Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial.
Lene Aasdahl, Tom Ivar Lund Nilsen, Paul Jarle Mork and 2 others
PMID 38214181WHAT IT FOUND
Inpatient multimodal rehabilitation nearly doubled the likelihood of sustainable return-to-work compared with outpatient care.
This benefit occurred regardless of whether pain, anxiety, or depression improved. Reducing symptoms at the end of treatment was not necessary for patients to return to work.
Key findings
01The inpatient intervention group had a hazard ratio for return-to-work of 1.96 compared with the outpatient programme.
02There was no evidence of mediation by pain intensity, as the indirect effect hazard ratio was 0.98.
03Weak suppression effects were observed for anxiety and depression, resulting in a slightly stronger direct effect of the intervention (HR 2.19).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Information about mediators (pain and mental distress) was missing for 26% of inpatient participants and 46% of outpatient participants, which could introduce selection bias. The study could not blind participants or caregivers to the intervention. Residual mediator-outcome confounding cannot be ruled out despite randomization. The analysis showed wide confidence intervals for the suppression effects of anxiety and depression, making these specific findings imprecise.
Declared interests
The authors have no conflicts of interest to declare.
The easy way to misread this
Do not assume that patients who do not report reduced pain or anxiety at the end of an inpatient programme have failed or will not return to work. The study shows that the return-to-work benefit occurred independently of symptom reduction.