Back to search

VAM-Velferd, arbeid og migrasjon

Can Motivational Interviewing facilitate Return-to-Work in sicklisted people with musculoskeletal disorders? a randomised trial within NAV

Alternative title: Har Motiverende Intervju effekt på raskere retur-til-arbeid hos sykemeldte med muskelskjelettsmerter ? et randomisert eksperiment innen NAV

Awarded: NOK 10.1 mill.

Musculoskeletal (MSK) disorders are the main cause of sickness absence and disability benefits in Norway, and the single leading cause of disability worldwide. Facilitating return to work (RTW) and preventing long-term sickness absence are critical concerns for the Norwegian Labour and Welfare Administration (NAV). Using Motivational Interviewing (MI) in the dialogue with people on sick leave has become a popular strategy in NAV, despite limited scientific evidence for the effectiveness of MI on RTW. Providing MI to all people on sick leave requires large resources from NAV. One way around this challenge is to use a stratified approach, based on screening, to target individuals with a high risk for long-term sickness absence. Stratified primary care enables us to identify the right people for the right treatment. The main objective of this MI-NAV project was therefore to evaluate the effectiveness and cost-effectiveness of usual case management alone (UC) with UC plus MI or UC plus Stratified Vocational Advice Intervention (SVAI) on RTW among people on sick leave due to MSK disorders. Secondary objectives were to investigate: 1) scientific evidence for the use of MI and the current NAV practice on counseling approaches in meetings with people on sick leave with MSKdisorders; 2) precision of screening tools in identifying in risk of prolonged sick leave; 3) the cost-effectiveness of adding MI or SVAI to usual NAV practice; 4) potential mediators on RtW; and 5) potential predictors of prolonged sick leave. All data collection in the MI-NAV project has been completed: In WP 1, the scientific evidence for the use of MI on people on sick leave with MSK disorders were investigated by a systematic mapping review. Current NAV practice were explored by survey and focus group interviews of NAV caseworkers on their experiences of the RTW process among people with MSK disorders. Three papers have been published on results from WP1. We have also contributed in two papers from the parallel MI-NAV project conducted in Trondheim, led by professor Egil Fors (NFR project 280431), which concerned overlapping topics for our WP1. In WP2, we carried out a prospective cohort study of 550 people on sick leave due to MSK disorder of 4 weeks or more, who were followed one year by NAV and healthcare registry data (ClinicalTrials.gov ID: NCT04196634). Four papers have been published, one protocol paper, two methodology papers on screening and health questionnaires, and one paper on sickness trajectories. One paper on a new prediction model and one paper on prognostic factors of high social costs are under review, and additional two papers are in progress. In WP3 we have conducted a multi-arm randomised controlled trial (RCT) within NAV in Norway (ClinicalTrials.gov ID: NCT03871712), including 450 included participants, aged 18-67 years, on 50-100% sick leave for >7 weeks due to MSK disorders. Primary outcomes were days of sickness absence at 6 and 12 months. The primary result was published in the Occupational and Environmental Medicine in Oct-2022, followed by publications of fidelity and process evaluations of both interventions. In 2023 the evaluation of cost-effectiveness and cost-benefits has been published, showing that adding MI to UC tended to be cost-effective, whereas adding SVAI to UC was cost-effective. In total 8 papers have been published based upon the trial data. In addition, there are at least three paper-works in progress. One of the three doctoral candidates in the project defended her thesis in 2022, and the two others submitted in autumn 2023. They have all presented their results on national and international conferences, meetings and seminars. The results have been presented in two annual meetings with involved NAV partners and stakeholders, and research collaborators. This project has provided important knowledge regarding the effectiveness of today’s case management in NAV, showing that two light-touch vocational advisory interventions (MI and SVAI) are cost-effective and cost-beneficial for people on sick leave due to MSK disorders. The results are important for policy and decision makers in health and social services. The findings from the MI-NAV project will be disseminated to different stakeholders throughout at a planned national meeting/seminar during spring 2024, and we have ongoing plans to implement the results in education programs within social welfare and health at OsloMet.

Musculoskeletal disorders is the main cause to sickness absence and disability benefits in Norway, and is the single leading cause of disability worldwide. Facilitating return to work (RtW) and preventing long-term sickness absence are critical concerns for the Norwegian Labour and Welfard Administration (NAV), as well as future health service. Using Motivational Interviewing (MI) in the dialogue with sick-listed people has become a popular strategy in NAV offices in Norway despite that there is limited evidence for the effect of MI on RtW outcomes. Providing MI interviews to all sick-listed people requires large resources from the NAV offices. One way around this challenge is to use a Stratified Primary Care approach based on screening and targeting of individuals with a high risk for long-term sickness absence. Stratified Primary Care for musculoskeletal disorders enables to identify the right people for the right treatment at the right time. This approach has succeeded in reducing time off work with 50% and lowered the levels of sickness absence among people with low back pain. Therefore, the primary objective for this study is to evaluate the effects of MI, provided by trained NAV case-workers, a Stratified Primary care including principles of MI and vocational advice provided by trained physiotherapists, and usual NAV practice with regards to facilitating RtW among people sick-listed due to a musculoskeletal disorder. The project consists of 3 work packages (WP); in WP1 the current practice of NAV in dealing with sick-listed people due to a musculoskeletal disorder will be explored, as well as the current evidence for using MI to facilitate RtW in musculoskeletal disorders. In WP2 a brief screening tool to identify the risk profile of the musculoskeletal disorders population will be tested among Norwegian people. In WP3 a randomized controlled trial with 3 arms will be conducted comparing the effects of a MI-intervention and Stratified Primary Care with ordinary NAV practice. A complete health-economy and mediation analysis will be included.

Publications from Cristin

No publications found

No publications found

No publications found

Funding scheme:

VAM-Velferd, arbeid og migrasjon