{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:54:08Z","timestamp":1782489248048,"version":"3.54.5"},"reference-count":40,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100024075","name":"Region Syddanmark","doi-asserted-by":"publisher","award":["21\/17575"],"award-info":[{"award-number":["21\/17575"]}],"id":[{"id":"10.13039\/501100024075","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Hospital of Lillebaelts\u201d"},{"name":"Hospital of Lillebaelt"},{"name":"Danish Physiotherapists Foundation","award":["A1518\/A1665"],"award-info":[{"award-number":["A1518\/A1665"]}]},{"DOI":"10.13039\/501100024075","name":"Region of Southern Denmark","doi-asserted-by":"crossref","award":["22\/44998"],"award-info":[{"award-number":["22\/44998"]}],"id":[{"id":"10.13039\/501100024075","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,17]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To co-develop the Stay-At-Work (SAW) intervention, a person-centred, interdisciplinary, cross-sectoral vocational rehabilitation (VR) programme for individuals on, or at risk of, sick leave due to chronic low back pain (CLBP) and to advance methodological understanding of how evidence, qualitative insights, stakeholder input and programme theory can be systematically integrated and operationalised into concrete intervention components.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A three-stage intervention development study, guided by the Medical Research Council framework for complex interventions, involving evidence review and stakeholder consultation (previously reported); multistakeholder co-design; and prototyping in clinical settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The intervention was developed within a Danish public healthcare and welfare context, involving a secondary care spinal service, municipal employment services (n=3), municipal rehabilitation services (n=3) and general practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Stage 1: 17 individuals on long-term sick leave due to CLBP participated in interviews and focus groups. Stages 2 and 3: The co-design group included individuals living with CLBP (n=2); clinicians from a secondary care spine service (n=2) and municipal rehabilitation services (n=6); general practitioners (n=2); municipal employment service professionals (n=3) and local managers (n=3); and employer and employee representatives (n=2). Participants were purposively recruited based on their roles and experience in VR and return-to-work processes and contributed across different stages of intervention development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The SAW intervention consists of eight structured activities, developed through multistakeholder co-design and underpinned by a programme theory with four core mechanisms: (1) strengthened interprofessional and cross-sectoral understanding and collaboration; (2) stronger alignment around functional capacity and work ability; (3) addressing psychological vulnerability through systematic screening and support; and (4) enhanced coordination of care and rehabilitation efforts across services.<\/jats:p>\n                    <jats:p>Stakeholder input from the co-design group informed the intervention\u2019s content and procedures, thereby improving alignment with local contexts and strengthening cross-sector collaboration. Some proposals were excluded due to inconsistency with clinical guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates how a structured, theory-informed co-development process can be used to integrate evidence, stakeholder input and programme theory into a coherent, cross-sectoral VR intervention. The approach enhanced transparency, supported alignment with real-world practice, and provides methodological insight to strengthen the reproducibility and transferability of complex interventions.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Registration number<\/jats:bold>\n                      : The Region of Southern Denmark\u2019s Research Registry (journal no. 23\/44927).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-116084","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T14:05:16Z","timestamp":1778249116000},"page":"e116084","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Co-developing a vocational rehabilitation intervention for individuals with chronic low back pain across a regional spine centre and three municipalities in Denmark: a three-stage intervention development study guided by the Medical Research Council framework"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6004-5620","authenticated-orcid":false,"given":"Gitte","family":"Frydenlund","sequence":"first","affiliation":[{"name":"Medical Research Unit, Spine Centre of Southern Denmark, Hospital Lillebaelt, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark"},{"name":"Department of Regional Health Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ole Steen","family":"Mortensen","sequence":"additional","affiliation":[{"name":"Section of Social Medicine, University of Copenhagen Department of Public Health, Kobenhavn, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"Medical Research Unit, Spine Centre of Southern Denmark, Hospital Lillebaelt, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark"},{"name":"Department of Regional Health Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1629-1864","authenticated-orcid":false,"given":"Jens","family":"S\u00f8ndergaard","sequence":"additional","affiliation":[{"name":"Research Unit for General Practice, Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5400-8847","authenticated-orcid":false,"given":"Anders","family":"Hansen","sequence":"additional","affiliation":[{"name":"Medical Research Unit, Spine Centre of Southern Denmark, Hospital Lillebaelt, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark"},{"name":"Department of Regional Health Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"2026062608321045000_16.5.e116084.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-017-4695-8","article-title":"Development of a framework for the co-production and prototyping of public health interventions","volume":"17","author":"Hawkins","year":"2017","journal-title":"BMC Public Health"},{"key":"2026062608321045000_16.5.e116084.2","doi-asserted-by":"crossref","DOI":"10.17061\/phrp3222211","article-title":"Co-creation, co-design, co-production for public health - a perspective on definition and distinctions","volume":"32","author":"Vargas","year":"2022","journal-title":"Public Health Res Pract"},{"key":"2026062608321045000_16.5.e116084.3","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.publhealth.29.091307.083824"},{"key":"2026062608321045000_16.5.e116084.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"},{"key":"2026062608321045000_16.5.e116084.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-033516","article-title":"Guidance for reporting intervention development studies in health research (GUIDED): an evidence-based consensus study","volume":"10","author":"Duncan","year":"2020","journal-title":"BMJ Open"},{"key":"2026062608321045000_16.5.e116084.6","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s10926-025-10308-0","article-title":"Mapping Vocational Rehabilitation Interventions for People with Chronic Low Back Pain: A Scoping Review","volume":"36","author":"Frydenlund","year":"2026","journal-title":"J Occup Rehabil"},{"key":"2026062608321045000_16.5.e116084.7","unstructured":"National Institute of Public Health, University of Southern Denmark . 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