Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial

Daniëlle Volker,^1,2 Moniek C Vlasveld,¹ Johannes R Anema,³ Aartjan TF Beekman,⁴ Leona Hakkaart-van Roijen,⁵ Evelien PM Brouwers,² A Gijsbert C van Lomwel,⁶ Christina M van der Feltz-Cornelis<sup>1,2,7

1</sup>Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, ²Tranzo Department, Tilburg University, Tilburg, ³Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, ⁴Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, ⁵Institute for Medical Technology Assessment, Erasmus University, Rotterdam, ⁶Achmea Disability Insurance, Tilburg, ⁷Clinical Centre for Body, Mind and Health, GGZ Breburg, Tilburg, The Netherlands

Background: Common mental disorders (CMD) have a major impact on both society and individual workers, so return to work (RTW) is an important issue. In The Netherlands, the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW. Evidence-based guidelines are available, but seem not to be effective in improving RTW in people with CMD. An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed. A blended E-health module embedded in collaborative occupational health care is now available, and comprises a decision aid supporting the occupational physician and an E-health module, Return@Work, to support sick-listed workers in the RTW process. The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual.
Methods: This study is a two-armed cluster randomized controlled trial, with randomization done at the level of occupational physicians. Two hundred workers with CMD on sickness absence for 4–26 weeks will be included in the study. Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention. Occupational physicians allocated to the care as usual group will give conventional sickness guidance. Follow-up assessments will be done at 3, 6, 9, and 12 months after baseline. The primary outcome is duration until RTW. The secondary outcome is severity of symptoms of CMD. An economic evaluation will be performed as part of this trial.
Conclusion: It is hypothesized that collaborative occupational health care intervention will be more (cost)-effective than care as usual. This intervention is innovative in its combination of a decision aid by email sent to the occupational physician and an E-health module aimed at RTW for the sick-listed worker.

Keywords: design protocol, randomized controlled trial, common mental disorders, sickness absence, return to work, blended E-health