Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial
Objective: Studies suggest that symptom reduction is not necessary for improved return-to-work after occupational rehabilitation programmes. This secondary analysis of a randomized controlled trial examined whether pain intensity and mental distress mediate the effect of an inpatient programme on su...
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| Format: | Article |
| Language: | English |
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Medical Journals Sweden
2024-01-01
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| Series: | Journal of Rehabilitation Medicine |
| Subjects: | |
| Online Access: | https://medicaljournalssweden.se/jrm/article/view/18385 |
| _version_ | 1797356737762689024 |
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| author | Lene Aasdahl Tom Ivar Lund Nilsen Paul Jarle Mork Marius Steiro Fimland Eivind Schjelderup Skarpsno |
| author_facet | Lene Aasdahl Tom Ivar Lund Nilsen Paul Jarle Mork Marius Steiro Fimland Eivind Schjelderup Skarpsno |
| author_sort | Lene Aasdahl |
| collection | DOAJ |
| description | Objective: Studies suggest that symptom reduction is not necessary for improved return-to-work after occupational rehabilitation programmes. This secondary analysis of a randomized controlled trial examined whether pain intensity and mental distress mediate the effect of an inpatient programme on sustainable return-to-work.
Methods: The randomized controlled trial compared inpatient multimodal occupational rehabilitation (n = 82) with outpatient acceptance and commitment therapy (n = 79) in patients sick-listed due to musculoskeletal and mental health complaints. Pain and mental distress were measured at the end of each programme, and patients were followed up on sick-leave for 12 months. Cox regression with an inverse odds weighted approach was used to assess causal mediation.
Results: The total effect on return-to-work was in favour of the inpatient programme compared with the control (hazard ratio (HR) 1.96; 95% confidence interval (95% CI) 1.15–3.35). There was no evidence of mediation by pain intensity (indirect effect HR, 0.98; 95% CI, 0.61–1.57, direct effect HR, 2.00; 95% CI, 1.02–3.90), but mental distress had a weak suppression effect (indirect effect HR, 0.89; 95% CI, 0.59–1.36, direct effect HR, 2.19; 95% CI, 1.13–4.26).
Conclusion: These data suggest that symptom reduction is not necessary for sustainable return-to-work after an inpatient multimodal occupational rehabilitation intervention.
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| first_indexed | 2024-03-08T14:30:54Z |
| format | Article |
| id | doaj.art-49c5ec4645a3481d8133af1606578dc8 |
| institution | Directory Open Access Journal |
| issn | 1651-2081 |
| language | English |
| last_indexed | 2024-03-08T14:30:54Z |
| publishDate | 2024-01-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Journal of Rehabilitation Medicine |
| spelling | doaj.art-49c5ec4645a3481d8133af1606578dc82024-01-12T09:41:32ZengMedical Journals SwedenJournal of Rehabilitation Medicine1651-20812024-01-015610.2340/jrm.v56.18385Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trialLene Aasdahl0Tom Ivar Lund Nilsen1Paul Jarle Mork2Marius Steiro Fimland3Eivind Schjelderup Skarpsno4Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Unicare Helsefort Rehabilitation Centre, Rissa, NorwayDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, NorwayDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, NorwayUnicare Helsefort Rehabilitation Centre, Rissa, Norway; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, NorwayDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, NorwayObjective: Studies suggest that symptom reduction is not necessary for improved return-to-work after occupational rehabilitation programmes. This secondary analysis of a randomized controlled trial examined whether pain intensity and mental distress mediate the effect of an inpatient programme on sustainable return-to-work. Methods: The randomized controlled trial compared inpatient multimodal occupational rehabilitation (n = 82) with outpatient acceptance and commitment therapy (n = 79) in patients sick-listed due to musculoskeletal and mental health complaints. Pain and mental distress were measured at the end of each programme, and patients were followed up on sick-leave for 12 months. Cox regression with an inverse odds weighted approach was used to assess causal mediation. Results: The total effect on return-to-work was in favour of the inpatient programme compared with the control (hazard ratio (HR) 1.96; 95% confidence interval (95% CI) 1.15–3.35). There was no evidence of mediation by pain intensity (indirect effect HR, 0.98; 95% CI, 0.61–1.57, direct effect HR, 2.00; 95% CI, 1.02–3.90), but mental distress had a weak suppression effect (indirect effect HR, 0.89; 95% CI, 0.59–1.36, direct effect HR, 2.19; 95% CI, 1.13–4.26). Conclusion: These data suggest that symptom reduction is not necessary for sustainable return-to-work after an inpatient multimodal occupational rehabilitation intervention. https://medicaljournalssweden.se/jrm/article/view/18385Occupational therapyworkpain intensitychronic painmental healthsick leave |
| spellingShingle | Lene Aasdahl Tom Ivar Lund Nilsen Paul Jarle Mork Marius Steiro Fimland Eivind Schjelderup Skarpsno Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial Journal of Rehabilitation Medicine Occupational therapy work pain intensity chronic pain mental health sick leave |
| title | Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial |
| title_full | Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial |
| title_fullStr | Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial |
| title_full_unstemmed | Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial |
| title_short | Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial |
| title_sort | inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return to work causal mediation analyses of a randomized controlled trial |
| topic | Occupational therapy work pain intensity chronic pain mental health sick leave |
| url | https://medicaljournalssweden.se/jrm/article/view/18385 |
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