Discussion
pain-disability, disability, pain
SECONDARY
This study evaluated the effects of a preventive psychosocial intervention on employees reporting pain and stress-related ill-health compared to an active control intervention. No effects for the brief ECO intervention, relative to the control, were observed on the primary or secondary outcomes. It is possible the changed protocol due to the Covid-19 pandemic may have affected the results, but it is not possible to determine this. An indication of effect from the ECO on perceived social support from supervisor was noted, but this could have been due to chance and would need to be replicated. Preventive intervention trials are challenging in terms of estimations of expected effect size, power calculations, and identifying and including a target population at risk and this issue merits further discussion (see below).The positive effect of an intervention similar to the ECO program, reported in the previous study [The lower levels of pain-disability, as compared to the earlier study, might have affected how the intervention was received as well as effect sizes. Sample size did not allow for subgroup analyses of individuals at risk. Another indication that the sample was not a high risk population are results on moderate to good work ability according to the WAI, slightly lower than in a general population [Another possible explanation for our results is the brevity of the ECO intervention. Previous research indicates the workplace is an important arena for prevention of ill-health, and there are numerous examples of benefits on work disability of workplace involvement, and problem solving at the workplace for employees with work limitations [Employees in this study reported a relatively high prevalence of stress symptoms, which might have implications for the content of the interventions. Similar as for pain conditions, there is support for cognitive behavioral therapy as a treatment for stress-related diagnoses, and in addition as a form of occupational stress management [