Strengths and weaknesses
SECONDARY, RECRUITMENT
The strengths of this study are several. The trial was accomplished entirely in primary care. All participating PCC personnel as well as research personnel had very good contextual knowledge, and the intervention was adapted to a level possible to conduct in a Swedish primary care context with low level of resources for direct workplace intervention and cooperation. The intervention model was person-centred and emphasised the individual’s perceptions of workplace conditions facilitating own RTW. We succeeded in achieving the planned sample size of patients, despite the occurrence of the COVID-19 epidemic during the last 3 months before the 12 months follow-up was finalised for the latest included participants.Among limitations, the risk of identification and recruitment bias was a limitation since providers were aware of being in the intervention or control arm. More patients participated in the intervention arm than in the control arm, and there were some differences between the arms in the baseline characteristics of recruited patients. The impact that COVID-19 could have had on the last months of follow-up for RTW and 12 months sick leave duration should also be mentioned. However, this effect should have been comparable in the control group. Another limitation was that only around 55% of patients in the intervention group took part in the person-centred dialogue meeting. A major reason for this was that the dialogue meeting was not deemed relevant or needed for the patients with early RTW in the fast rehabilitation process, and this was mostly due to the patient’s own preference. Another limitation was that multiplicity was not accounted for in the analyses of secondary outcomes.The complexity of the intervention based on the individual patient’s preferences, needs and values, a structured cooperation among GP, care manager and rehabilitation coordinator and a person-centred dialogue meeting with employer could be called into question concerning possible biasing factors. However, primary care is a complex clinical context where the handling of care problems is guided by the individual patient’s needs as the starting point, and the pragmatic design of the trial compensates at least partly for multiple biasing factors.A further limitation was that the trial was only possible to carry out in a primary healthcare system where a collaborative care model and team-based care were implemented. However, the collaborative care model with a care manager function has also been implemented in several European countries such as the UK, Netherlands and Italy, in addition to Canada and the USA.