Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial.

Autor:	Aasdahl L; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Unicare Helsefort Rehabilitation Centre, Rissa, Norway. lene.aasdahl@ntnu.no., Nilsen TIL; Department 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, Norway., Mork PJ; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway., Fimland MS; Unicare 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, Norway., Skarpsno ES; Department 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, Norway.
Jazyk:	angličtina
Zdroj:	Journal of rehabilitation medicine [J Rehabil Med] 2024 Jan 12; Vol. 56, pp. jrm18385. Date of Electronic Publication: 2024 Jan 12.
DOI:	10.2340/jrm.v56.18385
Abstrakt:	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.
Databáze:	MEDLINE
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