SmaRTWork - a Decision Support System to Promote Return to Work Among People Sick-listed With Musculoskeletal Disorders

The objective of this study is to determine the effectiveness of SmaRTWork (intervention) on return to work (RTW) compared to usual care (comparator) for individuals sick-listed due to musculoskeletal disorders. The study is designed as a single-blinded randomised controlled trial (RCT) with two parallel groups. Individuals of working age (20-59 years) sick-listed due to a musculoskeletal disorder (neck pain, low back pain, or widespread pain) for up to 12 weeks living in Norway are eligible for the study. Potential participants are identified and informed about the project by their general practitioner. We plan to include a total of 298 participants in the trial (and 15-20 in a pilot, giving a total of 318). The primary outcome will be time to sustainable RTW, i.e., one month without receiving sickness benefits, during the 12 months of follow-up based on registry data. Secondary outcomes include other work outcomes and health outcomes. Along with the RCT we will also conduct qualitative studies and a process evaluation. If the SmaRTWork turns out to be effective on RTW, we will also perform a health economic evaluation.

Inclusion criteria

• Individuals 20-59 years old (working age)
• Living in Norway
• Own a smart phone with internet access
• Sick-listed due to a musculoskeletal disorder for up to 12 weeks
• The main diagnosis for sick leave is back pain, neck pain or widespread pain. For example one of the following (ICPC-2 diagnoses codes): Neck symptom/complaint (L01), Back symptom/complaint (L02), Low back symptom/complaint (L03), Muscle pain (L18), Back syndrome without radiating pain (L84)

Exclusion criteria

• Pregnant
• No employer (unemployed or self-employed)
• Poor Norwegian comprehension
• Sick listed for more than 3 months the previous 12 months
• Have a planned date for RTW during the next week
• previous participation in the trial or concurrent participation in another study that could interfere with the current trial
• Unable to take part in exercise/physical activity (e.g., use of walking aids, unable to get up and down on the floor independently)
• Leg pain worse than back pain
• Red flags that could indicate serious underlying pathology:

• Changes in bladder or bowel function
• General feeling of being unwell (malaise), fever and/or unexplained weight loss
• Reduced muscle (motor) function, sensory loss, walking problems or balance problems
• Neck or back pain that started after the age of 55 or feel different from previous pain episodes
• Pain that does not improve with rest or light activity or pain that is much worse during the night
• Previous or ongoing cancer
• Use of steroids/immune suppressing medications or drug use
• Pain that is trauma (injury) related
• Serious ongoing somatic (e.g., unstable heart disease) or mental disorder (e.g., psychosis, ongoing manic episode, suicidal ideation)
• Pain has not been assessed by a clinician