Expanding the Focus on Work Factors in an Outpatient Setting: Does a Nudge of Patients and Clinicians have an Effect on Return-to-Work and Benefits? Findings from the NSAC Nudge Multicentre Randomised Controlled Trial

Purpose The purpose of the study was to test the effects of a nudge on patients return-to-work (RTW) and benefits in a clinical service aimed to promote RTW and prevent sickness absence in patients referred for musculoskeletal disorders or mental illness. Methods The study was a multicentre, single-blinded, parallel two-arm randomised controlled trial design. The setting was five outpatient clinics in Northern Norway, offering a work-focussed treatment to patients referred for common mental- and/or musculoskeletal disorders. Patients were randomised to receive either a questionnaire mapping health factors only, or a questionnaire mapping also Motivation for work, Barriers for return-to-work and Work environment (MBW). Clinicians were also nudged by receiving patient reports based on the patient survey. Data on sickness absence and benefits was retrieved from national registries after one year of follow-up. Results Among 1171 patients consenting to participate in the study, 1091 were eligible for inclusion in the main analyses. The intervention group (n = 558) did not differ significantly from the control group (n = 533) with respect to key variables at baseline. The nudge had no effect on days of sickness absence, return to work rates, or disability benefits during follow-up. Conclusion This attempt to nudge patients and clinicians on MBW factors did not influence RTW or benefits during one year of follow-up. Although MBW factors were prevalent at baseline, the results suggest that increasing work focus in a setting where clinicians already address these factors to some extent has little effect. Trial Registration The trial was prospectively registered at clinicaltrials.gov on August 9th, 2021. Trial identifier NCT 05006976 ( https://clinicaltrials.gov/study/NCT05006976 ). In this study we report on the primary outcome listed as “Functional recovery: sickness absence registry data”.