Objectives: This study aimed to assess 12-month outcomes on return to work (RTW) and cost-effectiveness in adults on sick leave due to musculoskeletal disorders who were randomized to either usual case management (UC), UC+motivational interviewing (MI) or UC+stratified vocational advice intervention (SVAI).
Methods: The study was conducted in the Norwegian Labor and Welfare Administration (NAV). Workers on sick leave due to musculoskeletal disorders for ≥50% of their contracted work hours for ≥7 consecutive weeks were included. Trained caseworkers delivered MI in two face-to-face sessions, and physiotherapists provided SVAI and identified RTW obstacles. The main outcomes were sick leave days over 12 months and cost-effectiveness, cost-utility and cost-benefit.
Results: The trial included 509 workers with a mean age of 48 years. There were statistically significant differences between UC+MI versus UC [-15.6 days, 95% confidence interval (CI) -31.0- -0.2], and UC+SVAI versus UC (-17.6 days, 95% CI -33.0- -2.2). Compared to UC, odds ratios (OR) for receiving wage replacement benefits each month were lower for UC+MI (OR=0.73, 95% CI 0.64-0.84), and UC+SVAI (OR 0.74, 95% CI 0.64-0.84). The probabilities of cost-effectiveness were high for adding either MI or SVAI to UC (ceiling ratio 0.90), and the net benefit for MI was €5225 (95% CI -592-10 985) and for SVAI €7214 ((95% CI 1548-12 851) per person.
Conclusions: Adding MI or SVAI to UC significantly improved RTW outcomes and was cost-effective among people on sickness absence due to musculoskeletal disorders.