title: Effectiveness of guideline-based care by occupational physicians on the return-to-work of workers with common mental disorders: design of a cluster-randomised controlled trial.
abstract: BACKGROUND
  Sickness absence due to common mental disorders (such as depression, anxiety disorder, adjustment disorder) is a problem in many Western countries. Long-term sickness absence leads to substantial societal and financial costs. In workers with common mental disorders, sickness absence costs are much higher than medical costs. In the Netherlands, a practice guideline was developed that promotes an activating approach of the occupational physician to establish faster return-to-work by enhancing the problem-solving capacity of workers, especially in relation to their work environment. Studies on this guideline indicate a promising association between guideline adherence and a shortened sick leave duration, but also minimal adherence to the guideline by occupational physicians. Therefore, this study evaluates the effect of guideline-based care on the full return-to-work of workers who are sick listed due to common mental disorders.
  
  
  METHODS
  This is a two-armed cluster-randomised controlled trial with randomisation at the occupational physician level. During one year, occupational physicians in the intervention group receive innovative training to improve their guideline-based care whereas occupational physicians in the control group provide care as usual. A total of 232 workers, sick listed due to common mental disorders and counselled by participating occupational physicians, will be included. Data are collected via the registration system of the occupational health service, and by questionnaires at baseline and at 3, 6 and 12 months. The primary outcome is time to full return-to-work. Secondary outcomes are partial return-to-work, total number of sick leave days, symptoms, and workability. Personal and work characteristics are the prognostic measures. Additional measures are coping, self-efficacy, remoralization, personal experiences, satisfaction with consultations with the occupational physician and with contact with the supervisor, experiences and behaviour of the supervisor, and the extent of guideline adherence.
  
  
  CONCLUSIONS
  If the results show that guideline-based care in fact leads to faster and sustainable return-to-work, this study will contribute to lowering personal, societal and financial costs.
  
  
  BACKGROUND
  ISRCTN86605310.
authors.affiliation: Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, Tilburg 5000 LE, The Netherlands. k.vanbeurden@tilburguniversity.edu
authors.forename: Karlijn M
authors.initials: KM
authors.lastname: van Beurden
authors.forename: Evelien P M
authors.initials: EP
authors.lastname: Brouwers
authors.forename: Margot C W
authors.initials: MC
authors.lastname: Joosen
authors.forename: Berend
authors.initials: B
authors.lastname: Terluin
authors.forename: Jac J L
authors.initials: JJ
authors.lastname: van der Klink
authors.forename: Jaap
authors.initials: J
authors.lastname: van Weeghel
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D009426:Netherlands; D009786:Occupational Health Services / Q000592:standards*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012107:Research Design; D062707:Return to Work / Q000706:statistics & numerical data*; D018582:Sick Leave / Q000706:statistics & numerical data*; D013997:Time Factors; D017132:Workplace / Q000523:psychology; D055815:Young Adult