Motivational Interviewing for Workers with Disabling Musculoskeletal Disorders: Results of a Cluster Randomized Control Trial

Abstract

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.

Model of Human Occupation as a framework for implementation of Motivational Interviewing in occupational rehabilitation

“…Transition between stages and overall readiness for work are influenced by physical, psychological and social factors that can create uncertainty about ability to function or RTW [22,23]. There is an increasing emphasis in occupational rehabilitation on how psychosocial factors contribute to prolonged work disability; however, further research is needed on practical approaches and interventions that address psychosocial and behavioral barriers to RTW [16,17,22,23]. In addition, OTs report several challenges when implementing evidence-based principles into practice [7].…”

“…The applicability of MI across a variety of issues, its brief and specific interactions, and practical use in combination with other active treatment methods has intrigued many health care practitioners and lead to explorations of the utility of MI in other areas of health care practice [29]. Two recent studies examined the effectiveness of MI in a population of workers with disabling musculoskeletal disorders [16,17]. MI led to higher percentages of RTW at the end of rehabilitation and more sustainable RTW over a 1-year follow-up.…”

“…The primary advantage of MI over comparable alternative treatments is the shorter duration of care required to achieve successful results [24]. Two recent studies involving MI and RTW demonstrated only one to two MI sessions were required to achieve long term behavior change established through sustainable RTW outcomes [16,17]. The equivalent success rates but shorter time commitment of MI compared to other evidence-based therapies may make it a more cost effective and practical approach for OTs to address ambivalence with injured workers [24].…”

“…The clinical procedure of MI involves a conversation about change with the primary purpose of strengthening the client's motivation for change based on the client's values and interests [12][13][14]. MI has been used to address maladaptive behavior and promote healthy adaptive behaviors [15] and has recently been applied to occupational rehabilitation to improve RTW outcomes [16,17].…”

A Descriptive Study of the Implementation of Remote Occupational Rehabilitation Services Due to the COVID-19 Pandemic Within a Workers’ Compensation Context

“…Findings indicated the FIT led to comparable return to work outcomes as FCE, with lower risk of pain exacerbation during rehabilitation. Since the FIT incorporated principles of motivational interviewing [ 9 ], subsequently the effectiveness of motivational interviewing as an adjunct to routine occupational rehabilitation was examined [ 10 , 11 ]. Incorporating motivational interviewing into functional restoration programs led to higher return-to-work rates at program discharge in non-job attached workers and more sustained return to work over a follow-up year.…”