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      Rehabilitation cooperation and person-centred dialogue meeting for patients sick-listed for common mental disorders: 12 months follow-up of sick leave days, symptoms of depression, anxiety, stress and work ability – a pragmatic cluster randomised controlled trial from the CO-WORK-CARE project

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          Abstract

          Objectives

          To study whether early and enhanced cooperation within the primary care centres (PCC) combined with workplace cooperation via a person-centred employer dialogue meeting can reduce days on sick leave compared with usual care manager contact for patients on sick leave because of common mental disorders (CMD). Secondary aim: to study lapse of CMD symptoms, perceived Work Ability Index (WAI) and quality of life (QoL) during 12 months.

          Design

          Pragmatic cluster randomised controlled trial, randomisation at PCC level.

          Setting

          28 PCCs in Region Västra Götaland, Sweden, with care manager organisation.

          Participants

          30 PCCs were invited, 28 (93%) accepted invitation (14 intervention, 14 control) and recruited 341 patients newly sick-listed because of CMD (n=185 at intervention, n=156 at control PCCs).

          Intervention

          Complex intervention consisting of (1) early cooperation among general practitioner (GP), care manager and a rehabilitation coordinator, plus (2) a person-centred dialogue meeting between patient and employer within 3 months. Control group: regular contact with care manager.

          Main outcome measures

          12 months net and gross number of sick leave days at group level. Secondary outcomes: 12 months depression, anxiety, stress symptoms, perceived WAI and QoL (EuroQoL-5 Dimensional, EQ-5D).

          Results

          No significant differences were found between intervention and control groups concerning days of sick leave (intervention net days of sick leave mean 102.48 (SE 13.76) vs control 96.29 (SE 12.38) p=0.73), return to work (HR 0.881, 95% CI 0.688 to 1.128), or CMD symptoms, WAI or EQ-5D after 12 months.

          Conclusions

          It is not possible to speed up CMD patients’ return to work or to reduce sick leave time by early and enhanced coordination among GP, care manager and a rehabilitation coordinator, combined with early workplace contact over and above what ‘usual’ care manager contact during 3 months provides.

          Trial registration number

          NCT03250026.

          Related collections

          Most cited references28

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            EuroQol - a new facility for the measurement of health-related quality of life

            (1990)
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              • Article: not found

              A new depression scale designed to be sensitive to change

              The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inner-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2023
                9 June 2023
                : 13
                : 6
                : e074137
                Affiliations
                [1 ]departmentPrimary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy , University of Gothenburg , Gothenburg, Sweden
                [2 ]departmentResearch and Development Primary Health Care , Region Västra Götaland , Gothenburg, Sweden
                [3 ]departmentSection for rehabilitation and Health , Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Goteborg, Sweden
                [4 ]departmentDepartment of Social Work , Ringgold_3570University of Gothenburg , Goteborg, Sweden
                [5 ]departmentSchool of Public Health and Community Medicine, Sahlgrenska Academy , University of Gothenburg , Gothenburg, Sweden
                Author notes
                [Correspondence to ] Dr Cecilia Björkelund; cecilia.bjorkelund@ 123456allmed.gu.se
                Author information
                http://orcid.org/0000-0003-4083-7342
                http://orcid.org/0000-0002-7421-8171
                http://orcid.org/0000-0002-1225-9736
                http://orcid.org/0000-0003-1114-4440
                Article
                bmjopen-2023-074137
                10.1136/bmjopen-2023-074137
                10277141
                37295824
                6eea9afe-cac4-4e96-be5f-d35afe9e5a37
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 29 March 2023
                : 23 May 2023
                Funding
                Funded by: ALF agreement;
                Award ID: ALFGBG-722441, ALFGBG-965520
                Funded by: FundRef http://dx.doi.org/10.13039/501100006636, Forskningsrådet om Hälsa, Arbetsliv och Välfärd;
                Award ID: Dnr 2018-01266
                Award ID: Dnr 2016-07412
                Categories
                General practice / Family practice
                1506
                1696
                Original research
                Custom metadata
                unlocked

                Medicine
                depression & mood disorders,anxiety disorders,primary health care,clinical trial,patient-centered care,rehabilitation medicine

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