title: Effectiveness of a multidisciplinary care program on recovery and return to work of patients after gynaecological surgery; design of a randomized controlled trial.
abstract: BACKGROUND
  Return to work after gynaecological surgery takes much longer than expected, irrespective of the level of invasiveness. In order to empower patients in recovery and return to work, a multidisciplinary care program consisting of an e-health intervention and integrated care management including participatory workplace intervention was developed.
  
  
  METHODS
  We designed a randomized controlled trial to assess the effect of the multidisciplinary care program on full sustainable return to work in patients after gynaecological surgery, compared to usual clinical care. Two hundred twelve women (18-65 years old) undergoing hysterectomy and/or laparoscopic adnexal surgery on benign indication in one of the 7 participating (university) hospitals in the Netherlands are expected to take part in this study at baseline. The primary outcome measure is sick leave duration until full sustainable return to work and is measured by a monthly calendar of sickness absence during 26 weeks after surgery. Secondary outcome measures are the effect of the care program on general recovery, quality of life, pain intensity and complications, and are assessed using questionnaires at baseline, 2, 6, 12 and 26 weeks after surgery.
  
  
  CONCLUSIONS
  The discrepancy between expected physical recovery and actual return to work after gynaecological surgery contributes to the relevance of this study. There is strong evidence that long periods of sick leave can result in work disability, poorer general health and increased risk of mental health problems. We expect that this multidisciplinary care program will improve peri-operative care, contribute to a faster return to work of patients after gynaecological surgery and, as a consequence, will reduce societal costs considerably.
  
  
  BACKGROUND
  Netherlands Trial Register (NTR): NTR2087.
authors.affiliation: Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands. t.vonknoordegraaf@vumc.nl
authors.forename: Antonie
authors.initials: A
authors.lastname: Vonk Noordegraaf
authors.forename: Judith A F
authors.initials: JA
authors.lastname: Huirne
authors.forename: Hans A M
authors.initials: HA
authors.lastname: Brölmann
authors.forename: Mark H
authors.initials: MH
authors.lastname: Emanuel
authors.forename: Paul J M
authors.initials: PJ
authors.lastname: van Kesteren
authors.forename: Gunilla
authors.initials: G
authors.lastname: Kleiverda
authors.forename: Jos P
authors.initials: JP
authors.lastname: Lips
authors.forename: Alexander
authors.initials: A
authors.lastname: Mozes
authors.forename: Andreas L
authors.initials: AL
authors.lastname: Thurkow
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Anema
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000706:statistics & numerical data; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000523:psychology* / Q000534:rehabilitation; D006801:Humans; D007044:Hysterectomy / Q000534:rehabilitation; D010535:Laparoscopy / Q000534:rehabilitation; D008875:Middle Aged; D009426:Netherlands; D009786:Occupational Health Services / Q000191:economics / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010146:Pain / Q000150:complications / Q000503:physiopathology; D015397:Program Evaluation; D011788:Quality of Life / Q000523:psychology; D020127:Recovery of Function / Q000502:physiology*; D018582:Sick Leave / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000150:complications; D011795:Surveys and Questionnaires