title: Work status and health-related quality of life following multimodal work hardening: a cluster randomised trial.
abstract: BACKGROUND
  Systematic reviews have confirmed the effectiveness of work-related rehabilitation with significant cognitive-behavioural components for patients with musculoskeletal disorders (MSDs). In Germany, however, work-related rehabilitation focuses mainly on functional capacity training and less on psychosocial work demands.
  
  
  OBJECTIVE
  To evaluate the efficacy of multimodal work hardening (MWH) with a cognitive-behavioural approach.
  
  
  METHODS
  Patients with MSDs resulting in severe restriction of work ability were randomly assigned to treatment by either MWH or conventional musculoskeletal rehabilitation (controls). The primary outcome was work status. The work status at 6 months of follow-up was defined as positive if the patient was working and had ≤ 6 weeks of sick leave, and that at 12 months was defined as positive if the patient was working and had ≤12 weeks of sick leave. Follow-up data were collected by postal questionnaires.
  
  
  RESULTS
  236 patients consented to participate. Follow-up data were obtained from 169 (71.6%) participants at 6 months and 146 (61.9%) participants at 12 months. At 6 months, participants in the MWH group had a 2.4 times higher chance of a positive work status than the controls (OR=2.363; 95% CI: 1.266 to 4.410; p=0.007). At 12 months, the chances of a positive work status were still higher, but this difference was not statistically significant (OR=1.914; 95% CI: 0.849 to 4.317; p=0.118). Significance of the interaction term of treatment and time indicated more favourable outcomes for depression and anxiety, mental and physical health-related quality of life, and pain management in the MWH group.
  
  
  CONCLUSIONS
  MWH improves health-related quality of life and is able to enhance the mid-term chances of work-life participation.
authors.affiliation: Department of Rehabilitation Medicine, Coordination Centre for Applied Rehabilitation Research, Hannover Medical School, Germany. bethge.matthias@mh-hannover.de
authors.forename: M
authors.initials: M
authors.lastname: Bethge
authors.forename: D
authors.initials: D
authors.lastname: Herbold
authors.forename: L
authors.initials: L
authors.lastname: Trowitzsch
authors.forename: C
authors.initials: C
authors.lastname: Jacobi
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000523:psychology / Q000534:rehabilitation*; D059408:Pain Management; D011788:Quality of Life; D012050:Rehabilitation, Vocational / Q000379:methods*; D018582:Sick Leave; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014937:Work