addition to primary/secondary (clinical) outcomes, the presentation of process outcomes such as metrics of use and intensity of use (dose, exposure) and their operational de nitions is critical. This does not only refer to metrics of attrition (13-b) (often a binary variable), but also to more continuous exposure metrics such as "average session length". These must be accompanied by a technical description how a metric like a "session" is de ned (e.g., timeout after idle time) [1] (report under item 6a).
C l e a r s e l e c t i o n Does your paper address subitem 17a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant for our study.
18) Results of any other analyses performed, including subgroup analyses and adjusted analyses, distinguishing pre-specified from exploratory Does your paper address CONSORT subitem 17b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant for our study. Does your paper address CONSORT subitem 18? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Long-Term Follow-Up The mean scores in the primary and secondary outcomes were maintained or continued to improve in both intervention groups at the 12-month follow-up. Significant differences between the iCBT and W-iCBT groups (Appendix 1) were only seen on the SMBQ subscale tension (F1,688=5.80; P=.02) and REQ subscale psychological detachment (F1,688=6.11; P=.01).
Intervention Support Participants received an equal amount of time (minutes per week) for support (W-iCBT mean 12.11, SD 7.76; iCBT mean 12.92, SD 7.08; F1,120=0.356; P=.55). In addition, the participants were asked questions about how they perceived the support. Overall, 90% (55/61) in the W-iCBT group and 96% (59/182) in the iCBT group experienced the support as relevant and helpful.

18-i) Subgroup analysis of comparing only users
A subgroup analysis of comparing only users is not uncommon in ehealth trials, but if done, it must be stressed that this is a self-selected sample and no longer an unbiased sample from a randomized trial (see 16-iii).
C l e a r s e l e c t i o n Does your paper address subitem 18-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant for our study.
Does your paper address CONSORT subitem 19? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant for our study. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant for our study. subitem not at all important 1 2 3 4 5 essential 22-i) Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use) Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use).
C l e a r s e l e c t i o n Does your paper address subitem 22-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study To the best of our knowledge, this study is the first trial examining a work-focused intervention and a generic internet-based intervention in a clinical sample of employees with stress-related disorders. The results confirmed the primary hypothesis that both interventions were equally effective in reducing symptoms of perceived stress, burnout, exhaustion, depression, anxiety, and insomnia and in improving recovery from work and quality of life compared with a WLC group. Secondary explorative analyses indicated positive effects on work ability and a reduction in the number of days of SA in the workfocused group. No significant effects were found on outcomes for alcohol use, work experience, or net days on the benefits for long-term sick leave. The effects found on health-related outcomes were larger than those previously reported in a meta-analysis of internet-based stress management trials [27]; perceived stress d=0.43, depression d=0.34, and anxiety d=0.32. One plausible explanation may be that previous internet-based studies of interventions to reduce stress have largely included individuals with lower symptom severity (nonclinical). There are indications that greater initial symptom severity results in higher response and remission rates [77,78]. Most of the participants (W-iCBT, 42/61, 69%; iCBT, 41/61, 67%) in the intervention groups fulfilled the criteria for clinically significant change in the primary outcome, SMBQ, and were maintained at the 6-month follow-up. The proportion of clinically significant changes was comparable with previous trials [33,76]. However, there was a considerable discrepancy in the number of participants who achieved clinically significant changes when measured using KEDS compared with SMBQ. This might reflect that SMBQ and KEDS measure different underlying constructs, as noted in previous research [80]. As hypothesized, changes in health-and work-related outcomes remained stable in both intervention groups at the 12-month follow-up. The results were in line with the long-term effects found in a meta-analysis of internet-based stress management trials [27], which showed moderate effect sizes (d=0.56) up to 6 months after the treatment. These results are encouraging as they provide further evidence of the long-term benefits of relativity short iCBT interventions. However, we still struggle with the fact that about one-third of patients relapse or continue to experience residual symptoms several years after treatment for stress-related disorders [81]. Future studies should examine the use of minimally invasive long-term remote patient monitoring to further extend the long-term effects of iCBT stress interventions.
Interestingly, the effects on work ability and SA were only seen between the W-iCBT and WLC groups. However, these effects were small but comparable with those found in a metaanalysis of psychological interventions for individuals in SA because of common mental disorders [19]; Hedges g=0.22 for work-focused CBT interventions. These results are promising because SA has direct effects on people's well-being and leads to large costs for society [16]. Although effects on SA were present in the W-iCBT group, no significant effects were present in any group with regard to net days on the benefits of long-term sick leave. One possible explanation could be that the 2 outcomes were assessed differently. SA was conceptualized as the self-rated number of days absent from work during the past 3 months while being physically or mentally ill and measured at 3 time points: pretreatment, posttreatment, and 6-month follow-up. However, long-term sick leave was based on data from the Swedish Social Insurance Agency on the number of net days on sickness benefit between the pretreatment and 6-month follow-up assessments.

20-i) Typical limitations in ehealth trials
Typical limitations in ehealth trials: Participants in ehealth trials are rarely blinded. Ehealth trials often look at a multiplicity of outcomes, increasing risk for a Type I error. Discuss biases due to non-use of the intervention/usability issues, biases through informed consent procedures, unexpected events. , this might be due to the work-focused content (3 regular pages including text and corresponding worksheets and homework assignments) included in the W-iCBT and the extra workload relative to the generic iCBT intervention, constituting a potential stressor. Perhaps individualization and integration of the work-focused content could further streamline the treatment protocol, increase adherence, and prevent dropout. Fourth, we did not include any mediator or moderator analysis. Hence, future studies should be designed with repeated assessments to test for mediating and moderating mechanisms. For instance, it would be interesting to examine the mediation role of recovery in interventions for stress-related disorders. Fifth, none of the interventions examined in this trial included workplace involvement. Workplace dialogue and involvement (eg, manager, human resource professionals) were only encouraged indirectly through the participants. Workplace involvement is an important factor for returning to work [13,85]. Hence, it would be interesting to evaluate an internet-based and work-focused program for employees experiencing stress-related disorders with a parallel program including workplace involvement (eg, managerial support and perspective on stress, burnout, recovery, RTW, etc). Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study With regard to the Generalizability: 92% (167/182) of the participants had a university-level educational background, compared with 28% in the general population [84], and 62% (113/182) were working in the social, health care, or education sector. Therefore, future studies that include participants that are more representative of the general working population are needed. Providing W-iCBT directly, integrated into the workplace, could lower thresholds and be a successful approach in including various employees from different industries.
None of the interventions examined in this trial included workplace involvement. Workplace dialogue and involvement (eg, manager, human resource professionals) were only encouraged indirectly through the participants. Workplace involvement is an important factor for returning to work [13,85]. Hence, it would be interesting to evaluate an internetbased and work-focused program for employees experiencing stress-related disorders with a parallel program including workplace involvement (eg, managerial support and perspective on stress, burnout, recovery, RTW, etc). Discuss if there were elements in the RCT that would be different in a routine application setting (e.g., prompts/reminders, more human involvement, training sessions or other cointerventions) and what impact the omission of these elements could have on use, adoption, or outcomes if the intervention is applied outside of a RCT setting.
C l e a r s e l e c t i o n Does your paper address subitem 21-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable/relevant for our study. Does your paper address CONSORT subitem 23? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study The study was registered retrospectively at clinical trial: ClinicalTrials.gov, reference number NCT05240495.
Does your paper address CONSORT subitem 24? * Cite a Multimedia Appendix, other reference, or copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study About the CONSORT EHEALTH checklist yes, major changes yes, minor changes no X27-i) State the relation of the study team towards the system being evaluated In addition to the usual declaration of interests ( nancial or otherwise), also state the relation of the study team towards the system being evaluated, i.e., state if the authors/evaluators are distinct from or identical with the developers/sponsors of the intervention.
C l e a r s e l e c t i o n Does your paper address subitem X27-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Conflicts of Interest None declared.
As a result of using this checklist, did you make changes in your manuscript? * What were the most important changes you made as a result of using this checklist?
Not applicable for our study.
How much time did you spend on going through the checklist INCLUDING making changes in your manuscript * Not applicable for our study.
As a result of using this checklist, do you think your manuscript has improved? * Would you like to become involved in the CONSORT EHEALTH group?
This would involve for example becoming involved in participating in a workshop and writing an "Explanation and Elaboration" document C l e a r s e l e c t i o n

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