Return to Work in Employees on Sick Leave due to Neck or Shoulder Pain: A Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention with One-Year Register-Based Follow-Up.
Line Thorndal Moll, Ole Kudsk Jensen, Berit Schiøttz-Christensen and 4 others
PMID 28836120WHAT IT FOUND
Adding a case manager and multidisciplinary team to a brief clinical examination did not improve return to work rates for employees on sick leave with neck or shoulder pain.
Both groups had similar outcomes at one year, suggesting the brief intervention was sufficient.
Key findings
01The proportion of participants returning to work within one year was 59% in the multidisciplinary group and 58% in the brief intervention group, with no significant difference in the hazard ratio.
02There was no significant difference between the groups in the likelihood of achieving a clinically important reduction in pain or in disability scores at one-year follow-up.
03Workplace involvement, such as roundtable discussions, occurred in only 22% of the multidisciplinary group, which may explain the lack of additional benefit over brief care.
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
The study was underpowered, with a 30% risk of type 2 errors, meaning a true difference might have been missed. Workplace involvement was optional and occurred in only 22% of the multidisciplinary group, potentially diluting the effect of the intervention. High dropout rates for secondary outcomes (n=89) may introduce bias in pain and disability results. Participants had severe pain and psychosocial risk factors at baseline, which may limit generalizability to less complex cases. Blinding of participants and providers to the intervention was not possible.
Declared interests
Funded by TrygFonden, Helga og Peter Kornings Fond, Gigtforeningen, Aarhus Universitet, and Aase og Ejnar Danielsens Fond. No conflicts of interest were declared.
The easy way to misread this
Do not conclude that multidisciplinary interventions are ineffective for return to work. The lack of difference may be due to the low rate of workplace involvement in the multidisciplinary group, not the intervention model itself. The study was also underpowered to detect small differences.