Biopsychosocial predictors and trajectories of work participation after transdiagnostic occupational rehabilitation of participants with mental and somatic disorders: a cohort study

Karen Walseth Hara^{1

2

3

4}, Johan Håkon Bjørngaard^{5

6}, Henrik Børsting Jacobsen^{7

8

9}, Petter C Borchgrevink^{7

10

8}, Roar Johnsen⁵, Tore C Stiles¹¹, Søren Brage¹², Astrid Woodhouse^{5

7

10}

Affiliations

¹ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. karen.w.hara@ntnu.no.
² Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway. karen.w.hara@ntnu.no.
³ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. karen.w.hara@ntnu.no.
⁴ The Norwegian Labour and Welfare Service of Trøndelag, Trondheim, Norway. karen.w.hara@ntnu.no.
⁵ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
⁶ Forensic Department and Research Centre Brøset, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway.
⁷ Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway.
⁸ Hysnes Rehabilitation Center, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway.
⁹ Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
¹⁰ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
¹¹ Department of Psychology, Faculty of Social Sciences and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
¹² The Norwegian Directorate for Labour and Welfare, Oslo, Norway.

PMID: 30111291
PMCID: PMC6094579
DOI: 10.1186/s12889-018-5803-0

Randomized Controlled Trial

Biopsychosocial predictors and trajectories of work participation after transdiagnostic occupational rehabilitation of participants with mental and somatic disorders: a cohort study

Karen Walseth Hara et al. BMC Public Health. 2018.

. 2018 Aug 15;18(1):1014.

doi: 10.1186/s12889-018-5803-0.

Authors

Affiliations

¹ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. karen.w.hara@ntnu.no.
² Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway. karen.w.hara@ntnu.no.
³ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. karen.w.hara@ntnu.no.
⁴ The Norwegian Labour and Welfare Service of Trøndelag, Trondheim, Norway. karen.w.hara@ntnu.no.
⁵ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
⁶ Forensic Department and Research Centre Brøset, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway.
⁷ Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway.
⁸ Hysnes Rehabilitation Center, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway.
⁹ Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
¹⁰ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
¹¹ Department of Psychology, Faculty of Social Sciences and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
¹² The Norwegian Directorate for Labour and Welfare, Oslo, Norway.

PMID: 30111291
PMCID: PMC6094579
DOI: 10.1186/s12889-018-5803-0

Abstract

Background: Group-based transdiagnostic occupational rehabilitation programs including participants with mental and somatic disorders have emerged in clinical practice. Knowledge is sparse on subsequent participation in competitive work. This study aimed to investigate trajectories for (re)entry to work for predefined subgroups in a diagnostically heterogeneous sample of sick-listed participants after completing occupational rehabilitation.

Methods: A cohort of 212 participants aged 18-69 on long-term sick leave (> 8 weeks) with chronic pain, chronic fatigue and/or common mental disorders was followed for one year after completing a 3½-week rehabilitation intervention based on Acceptance and Commitment Therapy. Self-reported, clinical and registry data were used to study the associations between predefined biopsychosocial predictors and trajectories for (re)entry to competitive work (≥ 1 day per week on average over 8 weeks). Generalized estimating equations analysis was used to investigate trajectories.

Results: For all biopsychosocial subgroups (re)entry to work increased over time. Baseline employment, partial sick leave and higher expectation of return to work (RTW) predicted higher probability of having (re)entered work at any given time after discharge. The odds of increasing reentry over time (statistical interaction with time) was weaker for the group receiving the benefit work assessment allowance compared with those receiving sickness benefit (OR = 0.92, p = 0.048) or for those on partial sick leave compared with full sick leave (OR 0.77, p < 0.001), but higher for those who at baseline had reported having a poor economy versus not (OR 1.16, p = 0.010) or reduced emotional functioning compared with not (OR 1.11, p = 0.012). Health factors did not differentiate substantially between trajectories.

Conclusions: Work participation after completing a transdiagnostic occupational rehabilitation intervention was investigated. Individual and system factors related to work differentiated trajectories for (re)entry to work, while individual health factors did not. Having a mental disorder did not indicate a worse prognosis for (re)entry to work following the intervention. Future trials within occupational rehabilitation are recommended to pivot their focus to work-related factors, and to lesser extent target diagnostic group.

Keywords: Acceptance and commitment therapy; Chronic pain; Comorbidity; Fatigue; Mental disorders; Musculoskeletal diseases; Prognosis; Return to work; Unemployment; Vocational rehabilitation.

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Conflict of interest statement

Ethics approval and consent to participate

All procedures performed in the study involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in the study. The study has been approved by the Regional Committee for Medical and Health Research Ethics in Central Norway (No.: 2010/2404).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Sociodemography: Generalized estimating equations analysis (GEE) of work participation over the first year after completing on-site rehabilitation. Participants are subgrouped by sociodemographic factors and their associated trajectories of work participation are presented. a Trajectory for work participation by gender. b Trajectory for work participation by age. c Trajectory for work participation by level of education. d Trajectory for work participation by personal economy

**Fig. 2**
Work and benefit factors: Generalized estimating equations analysis (GEE) of work participation over the first year after completing on-site rehabilitation. Participants are subgrouped by work and benefit factors and their associated trajectories of work participation are presented. a Trajectory for work participation by employment state. b Trajectory for work participation by type of benefit. c Trajectory for work participation by grading of sick leave. d Trajectory for work participation by type of work

**Fig. 3**
Psychological factors: Generalized estimating equations analysis (GEE) of work participation over the first year after completing on-site rehabilitation. Participants are subgrouped by psychological factors and their associated trajectories of work participation are presented. a Trajectory for work participation by expectation of RTW. b Trajectory for work participation by psychological flexibility. c Trajectory for work participation by work self-efficacy

**Fig. 4**
Health-related factors: Generalized estimating equations analysis (GEE) of work participation over the first year after completing on-site rehabilitation. Participants are subgrouped by health-related factors and their associated trajectories of work participation are presented. a Trajectory for work participation by pain state. b Trajectory for work participation by fatigue state. c Trajectory for work participation by self-reported mental distress. d Trajectory for work participation by diagnosis on sickness certificate. e Trajectory for work participation by interdisciplinary diagnosis. f Trajectory for work participation by sleep disturbance

**Fig. 5**
Functioning: Generalized estimating equations analysis (GEE) of work participation over the first year after completing on-site rehabilitation. Participants are subgrouped by functioning factors and their associated trajectories of work participation are presented. a Trajectory for work participation by emotional functioning. b Trajectory for work participation by physical functioning

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