https://stolav.no/avdelinger/sentral-stab/fagavdelingen/hysnes-helsefort

Inpatient Multidiciplinary

Occupational Rehabilitation

(Slide design: Aasdahl)

Sigmund Gismervik MD, Ph.D. Candidate

sigmund.gismervik@ntnu.no

DISCLOSURE: The presenter has not received and will not receive any commercial

support related to this presentation or the work presented in this presentation.

Background

Aims

Design

The rehabilitation model

Results

Concluding remarks

8 of 10 will experience back pain

1 of 3 report current pain lasting > 6 months.

1 of 2 will fulfil criteria for a mental disorder

1 of 5 will experience depression

1 of 2 will experience suicidal thoughts >14 days

1 of 4 will experience an alcohol or drug problem

(1 of 2 marriages will end with divorce)

> 60% of sick leave is caused by PAIN or CMD

(Norwegian HUNT studies, Harris 2010, Kessler-Berglund 2005, SSB)

Eliza Josolyne (Admitted Februar 1857)

Diagnosis: Insanity caused by overwork

http://www.dailymail.co.uk/home/you/article-2141741/Sent-asylum-The-Victorian-women-locked-suffering-stress-post-natal-depression-anxiety.html

http://tidsskriftet.no/2015/06/tidligere-i-tidsskriftet/lysslottet-i-luster

http://www.vest-telemark.no/OPPLEV/AiR-fyller-25-aar

3 ½ week

of

I-MORE

AIM

Outpatient

single-

component

program

vs.

Identified in the National SocialSecurity System Registry

Randomization 1

Invitation«short study»

Randomization 2

Short inpatientprogram

OutpatientACT

Invitation«long study»

Untouched controlgroup

Long inpatientprogram(I-MORE)

Screening

Randomization 2

Sicknessabsence

Screening

Identified in the National SocialSecurity System Registry

Randomization 1

Invitation«short study»

Randomization 2

Short inpatientprogram

OutpatientACT

Invitation«long study»

Untouched controlgroup

Long inpatientprogram (I-MORE)

Screening

Randomization 2

Sicknessabsence

Screening

Participants

Sick listed2-12 months

At least 50%

18-60 years oldMusculoskeletal

Psycological(Fatigue)

http://genius.com/http://www.fastcompany.com/ http://www.redbubble.com http://medicalnegligence.center

(Slide design: Aasdahl)

Diagnosis

57 %

43 %

43 %

Pain Mental disorders(including fatigue)

ACT1

CO-

ORDINATE

EXERCISE

REHABILITATION MODEL

1 A-Tjak et.al. 2015 Meta-Analysis of Efficacy of

Acceptance and Commitment Therapy (ACT)

RESULTS• N= 166• 79% Female• 40 % Higher education• 10% Had no employer• Median days on sick leave

> 200• Similar baseline

86 I-MORE (3 ½ weeks)80 O-ACT (6 weeks)

http://www.blog.friskbrisrc.com/sick-leave-benefits-norway/

Days on sick-leave(cumulativ median)

Inpatient rehabilitation 85 (IQR 33-149)*

Outpatient ACT 117 (IQR 59-189)

*(Mann-Whitney U test, p=0.034)

RETURN TO WORK

(4 weeks without receiving any benefits)

http://all-free-download.com/free-photos/stairs_silhouettes_human_214194.html

Hazard ratio 1.9 (95% CI 1.2-3.0, p=0.009)

http://www.thesil.ca/the-sad-state-of-mental-health

* Anxiety/Depression (HADS)

* Level of pain (BPI)

* Quality of life (15D)

* Subjective health (SHC)

SELF REPORTED OUTCOMES

Pain improved in outpatient ACT at 12 months follow up (-1 on 1-10 numeric rating scale)

No other statistical significant differences found

http://isha.sadhguru.org/blog/podcast/action-receptivity-right-balance/

Identified in the National SocialSecurity System Registry

Randomization 1

Invitation«short study»

Randomization 2

Short inpatient(4+4 days)

OutpatientACT

Invitation«long study»

Untouched controlgroup

Long inpatientprogram

Screening

Randomization 2

Sicknessabsence

Screening

0.6

0.7

0.8

0.9

1.0

Hea

lth-r

ela

ted q

ualit

y o

f lif

e

start 3 months 6 months 12 months

Inpatient program

Outpatient program

Health-related quality of life 15D (0-1)

Aasdahl et al. Journal of Occupational Rehabilitation 2016

Summary (4+4 study)

No difference between a 4+4 days inpatient multimodal

occupational rehabilitation program and a 6 weeks of

outpatient ACT on sickness absence or health outcomes.

No evidence supporting implementation of the 4+4 days

inpatient program in ordinary practice.

Concluding remarks

3 ½ weeks of inpatient multimodal rehabilitation significantly

reduced sick-leave compared to 6 weeks of outpatient ACT.

Longer term health economic assessments are needed.

Integrating care for individuals with common mental and/or

pain disorders is a workable strategy within an ACT based

approach.

Thanks to all collaborators!

REFERENCES

• Fimland, M. S., et al. (2014). "Occupational rehabilitation programs for musculoskeletal pain and common mental health disorders: study protocol of a randomized controlled trial." BMC Public Health 14: 9.

• Aasdahl, L., et al. (2017). "Effect of Inpatient Multicomponent Occupational Rehabilitation Versus Less Comprehensive Outpatient Rehabilitation on Sickness Absence in Persons with Musculoskeletal- or Mental Health Disorders: A Randomized Clinical Trial." J Occup Rehabil.

• Aasdahl, L., et al. (2016). "Effects of Inpatient Multicomponent Occupational Rehabilitation versus Less Comprehensive Outpatient Rehabilitation on Somatic and Mental Health: Secondary Outcomes of a Randomized Clinical Trial." J Occup Rehabil.

• Hara, K. W., et al. (2017). "Transdiagnostic group-based occupational rehabilitation for participants withchronic pain, chronic fatigue and common mental disorders. A feasibility study." Disabil Rehabil: 1-11.

• Gismervik, S. O., et al. (2018). "The acceptance and commitment therapy model in occupational rehabilitationof musculoskeletal and common mental disorders: a qualitative focus group study." Disabil Rehabil: 1-11.

sigmund.gismervik@ntnu.no

THERE IS A CRACK IN EVERYTHING

…that’s how the light gets in

(Leonard Cohen)