title: Effectiveness of an exposure-based return-to-work program for workers on sick leave due to common mental disorders: a cluster-randomized controlled trial.
abstract: OBJECTIVE
  In case of long-term sick leave, gradually increasing workload appears to be an effective component of work-directed interventions to reduce sick leave due to common mental disorders (CMD). CMD are defined as stress-related, adjustment, anxiety, or depressive disorders. We developed an exposure-based return-to-work (RTW-E) intervention and evaluated the effect on time-to-full return to work (RTW) among workers who were on sick leave due to CMD in comparison to those treated with care-as-usual (CAU). CAU is guideline-directed and consists of problem-solving strategies and graded activities.
  
  
  METHODS
  Using a two-armed cluster-randomized trial, we randomized 56 occupational physicians (OP). Of these, 35 OP treated 160 workers at the start of their sick leave; 75 workers received RTW-E and 85 workers received CAU. These workers were followed over a 12-month follow-up period. The time-to-full RTW lasting ≥28 days without recurrence was the primary outcome measure. To evaluate differences between groups, we used intention-to-treat and multilevel Cox's regression analysis.
  
  
  RESULTS
  The median time-to-full RTW differed significantly between groups [hazard ratio (HR) 0.55; 95% confidence interval (95% CI) 0.33-0.89]. The workers receiving RTW-E (209 days; 95% CI 62-256) had a prolonged time-to-full RTW compared to workers receiving CAU (153 days; 95% CI 128-178).
  
  
  CONCLUSIONS
  Workers on sick leave due to CMD treated with RTW-E showed a prolonged time-to-full RTW compared to those treated with CAU. We recommend that OP do not apply RTW-E but continue counseling workers on sick leave due to CMD according to CAU.
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands. f.w.noordik@amc.nl
authors.forename: Erik
authors.initials: E
authors.lastname: Noordik
authors.forename: Jac J
authors.initials: JJ
authors.lastname: van der Klink
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Geskus
authors.forename: Michiel R
authors.initials: MR
authors.lastname: de Boer
authors.forename: Frank J H
authors.initials: FJ
authors.lastname: van Dijk
authors.forename: Karen
authors.initials: K
authors.lastname: Nieuwenhuijsen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D062707:Return to Work / Q000523:psychology*; D018582:Sick Leave / Q000706:statistics & numerical data*