Work-directed rehabilitation or physical activity to support work ability and mental health in common mental disorders: a pilot randomized controlled trial

• Published in: Clinical rehabilitation 2020-02, Vol.34 (2), p.170-181
• Main Authors: Danielsson, Louise, Waern, Margda, Hensing, Gunnel, Holmgren, Kristina
• Format: Article
• Language: English
• Subjects: Ability; Adult; Antidepressants; Anxiety; Anxiety Disorders - physiopathology; Anxiety Disorders - psychology; Anxiety Disorders - rehabilitation; Attendance; burden; Clinical trials; cognitive-behavioral therapy; Critical incidents; Depression; Depressive Disorder - physiopathology; Depressive Disorder - psychology; Depressive Disorder - rehabilitation; Discontinued; disease; Exercise; Exercise Therapy - methods; Feasibility; Female; global; Health care; Humans; intervention; major depression; Male; Mental depression; Mental disorders; Mental Health; Middle Aged; Neurosciences; Neurovetenskaper; Occupational therapy; Physical activity; Physical therapy; physiotherapy; Pilot Projects; Primary care; Quality of Life; Rehabilitation; return; sick leave; Sweden; vocational; Well being; women; Work; Work Capacity Evaluation
• ISSN: 0269-2155; 1477-0873
• DOI: 10.1177/0269215519880230

Objective: To evaluate feasibility and potential effectiveness of work-directed rehabilitation in people with common mental disorders. Design: Pilot randomized controlled trial. Setting: Primary healthcare, Sweden. Subjects: Working adults (n = 42) of mean age 46.2 ± 11.1 years with depression or anxiety disorder. Interventions: Eight weeks of work-directed rehabilitation (n = 21) or physical activity (n = 21). Work-directed rehabilitation included sessions with a physiotherapist and/or an occupational therapist, to develop strategies to cope better at work. Physical activity included a planning session and access to a local gym. Main measures: Feasibility: attendance, discontinuation and adverse events. Measurements were the Work Ability Index, the Global Assessment of Functioning, the Montgomery–Asberg Depression Rating Scale, the Beck Anxiety Inventory and the World Health Organization—Five Well-Being Index. Results: Attendance to rehabilitation sessions was 88% (n = 147/167) and discontinuation rate was 14% (n = 3/21). No serious adverse events were reported. Within both groups, there was a significant improvement in Work Ability Index score (mean change: 3.6 (95% confidence interval (CI): 0.45, 6.7) in work-directed rehabilitation and 3.9 (95% CI: 0.9, 7.0) in physical activity) with no significant difference between groups. For the other outcomes, significant improvements were found within but not between groups. Per-protocol analysis showed a trend toward the antidepressant effect of work-directed rehabilitation compared to physical activity (mean difference in depression score −3.1 (95% CI: −6.8, 0.4), P = 0.075). Conclusion: Work-directed rehabilitation was feasible to persons with common mental disorders and improved their work ability and mental health. Comparable improvements were seen in the physical activity group. Suggested modifications for a larger trial include adding a treatment-as-usual control.