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Randomized Controlled Trial
. 2015 May 13;17(5):e116.
doi: 10.2196/jmir.4097.

Effectiveness of a blended web-based intervention on return to work for sick-listed employees with common mental disorders: results of a cluster randomized controlled trial

Daniëlle Volker  1 , Moniek C Zijlstra-Vlasveld, Johannes R Anema, Aartjan Tf Beekman, Evelien Pm Brouwers, Wilco Hm Emons, A Gijsbert C van Lomwel, Christina M van der Feltz-Cornelis
Affiliations
Randomized Controlled Trial

Effectiveness of a blended web-based intervention on return to work for sick-listed employees with common mental disorders: results of a cluster randomized controlled trial

Daniëlle Volker et al. J Med Internet Res. .

Abstract

Background: Common mental disorders are strongly associated with long-term sickness absence, which has negative consequences for the individual employee's quality of life and leads to substantial costs for society. It is important to focus on return to work (RTW) during treatment of sick-listed employees with common mental disorders. Factors such as self-efficacy and the intention to resume work despite having symptoms are important in the RTW process. We developed "E-health module embedded in Collaborative Occupational health care" (ECO) as a blended Web-based intervention with 2 parts: an eHealth module (Return@Work) for the employee aimed at changing cognitions of the employee regarding RTW and a decision aid via email supporting the occupational physician with advice regarding treatment and referral options based on monitoring the employee's progress during treatment.

Objective: This study evaluated the effect of a blended eHealth intervention (ECO) versus care as usual on time to RTW of sick-listed employees with common mental disorders.

Methods: The study was a 2-armed cluster randomized controlled trial. Employees sick-listed between 4 and 26 weeks with common mental disorder symptoms were recruited by their occupational health service or employer. The employees were followed up to 12 months. The primary outcome measures were time to first RTW (partial or full) and time to full RTW. Secondary outcomes were response and remission of the common mental disorder symptoms (self-assessed).

Results: A total of 220 employees were included: 131 participants were randomized to the ECO intervention and 89 to care as usual (CAU). The duration until first RTW differed significantly between the groups. The median duration was 77.0 (IQR 29.0-152.3) days in the CAU group and 50.0 (IQR 20.8-99.0) days in the ECO group (hazard ratio [HR] 1.390, 95% CI 1.034-1.870, P=.03). No significant difference was found for duration until full RTW. Treatment response of common mental disorder symptoms did not differ significantly between the groups, but at 9 months after baseline significantly more participants in the ECO group achieved remission than in the CAU group (OR 2.228, 95% CI 1.115-4.453, P=.02).

Conclusions: The results of this study showed that in a group of sick-listed employees with common mental disorders, applying the blended eHealth ECO intervention led to faster first RTW and more remission of common mental disorder symptoms than CAU.

Trial registration: Netherlands Trial Register NTR2108; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2108. (Archived by WebCite at http://www.webcitation.org/6YBSnNx3P).

Keywords: anxiety; depression; mental health; occupational health; randomized controlled trial; sick leave.

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Conflict of interest statement

Conflicts of Interest: D Volker, Dr MC Zijlstra-Vlasveld, and Prof Dr CM van der Feltz-Cornelis reported that their employer (Trimbos-institute) received grants from ZonMw and grants from Achmea SZ when conducting this study. Prof Dr CM van der Feltz-Cornelis reported grants from Eli Lilly outside the submitted work. Prof Dr JR Anema reported being a chair in Insurance Medicine paid by the Dutch Social Security Agency and is a stockholder of Evalua LTD. Dr ATF Beekman reported grants from Eli Lilly, grants from Astra Zeneca, grants from Jansen, grants from Shire, personal fees from Eli Lilly, and personal fees from Lundbeck when conducting this study. Dr EPM Brouwers, Dr WHM Emons, and Dr AGC van Lomwel had nothing to disclose.

Figures

Figure 1
Figure 1
Overview of the ECO intervention.
Figure 2
Figure 2
Screenshot of Return@Work.
Figure 3
Figure 3
Flowchart of the clusters and participants.
Figure 4
Figure 4
Kaplan-Meier curve of time to first partial or full return to work (RTW).
Figure 5
Figure 5
Kaplan-Meier curve of time to full return to work (RTW).
See this image and copyright information in PMC

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