***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Introduction Return to work ( RTW ) of employees on sick leave for common mental disorders may require a multidisciplinary approach . This article aims to assess time to RTW after a psychiatric consultation providing treatment advice to the occupational physician ( OP ) for employees on sick leave for common mental disorders in the occupational health ( OH ) setting , compared to care as usual ( CAU ) . Methods Cluster r and omized clinical trial evaluating patients of 12 OPs receiving consultation by a psychiatrist , compared to CAU delivered by 12 OPs in the control group . 60 patients suffering from common mental disorders and ≥ six weeks sicklisted were included . Follow up three and six months after inclusion . Primary outcome measure was time to RTW . Intention- to-treat multilevel analysis and a survival analysis were performed to evaluate time to RTW in both groups . Results In CAU , referral was the main intervention . Both groups improved in terms of symptom severity and quality of life , but time to RTW was significantly shorter in the psychiatric consultation group . At three months follow up , 58 % of the psychiatric consultation group had full RTW versus 44 % of the control group , a significant finding ( P = 0.0093 ) . Survival analysis showed 68 days earlier RTW after intervention in the psychiatric consultation group ( P = 0.078 ) compared to CAU . Conclusion Psychiatric consultation for employees on sick leave in the OH setting improves time to RTW in patients with common mental disorders as compared to CAU . In further research , focus should be on early intervention in patients with common mental disorders on short sick leave duration  . Psychiatric consultation might be particularly promising for improvement of RTW in those patients . Trial registration number IS RCT N : Background Common mental disorders are the most prevalent of all mental disorders , with the highest burden in terms of work absenteeism and utilization of health care services . Evidence -based treatments are available , but recognition and treatment could be improved , especially in the occupational health setting . The situation in this setting has recently changed in the Netherl and s because of new legislation , which has result ed in reduced sickness absence . Severe mental disorder has now become one of the main causes of work absenteeism . Occupational physicians ( OPs ) are expected to take an active role in diagnosis and treatment , and seem to be in need of support for a new approach to h and le cases of more complex mental disorders . Psychiatric consultation can be a collaborative care model to achieve this . Methods / design This is a two-armed cluster-r and omized clinical trial , with r and omization among OPs . Forty OPs in two big companies providing medical care for multiple companies will be r and omized to either the intervention group , i.e. psychiatric consultation embedded in a training programme , or the control group , i.e. only training aim ed at recognition and providing Care As Usual .  60 patients will be included who have been absent from work for 6–52 weeks and who , after screening and a MINI interview , are diagnosed with depressive disorder , anxiety disorder or somatoform disorder based on DSM-IV criteria . Baseline measurements and follow up measurements ( at 3 months and 6 months ) will be assessed with question naires and an interview . The primary outcome measure is level of general functioning according to the SF-20 . Secondary measures are severity of the mental disorder according to the PHQ and the SCL-90 , quality of life ( EQ-D5 ) , measures of Return To Work and cost-effectiveness of the treatment assessed with the TiC-P. Process measures will be adherence to the treatment plan and assessment of the treatment provided by the Psychiatric Consultant ( PC ) in both groups . Discussion In the current study , a psychiatric consultation model that has already proved to be effective in the primary care setting , and aim ed to enhance evidence -based care for patients with work absenteeism and common mental disorder will be evaluated for its efficacy and cost-effectiveness in the occupational health setting OBJECTIVE To test the reliability and validity of specific instructions to classify blinding , when unclearly reported in r and omized trials , as " probably done " or " probably not done . " STUDY DESIGN AND SETTING We assessed blinding of patients , health care providers , data collectors , outcome adjudicators , and data analysts in 233 r and omized trials in duplicate and independently using detailed instructions . The response options were " definitely yes , " " probably yes , " " probably no , " and " definitely no. " We contacted authors for data verification ( 46 % response ) . For each of the five questions , we assessed reliability by calculating the agreement between the two review ers and validity by calculating the agreement between review ers ' consensus and verified data . RESULTS The percentage with unclear blinding status varied between 48.5 % ( patients ) and 84.1 % ( data analysts ) . Reliability was moderate for blinding of outcome adjudicators ( κ=0.52 ) and data analysts ( κ=0.42 ) and substantial for blinding of patients ( κ=0.71 ) , providers ( κ=0.68 ) , and data collectors ( κ=0.65 ) . The raw agreement between the consensus record and the author-verified record varied from 84.1 % ( blinding of data analysts ) to 100 % ( blinding of health care providers ) . CONCLUSION With the possible exception of blinding of data analysts , use of " probably yes " and " probably no " instead of " unclear " may enhance the assessment of blinding in trials Objective To evaluate the effectiveness of an integrated care programme , combining a patient directed and a workplace directed intervention , for patients with chronic low back pain . Design Population based r and omised controlled trial . Setting Primary care ( 10 physiotherapy practice s , one occupational health service , one occupational therapy practice ) and secondary care ( five hospitals ) . Participants 134 adults aged 18 - 65 sick listed for at least 12 weeks owing to low back pain . Intervention Patients were r and omly assigned to usual care ( n=68 ) or integrated care ( n=66 ) . Integrated care consisted of a workplace intervention based on participatory ergonomics , involving a supervisor , and a grade d activity programme based on cognitive behavioural principles . Main outcome measures The primary outcome was the duration of time off work ( work disability ) due to low back pain until full sustainable return to work . Secondary outcome measures were intensity of pain and functional status . Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group ( P=0.003 ) . Integrated care was effective on return to work ( hazard ratio 1.9 , 95 % confidence interval 1.2 to 2.8 , P=0.004 ) . After 12 months , patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group ( P=0.01 ) . Improvement of pain between the groups did not differ significantly . Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life . Trial registration Current Controlled Trials IS RCT N28478651 Objectives : This prospect i ve cohort study examines number of self-reported days of sickness absence as a risk marker for future disability pension among a representative sample of employees in Denmark 1990 - 2004 . Material and methods : 4177 employees between 18 and 45 years were interviewed using a self-administered question naire in 1990 regarding sickness absence , age , gender , socioeconomic position , health behaviour , and physical and psychosocial work environment . They were followed for 168 months in a national disability pension register .  Logistic regression analysis  was performed in order to assess risk estimates for levels of absence and future disability pension . Results : During follow-up , a total of 140 persons ( 3.4 % ) received disability pension . Of these , 82 ( 58.6 % ) were women , 58 ( 41.4 % ) were men . There was a 2.5 fold risk of future disability pension for the part of the population reporting more than 6 days of sickness absence per annum at baseline , when taking into account gender , age , socioeconomic position , health behaviour , physical and psychosocial work environment . Conclusion : The findings suggest that information on self-reported days of sickness absence can be used to effectively identify “ at risk ” groups for disability pension BACKGROUND CONTEXT The impact of  lumbar spinal surgery  is commonly evaluated with three patient-reported outcome measures : Oswestry Disability Index ( ODI ) , the physical component summary ( PCS ) of the Short Form of the Medical Outcomes Study ( SF-36 ) , and pain scales . A minimum clinical ly important difference ( MCID ) is a threshold used to measure the effect of clinical treatments . Variable threshold values have been proposed as MCID for those instruments despite a lack of agreement on the optimal MCID calculation method . PURPOSE This study has three purpose s. First , to illustrate the range of values obtained by common anchor-based and distribution-based methods to calculate MCID . Second , to determine a statistically sound and clinical ly meaningful MCID for ODI , PCS , back pain scale , and leg pain scale in lumbar spine surgery patients . Third , to compare the discriminative ability of two anchors : a global health assessment and a rating of satisfaction with the results of the surgery . STUDY DESIGN This study is a review of prospect ively collected patient-reported outcomes data . PATIENT SAMPLE A total of 454 patients from a large data base of surgeries performed by the Lumbar Spine Study Group with a 1-year follow-up on either ODI or PCS were included in the study . OUTCOME MEASURES Preoperative and 1-year postoperative scores for ODI , PCS , back pain scale , leg pain scale , health transition item ( HTI ) of the SF-36 , and Satisfaction with Results scales . METHODS ODI , SF-36 , and pain scales were administered before and 1 year after spinal surgery . Several c and i date MCID calculation methods were applied to the data and the result ing values were compared . The HTI of the SF-36 was used as the anchor and compared with a second anchor ( Satisfaction with Results scale ) . RESULTS Potential MCID calculations yielded a range of values : fivefold for ODI , PCS , and leg pain , 10-fold for back pain . Threshold values obtained with the two anchors were very similar . CONCLUSIONS The minimum detectable change ( MDC ) appears as a statistically and clinical ly appropriate MCID value . MCID values in this sample were 12.8 points for ODI , 4.9 points for PCS , 1.2 points for back pain , and 1.6 points for leg pain Abstract . When measuring treatment effect in chronic low back pain with multi-item outcome instruments , it is necessary , both for clinical decision-making and research purpose s , to underst and the clinical importance of the outcome scores . The aims of the present study were three-fold . Firstly , it aim ed to estimate the minimal clinical ly important difference of three multi-item outcome instruments ( the Oswestry Disability Index , the General Function Score and the Zung Depression Scale )  and of the  visual analogue scale ( VAS ) of back pain .  Secondly , it aim ed to estimate the error of measurement of these instruments ; and its third aim was to describe the clinical meaning of score change . The study population consisted of 289 patients treated surgically or non-surgically in a r and omised controlled trial . The minimal clinical ly important difference was estimated with patient global assessment as the external criterion . It was compared with the st and ard error of measurement of the instruments . The individual items of the instruments were compared for score changes related to improvement and deterioration . The st and ard error of measurement of the Oswestry Disability Index , the General Function Score and the Zung Depression Scale was 4 , 6 and 3 units , respectively . The 95 % tolerance interval was 10 , 16 and 8 units , respectively . The minimal clinical ly important difference was 10 , 12 and 8–9 units , respectively , thus not significantly exceeding the tolerance interval . The minimal clinical ly important difference of VAS back pain was 18–19 units , well exceeding the 95 % tolerance interval , which was 15 units . Improvement after treatment for chronic low back pain tends to occur to a greater extent in sleep disturbance , ability to do usual things and psychological irritability , but to a lesser extent in the ability to sit , st and and lift . We conclude that the VAS of back pain is responsive enough to detect the minimal clinical ly important difference , whereas the smallest acceptable score changes of the Oswestry Disability Index , the General Function Score and the Zung Depression Scale may require an increase to exceed the 95 % tolerance interval when used for clinical decision making and for power calculation . Despite improvement after treatment , the ability to sit , st and and lift , remain notable problems STUDY DESIGN An intervention study by the medical advisers of a social security sickness fund  on a m and atorily insured patient population after open discectomy for herniated lumbar intervertebral disc . The medical advisers were r and omized into two groups : a control group ( n = 30 ) and an intervention group ( n = 30 ) . OBJECTIVES To compare a rehabilitation-oriented approach in insurance medicine focused primarily on early mobilization and early resumption of professional activities with the usual cl aim -based practice . SUMMARY OF BACKGROUND DATA This study included 710 patients , with a mean age of 39.2 years , who underwent surgery for herniated lumbar disc . METHODS Medical advisers in the rehabilitation-oriented group examined the patients monthly , starting at 6 weeks after the surgical intervention . They used a newly developed protocol to motivate the patients and treating physicians toward social and professional reintegration . RESULTS At 52 weeks , 10.1 % of the patients guided by medical advisers from the rehabilitation-oriented group had not resumed work in contrast to 18.1 % of the patients in the control group . It was statistically proven that this effect also holds during the follow-up period . CONCLUSIONS A rehabilitation-oriented approach by the medical advisers of social security can increase the probability 
    Output:
    
Moderate quality evidence suggests that RTW coordination results in small relative , but likely important absolute benefits in the likelihood of disabled or sick-listed patients returning to work , and associated small improvements in function and pain .