title: Effectiveness of a blended web-based intervention on return to work for sick-listed employees with common mental disorders: results of a cluster randomized controlled trial.
abstract: BACKGROUND
  Common mental disorders are strongly associated with long-term sickness absence, which has negative consequences for the individual employee's quality of life and leads to substantial costs for society. It is important to focus on return to work (RTW) during treatment of sick-listed employees with common mental disorders. Factors such as self-efficacy and the intention to resume work despite having symptoms are important in the RTW process. We developed "E-health module embedded in Collaborative Occupational health care" (ECO) as a blended Web-based intervention with 2 parts: an eHealth module (Return@Work) for the employee aimed at changing cognitions of the employee regarding RTW and a decision aid via email supporting the occupational physician with advice regarding treatment and referral options based on monitoring the employee's progress during treatment.
  
  
  OBJECTIVE
  This study evaluated the effect of a blended eHealth intervention (ECO) versus care as usual on time to RTW of sick-listed employees with common mental disorders.
  
  
  METHODS
  The study was a 2-armed cluster randomized controlled trial. Employees sick-listed between 4 and 26 weeks with common mental disorder symptoms were recruited by their occupational health service or employer. The employees were followed up to 12 months. The primary outcome measures were time to first RTW (partial or full) and time to full RTW. Secondary outcomes were response and remission of the common mental disorder symptoms (self-assessed).
  
  
  RESULTS
  A total of 220 employees were included: 131 participants were randomized to the ECO intervention and 89 to care as usual (CAU). The duration until first RTW differed significantly between the groups. The median duration was 77.0 (IQR 29.0-152.3) days in the CAU group and 50.0 (IQR 20.8-99.0) days in the ECO group (hazard ratio [HR] 1.390, 95% CI 1.034-1.870, P=.03). No significant difference was found for duration until full RTW. Treatment response of common mental disorder symptoms did not differ significantly between the groups, but at 9 months after baseline significantly more participants in the ECO group achieved remission than in the CAU group (OR 2.228, 95% CI 1.115-4.453, P=.02).
  
  
  CONCLUSIONS
  The results of this study showed that in a group of sick-listed employees with common mental disorders, applying the blended eHealth ECO intervention led to faster first RTW and more remission of common mental disorder symptoms than CAU.
  
  
  BACKGROUND
  Netherlands Trial Register NTR2108; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2108. (Archived by WebCite at http://www.webcitation.org/6YBSnNx3P).
authors.affiliation: Trimbos Institute, Netherlands institute of mental health and addiction, Utrecht, Netherlands. dvolker@trimbos.nl.
authors.forename: Daniëlle
authors.identifier: http://orcid.org/0000-0002-8422-5295
authors.initials: D
authors.lastname: Volker
authors.forename: Moniek C
authors.identifier: http://orcid.org/0000-0001-7066-9349
authors.initials: MC
authors.lastname: Zijlstra-Vlasveld
authors.forename: Johannes R
authors.identifier: http://orcid.org/0000-0001-8657-0917
authors.initials: JR
authors.lastname: Anema
authors.forename: Aartjan Tf
authors.identifier: http://orcid.org/0000-0003-2382-1410
authors.initials: AT
authors.lastname: Beekman
authors.forename: Evelien Pm
authors.identifier: http://orcid.org/0000-0002-4053-8054
authors.initials: EP
authors.lastname: Brouwers
authors.forename: Wilco Hm
authors.identifier: http://orcid.org/0000-0001-7576-0037
authors.initials: WH
authors.lastname: Emons
authors.forename: A Gijsbert C
authors.identifier: http://orcid.org/0000-0001-9649-687X
authors.initials: AG
authors.lastname: van Lomwel
authors.forename: Christina M
authors.identifier: http://orcid.org/0000-0001-6925-8956
authors.initials: CM
authors.lastname: van der Feltz-Cornelis
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000628:therapy; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D009426:Netherlands; D009786:Occupational Health Services; D016016:Proportional Hazards Models; D011788:Quality of Life; D062707:Return to Work; D020377:Self Efficacy; D018582:Sick Leave; D013001:Somatoform Disorders / Q000628:therapy; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: anxiety; depression; mental health; occupational health; randomized controlled trial; sick leave