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Venter M, Grotle M, Øiestad BE, Aanesen F, Tingulstad A, Rysstad T, Ferraro MC, McAuley JH, Cashin AG. Treatment Effect Modifiers for Return-to-Work in Patients With Musculoskeletal Disorders. THE JOURNAL OF PAIN 2024:104556. [PMID: 38710259 DOI: 10.1016/j.jpain.2024.104556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024]
Abstract
Investigating how individual characteristics modify treatment effects can improve understanding, interpretation, and translation of trial findings. The purpose of this secondary analysis was to identify treatment effect modifiers of the MI-NAV trial, a 3 arm, parallel randomized controlled trial which compared motivational interviewing and stratified vocational advice intervention in addition to usual case management (UC), to UC alone. This study included (n = 514) participants with musculoskeletal disorders on sick leave for at least 50% of their contracted work hours for at least 7 consecutive weeks with the Norwegian Labour and Welfare Administration. Sickness absence days was the primary outcome, measured from baseline assessment date until the 6-month follow-up. Potential treatment effect modifiers, identified a priori and informed by expert consultation and literature, were evaluated using linear regression models and statistical interaction tests. For motivational interviewing versus UC, age (mean difference [MD] -.7, 95% confidence interval [CI] -1.5 to .2; P = .13) and self-perceived health status (MD -.3, 95% CI -.7 to .1; P = .19) were identified as potential effect modifiers (P ≤ .2). For stratified vocational advice intervention versus UC, analgesic medication use (MD -26.2, 95% CI -45.7 to -6.7; P = .009) was identified as a treatment effect modifier (P ≤ .05). These findings may assist in more targeted treatment adaptation and translation as well as the planning of future clinical trials. PERSPECTIVE: This secondary analysis of the MI-NAV trial found that analgesic medication use, age, and self-perceived health may modify the effect of 2 vocational interventions on reducing sickness absence in people with musculoskeletal disorders.
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Affiliation(s)
- Martjie Venter
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia.
| | - Margreth Grotle
- Centre for Intelligent Musculoskeletal Health, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway; Research and Communication Unit for MSK Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Britt Elin Øiestad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Fiona Aanesen
- National Institute of Occupational Health, Oslo, Norway
| | - Alexander Tingulstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Tarjei Rysstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia; School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia; School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia; School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Tingulstad A, Maas ET, Rysstad T, Øiestad BE, Aanesen F, Pripp AH, Van Tulder MW, Grotle M. Six-month cost-effectiveness of adding motivational interviewing or a stratified vocational advice intervention to usual case management for workers with musculoskeletal disorders: the MI-NAV economic evaluation. J Occup Med Toxicol 2023; 18:25. [PMID: 37964240 PMCID: PMC10644648 DOI: 10.1186/s12995-023-00394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES This study evaluates the six-month cost-effectiveness and cost-benefits of motivational interviewing (MI) or a stratified vocational advice intervention (SVAI) added to usual case management (UC) for workers on sick leave due to musculoskeletal disorders. METHODS This study was conducted alongside a three-arm RCT including 514 employed workers on sick leave for at least 50% for ≥ 7 weeks. All participants received UC. The UC + MI group received two MI sessions, and the UC + SVAI group received 1-4 SVAI sessions. Sickness absence days, quality-adjusted life-years (QALYs), and societal costs were measured between baseline and six months. RESULTS Adding MI to UC, resulted in incremental cost-reduction of -2580EUR (95%CI -5687;612), and a reduction in QALYs of -0.001 (95%CI -0.02;0.01). Secondly, adding MI to UC resulted in an incremental cost-reduction of -538EUR (95%CI -1358;352), and reduction of 5.08 (95%CI -3.3;13.5) sickness-absence days. Financial return estimates were positive, but not statistically significant. Adding SVAI to UC, resulted in an incremental cost-reduction of -2899 EUR (95% CI -5840;18), and a reduction in QALYs of 0.002 (95% CI -0.02;0.01). Secondly, adding SVAI to UC resulted in an statistically significant incremental cost-reduction of -695 EUR (95% CI -1459;-3), and a reduction of 7.9 (95% CI -0.04;15.9) sickness absence days. Financial return estimates were positive and statistically significant. The probabilities of cost-effectiveness for QALYs were high for adding MI or SVAI (ceiling ratio 0.90). CONCLUSIONS In comparison to UC only, adding MI to UC tends to be cost-effective. Adding SVAI to UC is cost-effective for workers on sick leave due to musculoskeletal disorders. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT03871712).
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Affiliation(s)
- Alexander Tingulstad
- Department of Rehabilitation and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, St.Olavs Plass, P.O. Box 4, Oslo, 0130, Norway.
| | - Esther T Maas
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and the Amsterdam Movement Sciences Research Institute, de Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands
| | - Tarjei Rysstad
- Department of Rehabilitation and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, St.Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Britt Elin Øiestad
- Department of Rehabilitation and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, St.Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Fiona Aanesen
- National Institute of Occupational Health, Majorstuen, P.O. Box 5330, Oslo, 0304, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, St.Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Maurits W Van Tulder
- Faculty Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - Margreth Grotle
- Department of Rehabilitation and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, St.Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Ullevål, Building 37B, P.O. Box 4956, Oslo, Nydalen, 0424, Norway
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Amundsen PA, Underwood M, Burton K, Grotle M, Malmberg-Heimonen I, Kisa A, Småstuen MC, Holmgard TE, Martinsen A, Lothe J, Irgens PMS, Højen M, Monsen SS, Froud R. Individual supported work placements (ReISE) for improving sustained return to work in unemployed people with persistent pain: study protocol for a cohort randomised controlled trial with embedded economic and process evaluations. Trials 2023; 24:179. [PMID: 36906593 PMCID: PMC10006572 DOI: 10.1186/s13063-023-07211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/01/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Around one-third of workdays lost in Norway are due to musculoskeletal conditions, with persistent (chronic) pain being the most frequent cause of sick leave and work disability. Increasing work participation for people with persistent pain improves their health, quality of life, and well-being and reduces poverty; however, it is not clear how to best help unemployed people who have persistent pain to return to work. The aim of this study is to examine if a matched work placement intervention featuring case manager support and work-focused healthcare improves return to work rates and quality of life for unemployed people in Norway with persistent pain who want to work. METHODS We will use a cohort randomised controlled approach to test the effectiveness and cost-effectiveness of a matched work placement intervention featuring case manager support and work-focused healthcare compared to those receiving usual care in the cohort alone. We will recruit people aged 18-64, who have been out of work for at least 1 month, had pain for more than 3 months, and want to work. Initially, all (n = 228) will be recruited to an observational cohort study on the impact of being unemployed with persistent pain. We will then randomly select one in three to be offered the intervention. The primary outcome of sustained return to work will be measured using registry and self-reported data, while secondary outcomes include self-reported levels of health-related quality of life and physical and mental health. Outcomes will be measured at baseline and 3, 6, and 12 months post-randomisation. We will run a process evaluation parallel to the intervention exploring implementation, continuity of the intervention, reasons for participating, declining participation, and mechanisms behind cases of sustained return to work. An economic evaluation of the trial process will also be conducted. DISCUSSION The ReISE intervention is designed to increase work participation for people with persistent pain. The intervention has the potential to improve work ability by collaboratively navigating obstacles to working. If successful, the intervention may be a viable option for helping people in this population. TRIAL REGISTRATION ISRCTN Registry 85,437,524 Registered on 30 March 2022.
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Affiliation(s)
- Pål André Amundsen
- School of Health Sciences, Kristiana University College, PB 1190, Sentrum, 0107, Oslo, Norway.
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Kim Burton
- Professor of Occupational Healthcare, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| | - Ira Malmberg-Heimonen
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| | - Adnan Kisa
- School of Health Sciences, Kristiana University College, PB 1190, Sentrum, 0107, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| | - Thor Einar Holmgard
- User representative from the Norwegian Back Pain Association, Fjellhagen, P.O. Box 9612, 3065, Drammen, Norway
| | - Amy Martinsen
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Ullevål, Building 37B, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Jakob Lothe
- Co/FORMI, The Norwegian Council for Musculoskeletal Health, Oslo Universitetssykehus, Nydalen, P.O. Box 4956, 0424, Oslo, Norway
| | | | - Magnus Højen
- School of Health Sciences, Kristiana University College, PB 1190, Sentrum, 0107, Oslo, Norway
| | | | - Robert Froud
- School of Health Sciences, Kristiana University College, PB 1190, Sentrum, 0107, Oslo, Norway.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Aanesen F, Øiestad BE, Grotle M, Løchting I, Solli R, Sowden G, Wynne-Jones G, Storheim K, Eik H. Implementing a Stratified Vocational Advice Intervention for People on Sick Leave with Musculoskeletal Disorders: A Multimethod Process Evaluation. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:306-318. [PMID: 34606049 PMCID: PMC8489360 DOI: 10.1007/s10926-021-10007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
Purpose To perform a process evaluation of a stratified vocational advice intervention (SVAI), delivered by physiotherapists in primary care, for people on sick leave with musculoskeletal disorders participating in a randomised controlled trial. The research questions concerned how the SVAI was delivered, the content of the SVAI and the physiotherapists' experiences from delivering the SVAI. Methods We used qualitative and quantitative data from 148 intervention logs documenting the follow-up provided to each participant, recordings of 18 intervention sessions and minutes from 20 meetings with the physiotherapists. The log data were analysed with descriptive statistics. A qualitative content analysis was performed of the recordings, and we identified facilitators and barriers for implementation from the minutes. Results Of 170 participants randomised to the SVAI 152 (89%) received the intervention and 148 logs were completed. According to the logs, 131 participants received the correct number of sessions (all by telephone) and 146 action plans were developed. The physiotherapists did not attend any workplace meetings but contacted stakeholders in 37 cases. The main themes from the recorded sessions were: 'symptom burden', 'managing symptoms', 'relations with the workplace' and 'fear of not being able to manage work'. The physiotherapists felt they were able to build rapport with most participants. However, case management was hindered by the restricted number of sessions permitted according to the protocol. Conclusion Overall, the SVAI was delivered in accordance with the protocol and is therefore likely to be implementable in primary care if it is effective in reducing sick leave.
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Affiliation(s)
- Fiona Aanesen
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
| | | | - Margreth Grotle
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Ida Løchting
- Research and Communication Unit for MSK Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Rune Solli
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Gail Sowden
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
- Connect Health, Newcastle upon Tyne, UK
| | - Gwenllian Wynne-Jones
- School of Medicine, and School of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Kjersti Storheim
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for MSK Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Hedda Eik
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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Løchting I, Hagen R, Monsen CK, Grotle M, Storheim K, Aanesen F, Øiestad BE, Eik H, Bagøien G. Fidelity of a Motivational Interviewing Intervention for Improving Return to Work for People with Musculoskeletal Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910324. [PMID: 34639624 PMCID: PMC8507704 DOI: 10.3390/ijerph181910324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
The objective of this study was to conduct a fidelity evaluation of a motivational interviewing (MI) intervention delivered by social insurance caseworkers, in a three-arm randomized controlled trial (RCT) for improving return to work for people on sick leave with musculoskeletal disorders. The caseworkers received six days of MI training, including an intervention manual prior to the trial onset, as well as supervision throughout the trial. The caseworkers recorded 21 MI sessions at regular intervals during the trial. An independent MI analysis center scored the recordings using the MI treatment integrity code (MITI 4). In addition, three experienced MI trainers assessed the adherence to the MI intervention manual on a 1–4 Likert scale and MI competence. Total MITI 4 mean scores were at beginning proficiency levels for two components (global technical, mean 3.0; SD 0.6 and the reflections/questions ratio, mean 1.1; SD 0.2) and under beginning proficiency for two components (global relational, mean 3.2; SD 0.7 and complex question, mean 34.0; SD 21.2). The MI trainers’ assessment showed similar results. The mean adherence score for the MI sessions was 2.96 (SD 0.9). Despite delivering a thorough course and supervision package, most of the caseworkers did not reach proficiency levels of good MI competence during the study. The fidelity evaluation showed that a large amount of training, supervision and practice is needed for caseworkers to become competent MI providers. When planning to implement MI, it is important that thorough consideration is given regarding the resources and the time needed to train caseworkers to provide MI in a social insurance setting.
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Affiliation(s)
- Ida Løchting
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956, 0424 Oslo, Norway; (M.G.); (K.S.)
- Correspondence: ; Tel.: +47-9183-2700
| | - Roger Hagen
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway;
- Department of Psychology, Norwegian University of Science and Technology, P.O. Box 8900, 7491 Trondheim, Norway
- Research Institute, Modum Bad, P.O. Box 33, 3370 Vikersund, Norway
| | - Christine K. Monsen
- Division of Mental Health & Addiction, Vestfold Hospital Trust, P.O. Box 2168, 3103 Tønsberg, Norway;
| | - Margreth Grotle
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956, 0424 Oslo, Norway; (M.G.); (K.S.)
- Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. Box 4, 0130 Oslo, Norway; (F.A.); (B.E.Ø.); (H.E.)
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956, 0424 Oslo, Norway; (M.G.); (K.S.)
- Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. Box 4, 0130 Oslo, Norway; (F.A.); (B.E.Ø.); (H.E.)
| | - Fiona Aanesen
- Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. Box 4, 0130 Oslo, Norway; (F.A.); (B.E.Ø.); (H.E.)
| | - Britt Elin Øiestad
- Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. Box 4, 0130 Oslo, Norway; (F.A.); (B.E.Ø.); (H.E.)
| | - Hedda Eik
- Department of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, P.O. Box 4, 0130 Oslo, Norway; (F.A.); (B.E.Ø.); (H.E.)
| | - Gunnhild Bagøien
- Nidelv Community Mental Health Centre, Department of Mental Health, Trondheim University Hospital, P.O. Box 3250, 7006 Trondheim, Norway;
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