Background: Systematic reviews have confirmed the effectiveness of work-related rehabilitation
programmes with significant cognitive-behavioural components for patients with musculoskeletal
disorders. However, in Germany work-related rehabilitation for patients with musculoskeletal
disorders is mainly focussed on evaluating functional capacity and on enhancing it
by appropriate modules of exercise therapy while psychosocial work demands have been
less considered in the rehabilitation process so far. The aim of our study was the
efficacy evaluation of a multimodal work hardening following a cognitive-behavioural
approach. Methods: Participants were patients with musculoskeletal disorders and substantial work-related
problems that were allocated to an inpatient rehabilitation centre. Included patients
were randomised in groups either to a multimodal work hardening or to a common orthopaedic
rehabilitation (cluster randomisation). Primary outcome was return to work. Analyses
were based on data obtained 6 and 12 months after treatment. Results: 236 (86.8%) patients consented to participate. Response rates after 6 and 12 months
were 71.6% (n=169) and 61.9% (n=146). After 6 months participants of the intervention
group had a 2.4fold (OR=2.363; 95% CI: 1.266 to 4.410; p=0.007) higher chance of return
to work, after 12 months the chance of return to work was 1.9fold (OR=1,914; 95% CI:
0.849 to 4.317; p=0.118) higher than for the control group. Furthermore, participants
of the multimodal work hardening reported less depression and anxiety, better mental
and physically health-related quality of life and better pain management. Conclusions: Results of the trial confirmed that an intensified work-related programme with a
well-defined multimodal structure is able to enhance the chances of return to work
for patients with substantial work-related problems.
