Department of Occupational Therapy, University of Alberta, 3-48 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
Workers' Compensation Board of Alberta Millard Health, Edmonton, AB, Canada.
J Occup Rehabil. 2018 Jun;28(2):252-264. doi: 10.1007/s10926-017-9712-3.
Purpose Although functional restoration programs appear effective in assisting injured workers to return-to-work (RTW) after a work related musculoskeletal (MSK) disorder, the addition of Motivational Interviewing (MI) to these programs may result in higher RTW. Methods We conducted a cluster randomized controlled trial with claimants attending an occupational rehabilitation facility from November 17, 2014 to June 30, 2015. Six clinicians provided MI in addition to the standard functional restoration program and formed an intervention group. Six clinicians continued to provide the standard functional restoration program based on graded activity, therapeutic exercise, and workplace accommodations. Independent t tests and chi square analysis were used to compare groups. Multivariable logistic regression was used to obtain the odds ratio of claimants' confirmed RTW status at time of program discharge. Results 728 workers' compensation claimants with MSK disorders were entered into 1 of 12 therapist clusters (MI group = 367, control group = 361). Claimants were predominantly employed (72.7%), males (63.2%), with moderate levels of pain and disability (mean pain VAS = 5.0/10 and mean Pain Disability Index = 48/70). Claimants were stratified based on job attachment status. The proportion of successful RTW at program discharge was 12.1% higher for unemployed workers in the intervention group (intervention group 21.6 vs. 9.5% in control, p = 0.03) and 3.0% higher for job attached workers compared to the control group (intervention group 97.1 vs. 94.1% in control, p = 0.10). Adherence to MI was mixed, but RTW was significantly higher among MI-adherent clinicians. The odds ratio for unemployed claimants was 2.64 (0.69-10.14) and 2.50 (0.68-9.14) for employed claimants after adjusting for age, sex, pain intensity, perceived disability, and therapist cluster. Conclusion MI in addition to routine functional restoration is more effective than routine functional restoration program alone in improving RTW among workers with disabling MSK disorders.
尽管功能恢复计划似乎可以有效地帮助受伤工人在工作相关肌肉骨骼（MSK）障碍后重返工作岗位（RTW），但在这些计划中加入动机性访谈（MI）可能会导致更高的 RTW。
我们进行了一项基于 11 月 17 日至 2015 年 6 月 30 日参加职业康复设施的索赔人的集群随机对照试验。六名临床医生在提供标准功能恢复计划的基础上提供 MI，并组成干预组。六名临床医生继续提供基于分级活动、治疗性运动和工作场所适应的标准功能恢复计划。使用独立 t 检验和卡方分析比较组间差异。使用多变量逻辑回归获得方案出院时索赔人确认 RTW 状态的优势比。
728 名患有 MSK 疾病的工人赔偿索赔人进入 12 个治疗师组中的 1 个（MI 组=367，对照组=361）。索赔人主要是在职（72.7%），男性（63.2%），疼痛和残疾程度中等（平均疼痛 VAS=5.0/10，平均疼痛残疾指数=48/70）。根据工作岗位情况对索赔人进行分层。干预组失业工人的成功 RTW 比例比对照组高 12.1%（干预组 21.6%，对照组 9.5%，p=0.03），与对照组相比，在职工人的 RTW 比例高 3.0%（干预组 97.1%，对照组 94.1%，p=0.10）。MI 的依从性参差不齐，但 MI 依从性高的临床医生的 RTW 明显更高。调整年龄、性别、疼痛强度、感知残疾和治疗师组后，失业索赔人的优势比为 2.64（0.69-10.14），在职索赔人为 2.50（0.68-9.14）。
在常规功能恢复基础上增加 MI 比单纯常规功能恢复方案更能提高患有致残性 MSK 疾病的工人的 RTW。
