Long-term health- and cost evaluation of two work-oriented rehabilitation models for women on long-term work disability due to common mental disorders or chronic pain – a randomized controlled trial

Background Long-term outcomes of work rehabilitation for individuals on extended sick leave due to common mental disorders or chronic musculoskeletal pain remain insufficiently studied. This randomized controlled trial evaluated the long-term effects on work disability and cost-effectiveness over eight years, and health outcomes over ten years, comparing (1) unimodal Acceptance and Commitment Therapy (ACT) and (2) multidisciplinary assessment and treatment program including ACT (TEAM) with standard care (Control). Methods Work disability days were analysed using ordered beta regression, and health outcomes were assessed using mixed models for repeated measures. Results are presented as estimated marginal means. Results Both intervention groups demonstrated lower model-predicted median work disability days at all time points compared to Control, but the differences were only statistically significant for the TEAM group at years four, seven, and eight. Both ACT and TEAM interventions showed superior effects on psychiatric symptom reduction relative to Control at one- and two-years follow-up. Conclusion The findings highlight the importance of extended follow-up to fully capture the effects of rehabilitation efforts. The results support the consideration of both rehabilitation models for women with prolonged work disability, with the choice between them potentially guided by available resources, individual patient complexity, and a stepwise approach to care. Trial registration The study was retrospectively registered at the Clinicaltrials.gov Register Platform on November 15, 2017 (ID NCT03343457).