Effects of Inpatient Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy on Sick Leave and Cost of Lost Production: 7-Year Follow-Up of a Randomized Controlled Trial.

Only 161 people were followed up, so anything short of a large difference would be missed. The authors name the small sample as the main limitation and say the estimates lack precision. The plausible range around the main sick-leave comparison included no difference at all, so the question of whether inpatient rehabilitation reduces absence more than outpatient ACT is not settled by this paper. Participants and staff knew which programme they were in, and the researchers who analysed the data were not blinded; only the staff supplying the sickness absence data were kept unaware of group allocation. The inpatient programme mixed physical training, mindfulness, psychoeducation, ACT and work problem-solving, so no single component can be credited with the result. Sick leave payments, work assessment allowance and disability pension were all counted together as absence days, which puts partial work and full benefits into the same number. The two groups were not perfectly matched at the start: 65% of the inpatient group had a musculoskeletal sick-leave diagnosis against 51% of the outpatient group, and outpatient participants reported slightly higher anxiety and depression scores. Five people declined the seven-year follow-up, five had retired and four had died during follow-up, and many moved in and out of work and benefits over the seven years.

Funded by Norwegian public bodies: Helse Midt-Norge, the Research Council of Norway, NTNU and St Olavs Hospital in Trondheim. No commercial sponsor is named and no competing interests are reported.

Do not read the 80 or 114 fewer sick-leave days as proof that the inpatient programme works better than the outpatient one. The range of plausible values around those figures runs from 298 fewer days to 71 more days, so it includes no difference, and the authors themselves say the small sample makes the result uncertain. The trial also cannot show which part of the inpatient package mattered, because physical training, mindfulness, psychoeducation, ACT and work problem-solving were given together.