Effects of a short-term occupational therapy intervention in an acute geriatric unit. A randomized clinical trial. Effect of an intervention to enhance guideline adherence of occupational physicians on return-to-work self-efficacy in workers sick-listed with common mental disorders Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial Observation-to-Imitate Plus Practice Could Add Little to Physical Therapy Benefits Within 31 Days of Stroke Evaluation of a motivational interview for substance use within psychiatric in-patient services. Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands 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 Faster return to work after psychiatric consultation for sicklisted employees with common mental disorders compared to care as usual. A randomized clinical trial Collaborative care for sick-listed workers with major depressive disorder: a randomised controlled trial from the Netherlands Depression Initiative aimed at return to work and depressive symptoms Adjuvant occupational therapy improves long-term depression recovery and return-to-work in good health in sick-listed employees with major depression: results of a randomised controlled trial
OBJECTIVES To compare the benefits of a short-term occupational therapy intervention ( OTI ) when added to the conventional treatment model ( CTM ) in the functional recovery of patients admitted to an acute geriatric unit ( AGU ) . STUDY DESIGN Non-pharmacological r and omized clinical trial . 400 patients were r and omized to OTI ( n = 198 ) or CTM ( n = 202 ) group . Mean age 83.5 . Interventions included needs assessment , iatrogenic prevention , retraining in activities of daily living , and instructions for caregivers in three groups of patients defined a priori ( cardiopulmonary disease , stroke , other conditions ) 5 days a week , 30 - 45 min a day . MAIN OUTCOME MEASURE Recovery of ≥ 10 Barthel index points by discharge . Secondary outcome was the reduction in confusional episodes . RESULTS The adjusted relative risk ( RR ) of functional recovery in the OTI group was 1.16 ( 95%CI 0.91 - 1.47 ) . In participants with cardiopulmonary disease was 1.57 ( 95%CI 1.06 - 2.32 ) , number needed to treat ( NNT ) 5 . Participants with other conditions assigned to OTI had a reduction in acute confusional episodes ; RR 0.48 ( 95 % CI 0.26 - 0.87 ) , NNT 7 . CONCLUSIONS Although overall there were no significant differences , patients with cardiopulmonary disease or non-stroke pathologies admitted to an AGU , may benefit from a short-term OTI Background Since a higher level of self-efficacy in common mental disorders is associated with earlier return-to-work ( RTW ) , it is important to know if work related self-efficacy can be increased by occupational health care . The primary aim of this study was to evaluate whether an intervention to enhance guideline adherence of occupational physicians lead to an increase in RTW self-efficacy in workers three months later . The secondary aim was to evaluate whether the intervention modified the association between RTW self-efficacy and return-to-work three months later . Methods A total of 66 occupational physicians participated in the study . They were r and omized into two groups ; the intervention group received a training , the control group did not . The training aim ed to enhance adherence to a mental health guideline that contained strategies that are supposed to enhance RTW self-efficacy . In 128 sick-listed workers guided by these occupational physicians , RTW self-efficacy , RTW , and personal , health-related and work-related variables were measured at baseline and three months later . Generalized linear mixed models analysis and linear mixed models analysis were used for the evaluations . Results In workers whose occupational physicians had received the training RTW self-efficacy increased significantly more than in workers whose occupational physicians had participated in the control group ( t = −2.626 , p ≤ .05 ) . Higher baseline RTW self-efficacy scores were significantly more often associated with full RTW than with no RTW three months later ( OR 2.20 , 95 % CI 1.18–4.07 ) , but the intervention did not affect this association . Conclusions This study showed that a training to enhance guideline adherence of occupational physicians leads to increased RTW self-efficacy in workers sick-listed with common mental disorders during the first months of sickness absence in a real-life occupational health care setting . This insight is helpful for optimizing the recovery and RTW process , and for underst and ing the role of RTW self-efficacy in this process . Trial registration IS RCT Background Common mental disorders ( CMD ) have a major impact on both society and individual workers , so return to work ( RTW ) is an important issue . In The Netherl and s , the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW . Evidence -based guidelines are available , but seem not to be effective in improving RTW in people with CMD . An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed . A blended E-health module embedded in collaborative occupational health care is now available , and comprises a decision aid supporting the occupational physician and an E-health module , Return@Work , to support sick-listed workers in the RTW process . The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual . Methods This study is a two-armed cluster r and omized controlled trial , with r and omization done at the level of occupational physicians . Two hundred workers with CMD on sickness absence for 4–26 weeks will be included in the study . Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention . Occupational physicians allocated to the care as usual group will give conventional sickness guidance . Follow-up assessment s will be done at 3 , 6 , 9 , and 12 months after baseline . The primary outcome is duration until RTW . The secondary outcome is severity of symptoms of CMD . An economic evaluation will be performed as part of this trial . Conclusion It is hypothesized that collaborative occupational health care intervention will be more (cost)-effective than care as usual . This intervention is innovative in its combination of a decision aid by email sent to the occupational physician and an E-health module aim ed at RTW for the sick-listed worker Background and Purpose . Observation of action with intention-to-imitate ( OTI ) might enhance motor recovery . This early phase trial investigated whether OTI followed by physical practice ( OTI + PP ) enhanced the benefits of conventional physical therapy ( CPT ) on upper limb recovery early after stroke . Methods . Participants were 3 to 31 days poststroke . They had substantial paresis and ability to imitate action with their ipsilesional arm . After baseline measures , participants were r and omized to either OTI + PP in addition to CPT or to CPT only . Outcome measures were made after 15 days of treatment . The measurement battery was the Motricity Index ( MI ) and the Action Research Arm Test ( ARAT ) . Change , baseline to outcome , was examined using the Wilcoxon test for within group and Mann – Whitney U test for between groups . Results . Sixty-five of 570 stroke survivors were eligible , 55 were able to imitate , 37 gave informed consent , 7 were transferred out of area before baseline , and 29 were r and omized . Outcome measures were completed with 13 CPT participants and 9 OTI + PP participants . Both groups showed statistically significant improvements for the MI  ( CPT median change 8 , P = .003 ; OTI + PP median change 10 , P = .012 ) but the median ( 95 % confidence interval [ CI ] ) between-group difference was 0.0 ( −11 , 16 ) , P = 1.000 . For the ARAT , only the CPT group showed a statistically significant improvement ( median 9 , P = .006 ) . The median ( 95 % CI ) between-group difference of 1.0 ( −18 , 23 ) was not statistically significant ( P = .815 ) . Conclusions . These findings suggest that OTI + PP might add little to the benefits of CPT early after stroke AIMS To assess the effectiveness of a motivational interview among hospitalized psychiatric patients with comorbid substance use disorder in reducing alcohol and other drug ( AOD ) use . DESIGN Subjects were assigned r and omly to receive an individual motivational interview ( n=79 ) or a self-help booklet ( control condition ; n=81 ) . SETTING Subjects were volunteers recruited from a major public psychiatric hospital . PARTICIPANTS Subjects met abuse or dependence criteria on the structured clinical interview for diagnosis ( SCID ) for alcohol , cannabis or amphetamine or they reported hazardous use during the last month of one or more of these drug types on the opiate treatment index ( OTI ) . INTERVENTION Either one 30 - 45-minute motivational interview or brief advice . MEASUREMENTS The SCID and OTI were the main measures . FINDINGS There was a modest short-term effect of the motivational interview on an aggregate index of alcohol and other drug use ( polydrug use on the OTI ) . Cannabis use remained high among the sample over the 12-month follow-up period . CONCLUSION Although motivational interviewing appears feasible among in- patients in psychiatric hospital with comorbid substance use disorders , more extensive interventions are recommended , continuing on an out-patient basis , particularly for cannabis use Objectives To support return to work ( RTW ) among cancer patients , a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy . The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes . Design Longitudinal prospect i ve intervention study using a one-group design . Setting Two hospitals in the Netherl and s. Participants Of the eligible patients , 56 % participated ; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included . Patients completed question naires on RTW , the importance of work , work ability ( WAI ) , RTW self-efficacy , fatigue ( MFI ) , and quality of life ( EORTC QLQ C-30 ) at baseline and 6 , 12 and 18 months follow-up . Before and after the exercise programme 1-repetition maximum ( 1RM ) muscle strength and cardiorespiratory fitness ( VO2 peak ) were assessed . Results Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme , 59 % of the cancer patients returned to work , 86 % at 12 months and 83 % at 18 months . In addition , significant improvements ( p<0.05 ) in the importance of work , work ability , RTW self-efficacy , and quality of life were observed , whereas fatigue levels were significantly reduced . After completing the exercise programme , 1RM muscle strength was significantly increased but there was no improvement in VO2 peak level . Conclusions RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme . A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW , reduced fatigue and increased importance of work , work ability , and quality of life 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 aim ed 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 r and omized 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 r and omized 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 Netherl and s Trial Register NTR2108 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2108 . ( Archived by WebCite at http://www.webcitation.org/6YBSnNx3P ) Introduction Return to work ( RTW ) of employees on sick leave for common mental disorders may require a multidisciplinary approach . This article aims to assess time to RTW after a psychiatric consultation providing treatment advice to the occupational physician ( OP ) for employees on sick leave for common mental disorders in the occupational health ( OH ) setting , compared to care as usual ( CAU ) . Methods Cluster r and omized clinical trial evaluating patients of 12 OPs receiving consultation by a psychiatrist , compared to CAU delivered by 12 OPs in the control group . 60 patients suffering from common mental disorders and ≥ six weeks sicklisted were included . Follow up three and six months after inclusion . Primary outcome measure was time to RTW . Intention- to-treat multilevel analysis and a survival analysis were performed to evaluate time to RTW in both groups . Results In CAU , referral was the main intervention . Both groups improved in terms of symptom severity and quality of life , but time to RTW was significantly shorter in the psychiatric consultation group . At three months follow up , 58 % of the psychiatric consultation group had full RTW versus 44 % of the control group , a significant finding ( P = 0.0093 ) . Survival analysis showed 68 days earlier RTW after intervention in the psychiatric consultation group ( P = 0.078 ) compared to CAU . Conclusion Psychiatric consultation for employees on sick leave in the OH setting improves time to RTW in patients with common mental disorders as compared to CAU . In further research , focus should be on early intervention in patients with common mental disorders on short sick leave duration  . Psychiatric consultation might be particularly promising for improvement of RTW in those patients . Trial registration number IS RCT N : Objectives Major depressive disorder ( MDD ) is associated with absenteeism . In this study , the effectiveness of collaborative care , with a focus on return to work ( RTW ) , was evaluated in its effect on depressive symptoms and the duration until RTW in sick-listed workers with MDD in the occupational health setting . Methods In this r and omised controlled trial , 126 sick-listed workers with MDD were r and omised to usual care  ( N=61 ) or  collaborative care  ( N=65 ) . Collaborative care was applied by the occupational physician care manager , supported by a web-based tracking system and a consultant psychiatrist . Primary outcome measure was time to response . Secondary outcome measures were time to remission , depressive symptoms as continuous measure and the duration until full RTW . Results Collaborative care participants had a shorter time to response , with a difference of 2.8 months . However , no difference was found on time to remission or depressive symptoms as continuous measure . With a mean of 190 days in the collaborative care group , and 210 days in the usual care group , the groups did not differ significantly from each other in the duration until full RTW . Adherence to the collaborative care intervention was low . Conclusions These results do not justify a widespread implementation of collaborative care in occupational healthcare , as it was operationalised in this study . However , since the study might have been underpowered for RTW and because treatment integrity was low , further research , with larger sample sizes , is needed to develop the best fitting ( collaborative care ) model for addressing RTW in depressed sick-listed workers . Trial registration : IS RCT Objectives To evaluate whether adjuvant occupational therapy ( OT ) can improve the effectiveness of treatment-as-usual ( TAU ) in sick-listed employees with major depression . Methods In total , 117 employees sick-listed for a median duration of 4.8 months ( IQR=2.6 to 10.1 months ) because of major depression were r and omised to TAU  ( n=39 ) or adjuvant OT ( TAU+OT ; n=78 ) . OT ( 18 sessions ) focussed on a fast return to work ( RTW ) and improving work-related coping and self-efficacy . The primary outcome was work participation ( hours of absenteeism+ duration until partial/full RTW ) . Secondary outcomes were depression , at-work functioning , and health-related functioning . Intermediate outcomes were work-related , coping and self-efficacy . Blinded assessment s occurred at baseline and 6 , 12 and 18 months follow-up . Results The groups did not significantly differ in their overall work participation ( adjusted group difference=−1.9 , 95 % CI −19.9 to + 16.2 ) . However , those in TAU+OT did show greater improvement in depression symptoms ( −2.8 , −5.5 to −0.2 ) , an increased probability of long-term symptom remission ( + 18 % , + 7 % to + 30 % ) , and increased probability of long-term RTW in good health ( GH ) ( + 24 % , 12 % to 36 % ) . There were no significant group differences in the remaining secondary /intermediate outcomes . Conclusions In a highly impaired population , we could not demonstrate significant benefit of adjuvant OT for improving overall work participation . However , adjuvant OT did increase long-term depression recovery and long-term RTW in GH ( ie , full RTW while being remitted , and with better work and role functioning ) . Trial Registration Dutch Trial Register NTR2057
Results show systematic review ing of OTIs on RTW was challenging due to varying population s , different outcome measures , and poor descriptions of methodology .
There is evidence that OTIs as part of rehabilitation programs , increase RTW rates , although the method ological evidence of most studies is weak .
Background The primary aim of this review study was to gather evidence on the effectiveness in terms of return to work ( RTW ) of occupational therapy interventions ( OTIs ) in rehabilitation patients with non-congenital disorders .
A secondary aim was to be able to select the most efficient OTI .