{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T22:49:10Z","timestamp":1782773350958,"version":"3.54.5"},"reference-count":29,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2018,10,31]],"date-time":"2018-10-31T00:00:00Z","timestamp":1540944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"REHSAM","award":["Grant RS2011\/010"],"award-info":[{"award-number":["Grant RS2011\/010"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and\/or chronic pain. Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions. Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39\u20137.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13\u20139.15) compared to the control group in adjusted models. Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and\/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.<\/jats:p>","DOI":"10.3390\/ijerph15112424","type":"journal-article","created":{"date-parts":[[2018,10,31]],"date-time":"2018-10-31T11:55:41Z","timestamp":1540986941000},"page":"2424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Multidisciplinary Intervention and Acceptance and Commitment Therapy for Return-to-Work and Increased Employability among Patients with Mental Illness and\/or Chronic Pain: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6937-4025","authenticated-orcid":false,"given":"Erik","family":"Berglund","sequence":"first","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-75122 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5149-2744","authenticated-orcid":false,"given":"Ingrid","family":"Anderz\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-75122 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c5sa","family":"Anders\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-75122 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Carlsson","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-75122 Uppsala, Sweden"},{"name":"Centre for Clinical Research Dalarna, Uppsala University, SE-79182 Falun, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8709-4446","authenticated-orcid":false,"given":"Catharina","family":"Gustavsson","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-75122 Uppsala, Sweden"},{"name":"Centre for Clinical Research Dalarna, Uppsala University, SE-79182 Falun, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5965-2068","authenticated-orcid":false,"given":"Thorne","family":"Wallman","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-75122 Uppsala, Sweden"},{"name":"Centre for Clinical Research S\u00f6rmland, Uppsala University, SE-63188 Eskilstuna, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1949-6299","authenticated-orcid":false,"given":"Per","family":"Lytsy","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-75122 Uppsala, Sweden"},{"name":"Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institute, SE-17177 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1258\/jrsm.2011.100231","article-title":"Work and common psychiatric disorders","volume":"104","author":"Henderson","year":"2011","journal-title":"J. R. Soc. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/MRR.0b013e328306351d","article-title":"Long-term sick leavers with difficulty in resuming work: Comparisons between psychiatric-somatic comorbidity and monodiagnosis","volume":"32","author":"Linder","year":"2009","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e007122","DOI":"10.1136\/bmjopen-2014-007122","article-title":"The effectiveness of return-to-work interventions that incorporate work-focused problem-solving skills for workers with sickness absences related to mental disorders: A systematic literature review","volume":"5","author":"Dewa","year":"2015","journal-title":"BMJ Open"},{"key":"ref_4","unstructured":"Government Offices of Sweden (2018, May 29). Regeringens Proposition 2007\/08:136. En Reformerad Sjukskrivningsprocess f\u00f6r \u00f6kad \u00c5terg\u00e5ng i Arbete. [Government Proposition 2007\/08: 136. A Reformed Sick Leave Process to Increase Return to Work], Available online: https:\/\/www.riksdagen.se\/sv\/dokument-lagar\/dokument\/proposition\/en-reformerad-sjukskrivningsprocess-for-okad_GV03136\/html."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Oyeflaten, I., Lie, S.A., Ihlebaek, C.M., and Eriksen, H.R. (2012). Multiple transitions in sick leave, disability benefits, and return to work\u2014A 4-year follow-up of patients participating in a work-related rehabilitation program. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-748"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1080\/09638280210124338","article-title":"Long-term effects of early versus delayed vocational rehabilitation\u2014A four-year follow-up","volume":"24","author":"Marnetoft","year":"2002","journal-title":"Disabil. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s10926-012-9363-3","article-title":"Employees sick-listed with mental disorders: Who returns to work and when?","volume":"22","author":"Roelen","year":"2012","journal-title":"J. Occup. Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12998-016-0113-z","article-title":"Factors affecting return to work after injury or illness: Best evidence synthesis of systematic reviews","volume":"24","author":"Cancelliere","year":"2016","journal-title":"Chiropr. Man. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"270","DOI":"10.2105\/AJPH.91.2.270","article-title":"The benefits of interventions for work-related stress","volume":"91","author":"Blonk","year":"2001","journal-title":"Am. J. Public Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10926-016-9690-x","article-title":"Effectiveness of workplace interventions in return-to-work for musculoskeletal, pain-related and mental health conditions: An update of the evidence and messages for practitioners","volume":"28","author":"Cullen","year":"2018","journal-title":"J. Occup. Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/MRR.0000000000000080","article-title":"Health in women on long-term sick leave because of pain or mental illness","volume":"38","author":"Lytsy","year":"2015","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"170","DOI":"10.2340\/16501977-2188","article-title":"Effectiveness of two vocational rehabilitation programmes in women with long-term sick leave due to pain syndrome or mental illness: 1-Year follow-up of a randomized controlled trial","volume":"49","author":"Lytsy","year":"2017","journal-title":"J. Rehabil. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.jad.2015.10.053","article-title":"Acceptance and commitment therapy\u2014Do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials","volume":"190","author":"Hacker","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_15","unstructured":"Johnston, M.W., and John, S.C.W. (1995). Self-efficacy measurement and generalized self-efficacy scale. Measures in Health Psychology: A User\u2019s Portfolio, NFER-NELSON."},{"key":"ref_16","unstructured":"Schwarzer, R. (2016, July 06). Everything You Wanted to Know about the General Self-Efficacy Scale but Were Afraid to Ask. Available online: http:\/\/userpage.fu-berlin.de\/~health\/faq_gse.pdf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1007\/s11136-011-0030-5","article-title":"Validation of the Swedish translation of the general self-efficacy scale","volume":"21","author":"Love","year":"2012","journal-title":"Qual. Life Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1136\/oem.60.6.429","article-title":"Reducing long term sickness absence by an activating intervention in adjustment disorders: A cluster randomised controlled design","volume":"60","author":"Blonk","year":"2003","journal-title":"Occup. Environ. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s10926-005-8038-8","article-title":"Workplace-based return-to-work interventions: A systematic review of the quantitative literature","volume":"15","author":"Franche","year":"2005","journal-title":"J. Occup. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.genhosppsych.2006.02.005","article-title":"Effectiveness of an intervention to reduce sickness absence in patients with emotional distress or minor mental disorders: A randomized controlled effectiveness trial","volume":"28","author":"Brouwers","year":"2006","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s00420-006-0157-9","article-title":"Can sickness absence be reduced by stress reduction programs: On the effectiveness of two approaches","volume":"80","author":"Blonk","year":"2007","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1159\/000346369","article-title":"Effects of a multidisciplinary stress treatment programme on patient return to work rate and symptom reduction: Results from a randomised, wait-list controlled trial","volume":"82","author":"Friebel","year":"2013","journal-title":"Psychother. Psychosom."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Momsen, A.H., Stapelfeldt, C.M., Nielsen, C.V., Nielsen, M.B., Aust, B., Rugulies, R., and Jensen, C. (2016). Effects of a randomized controlled intervention trial on return to work and health care utilization after long-term sickness absence. BMC Public Health, 16.","DOI":"10.1186\/s12889-016-3812-4"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.brat.2005.06.006","article-title":"Acceptance and commitment therapy: Model, processes and outcomes","volume":"44","author":"Hayes","year":"2006","journal-title":"Behav. Res. Ther."},{"key":"ref_25","first-page":"CD006237","article-title":"Interventions to improve return to work in depressed people","volume":"12","author":"Nieuwenhuijsen","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1080\/14034950410021899","article-title":"Swedish council on technology assessment in health care (SBU). Chapter 9. Consequences of being on sick leave","volume":"63","author":"Vingard","year":"2004","journal-title":"Scand. J. Public Health Suppl."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1016\/j.socscimed.2010.08.017","article-title":"Looking upstream to understand low back pain and return to work: Psychosocial factors as the product of system issues","volume":"71","author":"Soklaridis","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1377\/hlthaff.27.2.339","article-title":"Targeting health disparities: A model linking upstream determinants to downstream interventions: Knowing about the interaction of societal factors and disease can enable targeted interventions to reduce health disparities","volume":"27","author":"Gehlert","year":"2008","journal-title":"Health Aff."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1080\/09638280701855545","article-title":"Outcome of multidisciplinary investigations of long-term sickness absentees","volume":"31","author":"Salmi","year":"2009","journal-title":"Disabil. Rehabil."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/11\/2424\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:27:13Z","timestamp":1760196433000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/11\/2424"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,31]]},"references-count":29,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2018,11]]}},"alternative-id":["ijerph15112424"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15112424","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,31]]}}}