human
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study evaluated a two-year multidisciplinary early intervention pilot programme for back-injured nurses employed at a large teaching hospital , using a pre- versus post-programme analysis . The purpose was to ascertain whether this programme could reduce the incidence , morbidity , time lost and cost due to  back injuries in the 250 nurses employed on ten targeted high-risk wards . Injuries in the remaining 1395 nurses employed on the other 45 wards were monitored concurrently for comparison . The programme consisted of prompt assessment , treatment and rehabilitation through modified work . Evaluative data were gathered by one research nurse on st and ardized forms at the time of injury , weekly until return to work , and at a six-month follow-up . Time lost and cost data for up to one-year post-injury were derived from workers ' compensation statements . Compared to the two years prior to introduction of the programme , the rates of back injuries and lost-time back injuries decreased by 23 % and 43 % , respectively , on the targeted wards , while these increased on the control wards . Combined expenditure was 32 % lower per injury and 34 % lower per lost-time injury for those in the targeted group who consented to take part in the programme compared to their counterparts on the control wards , as the increased assessment and treatment costs per case attributable to the programme were more than offset by the savings in lower compensation ( wage loss ) costs . This programme thus reduced the incidence and time lost due to back injuries and was cost-beneficial Background Major depressive disorder is among the medical conditions with the highest negative impact on work outcome . However , little is known regarding evidence -based interventions targeting the improvement of work outcomes in depressed employees . In this paper , the design of a r and omized controlled trial is presented in order to evaluate the effectiveness of adjuvant occupational therapy in employees with depression . This occupational intervention is based on an earlier intervention , which was design ed and proven effective by our research group , and is the only intervention to date that specifically targets work outcome in depressed employees . Methods / Design In a two-arm r and omized controlled trial , a total of 117 participants are r and omized to either ' care as usual ' or ' care as usual ' with the addition of occupational therapy . Patients included in the study are employees who are absent from work due to depression for at least 25 % of their contract hours , and who have a possibility of returning to their own or a new job .  The occupational intervention consists of six individual sessions , eight group sessions and a work-place visit over a 16-week period . By increasing exposure to the working environment , and by stimulating communication between employer and employee , the occupational intervention aims to enhance self-efficacy and the acquisition of more adaptive coping strategies . Assessment s take place at baseline , and at 6 , 12 , and 18-month follow-ups . Primary outcome measure is work participation ( hours of absenteeism and time until work resumption ) . Secondary outcome measures are work functioning , symptomatology , health-related quality of life , and neurocognitive functioning . In addition , cost-effectiveness is evaluated from a societal perspective . Finally , mechanisms of change ( intermediate outcomes ) and potential patient-treatment matching variables are investigated . Discussion This study hopes to provide valuable knowledge regarding an intervention to treat depression , one of the most common and debilitating diseases of our time . If our intervention is proven ( cost- ) effective , the personal , economic , and health benefits for both patients and employers are far-reaching . Trial registration Background In the present study the effect of a workplace-oriented intervention for persons on long-term sick leave for clinical burnout , aim ed at facilitating return to work ( RTW ) by job-person match through patient-supervisor communication , was evaluated . We hypothesised that the intervention group would show a more successful RTW than a control group . Methods In a prospect i ve controlled study , subjects were identified by the regional social insurance office 2 - 6 months after the first day on sick leave . The intervention group ( n = 74 ) was compared to a  control group who had declined participation , being matched by length of sick leave ( n = 74 ) . The RTW was followed up , using sick-listing register data , until 1.5 years after the time of intervention . Results There was a linear increase of RTW in the intervention group during the 1.5-year follow-up period , and 89 % of subjects had returned to work to some extent at the end of the follow-up period . The increase in RTW in the control group came to a halt after six months , and only 73 % had returned to work to some extent at the end of the 1.5-year follow-up . Conclusions We conclude that the present study demonstrated an improvement of long-term RTW after a workplace-oriented intervention for patients on long-term sick leave due to burnout . Trial registration Current Controlled Trials NCT01039168 BACKGROUND Occupational health guidelines recommend a biopsychosocial approach to manage  sickness absence due to musculoskeletal disorders ( MSDs ) , with a primary focus on early intervention through provision of a supportive network . AIMS To investigate the implementation of a guidelines -based intervention ( early contact of absentees ; addressing psychosocial obstacles ; offering temporary modified work ; communicating among the players ) , and to determine whether this is effective for reducing return-to-work times and duration of future absence . METHODS A non-r and omized controlled trial was conducted within a UK company . Occupational health nurses at two experimental sites ( 1,435 workers ) were trained to deliver the intervention to workers taking absence due to MSDs ( low back and upper limb disorders ) , while usual care was delivered at three control sites ( 1,483 workers ) .  Company-recorded absence data were collected over a 12-month follow-up period . RESULTS The implementation of the experimental intervention was impeded by unforeseen organizational obstacles at one site ( policies , procedures and individual approaches ) which had a detrimental effect on uptake and delivery . At the site where the intervention was delivered per protocol , absence was significantly less compared with controls ; 6.5 and 10.8 days , respectively . However , the duration of future absence was not significantly different ( 13.0 and 25.1 days , respectively ) . CONCLUSIONS An early intervention addressing psychosocial obstacles to recovery can be effective for reducing absence due to MSDs . Successful implementation , where the key players are onside and organizational obstacles are overcome , is difficult to achieve Background Common mental disorders , such as depression , anxiety disorder , and adjustment disorder , have emerged as a major public and occupational health problem in many countries . These disorders can have severe consequences such as absenteeism and work disability . Different interventions have been developed to improve the return-to-work of employees with common mental disorders , but still a large proportion of employees experiences health and work problems after their return-to-work . For this reason , the SHARP-at work intervention is developed to prevent a relapse of sickness absence among employees who have returned to work after a period of sickness absence because of common mental disorders . We aim to evaluate the effectiveness , cost-benefit and process of the intervention compared to care as usual . Methods / Design The study is design ed as a cluster-r and omised controlled trial with r and omisation at the level of the occupational physician . Employees who have returned to work after a period of sickness absence because of a common mental disorder are included in the study . Employees in the intervention group will receive the SHARP-at work intervention . The intervention focusses on active guidance of employees by occupational physicians  during the first weeks of work after sickness absence . Employees in the control group  will receive care as usual . Outcomes will be assessed at baseline and at 3 , 6 , and 12 months follow-up . The primary outcome is cumulative recurrent sickness absence days . Secondary outcome measures are mental health , work functioning , and coping . Adherence to the protocol , communication between stakeholders , and satisfaction with the treatment are the process measures assessed in both study groups . Cost-benefit is calculated from a societal perspective . Finally , prognostic factors for a relapse of sickness absence are investigated . Discussion This study goes beyond return-to-work by focussing on the prevention of recurrent sickness absence . The study incorporates not only outcomes on sickness absence and mental health but also on health-related work functioning . The results of this study can contribute to a further development of practice guidelines and the promotion of sustainable work participation . Trial registration R and omised controlled trial to evaluate the effectiveness of collaborative care in a Dutch occupational healthcare setting : 126 workers on sick leave with major depressive disorder were r and omised to usual care ( n = 61 ) or collaborative care ( n = 65 ) . After 3 months , collaborative care was more effective on the primary outcome measure of treatment response ( i.e. reduction in symptoms of ≥50 % ) on the Patient Health Question naire-9 ( PHQ-9 ) . However , the groups did not differ on the PHQ-9 as a continuous outcome measure . Implication s of these results are discussed Background To describe the design of a population based r and omized controlled trial ( RCT ) , including a cost-effectiveness analysis , comparing participative ergonomics interventions between 2–8 weeks of sick leave and Grade d Activity after 8 weeks of sick leave with usual care , in occupational back pain management . Methods Design : An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain . Interventions used are 1 . Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist . 2 . Grade d Activity based on cognitive behavioural principles by a physiotherapist . 3 . Usual care , provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain . The primary outcome measure is return to work . Secondary outcome measures are pain intensity , functional status and general improvement . Intermediate variables are kinesiophobia and pain coping . The cost-effectiveness analysis includes the direct and indirect costs due to low back pain . The outcome measures are assessed before r and omization ( after 2–6 weeks on sick leave ) and 12 weeks , 26 weeks and 52 weeks after first day of sick leave . Discussion The combination of these interventions has been subject of earlier research in Canada . The results of the current RCT will : 1 . crossvali date the Canadian findings in an different sociocultural environment ; 2 . add to the cost-effectiveness on treatment options for workers in the sub acute phase of low back pain . Results might lead to alterations of existing (inter)national guidelines Background The importance of staying active instead of bed rest has been acknowledged in the management of musculoskeletal disorders ( MSDs ) . This emphasizes the potential benefits of adjusting work to fit the employee 's remaining work ability . Despite part-time sick leave being an official option in many countries , its effectiveness has not been studied yet . We have design ed a r and omized controlled study to assess the health effects of early part-time sick leave compared to conventional full-day sick leave . Our hypothesis is that if work time is temporarily reduced and work load adjusted at the early stages of disability , employees with MSDs will have less disability days and faster return to regular work duties than employees on a conventional sick leave . Methods / Design The study population will consist of 600 employees , who seek medical advice from an occupational physician due to musculoskeletal pain . The inclusion requires that they have not been on a sick leave for longer than 14 days prior to the visit . Based on the physician 's judgement , the severity of the symptoms must indicate a need for conventional sick leave , but the employee is considered to be able to work part-time without any additional risk . Half of the employees are r and omly allocated to part-time sick leave group and their work time is reduced by 40–60 % , whereas in the control group work load is totally eliminated with conventional sick leave . The main outcomes are the number of days from the initial visit to return to regular work activities , and the total number of sick leave days during 12 and 24 months of follow-up . The costs and benefits as well as the feasibility of early part-time sick leave will also be evaluated . Conclusion This is the first r and omised trial to our knowledge on the effectiveness of early part-time sick leave compared to conventional full-time sick leave in the management of MSDs . The data collection continues until 2011 , but preliminary results on the feasibility of part-time sick leave will be available already in 2008 . The increased knowledge will assist in better decision making process regarding the management of disability related to MSDs . Trial Registration International St and ard R and omised Controlled Trial Number Register , register number IS RCT 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 . Tri 
    Output:
    
agent
There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains .
There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes .
There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW .
Evidence for the effectiveness of other single-domain interventions was mixed , with some studies reporting positive effects and others reporting no effects on lost time and work functioning .
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study evaluated a two-year multidisciplinary early intervention pilot programme for back-injured nurses employed at a large teaching hospital , using a pre- versus post-programme analysis . The purpose was to ascertain whether this programme could reduce the incidence , morbidity , time lost and cost due to  back injuries in the 250 nurses employed on ten targeted high-risk wards . Injuries in the remaining 1395 nurses employed on the other 45 wards were monitored concurrently for comparison . The programme consisted of prompt assessment , treatment and rehabilitation through modified work . Evaluative data were gathered by one research nurse on st and ardized forms at the time of injury , weekly until return to work , and at a six-month follow-up . Time lost and cost data for up to one-year post-injury were derived from workers ' compensation statements . Compared to the two years prior to introduction of the programme , the rates of back injuries and lost-time back injuries decreased by 23 % and 43 % , respectively , on the targeted wards , while these increased on the control wards . Combined expenditure was 32 % lower per injury and 34 % lower per lost-time injury for those in the targeted group who consented to take part in the programme compared to their counterparts on the control wards , as the increased assessment and treatment costs per case attributable to the programme were more than offset by the savings in lower compensation ( wage loss ) costs . This programme thus reduced the incidence and time lost due to back injuries and was cost-beneficial Background Major depressive disorder is among the medical conditions with the highest negative impact on work outcome . However , little is known regarding evidence -based interventions targeting the improvement of work outcomes in depressed employees . In this paper , the design of a r and omized controlled trial is presented in order to evaluate the effectiveness of adjuvant occupational therapy in employees with depression . This occupational intervention is based on an earlier intervention , which was design ed and proven effective by our research group , and is the only intervention to date that specifically targets work outcome in depressed employees . Methods / Design In a two-arm r and omized controlled trial , a total of 117 participants are r and omized to either ' care as usual ' or ' care as usual ' with the addition of occupational therapy . Patients included in the study are employees who are absent from work due to depression for at least 25 % of their contract hours , and who have a possibility of returning to their own or a new job .  The occupational intervention consists of six individual sessions , eight group sessions and a work-place visit over a 16-week period . By increasing exposure to the working environment , and by stimulating communication between employer and employee , the occupational intervention aims to enhance self-efficacy and the acquisition of more adaptive coping strategies . Assessment s take place at baseline , and at 6 , 12 , and 18-month follow-ups . Primary outcome measure is work participation ( hours of absenteeism and time until work resumption ) . Secondary outcome measures are work functioning , symptomatology , health-related quality of life , and neurocognitive functioning . In addition , cost-effectiveness is evaluated from a societal perspective . Finally , mechanisms of change ( intermediate outcomes ) and potential patient-treatment matching variables are investigated . Discussion This study hopes to provide valuable knowledge regarding an intervention to treat depression , one of the most common and debilitating diseases of our time . If our intervention is proven ( cost- ) effective , the personal , economic , and health benefits for both patients and employers are far-reaching . Trial registration Background In the present study the effect of a workplace-oriented intervention for persons on long-term sick leave for clinical burnout , aim ed at facilitating return to work ( RTW ) by job-person match through patient-supervisor communication , was evaluated . We hypothesised that the intervention group would show a more successful RTW than a control group . Methods In a prospect i ve controlled study , subjects were identified by the regional social insurance office 2 - 6 months after the first day on sick leave . The intervention group ( n = 74 ) was compared to a  control group who had declined participation , being matched by length of sick leave ( n = 74 ) . The RTW was followed up , using sick-listing register data , until 1.5 years after the time of intervention . Results There was a linear increase of RTW in the intervention group during the 1.5-year follow-up period , and 89 % of subjects had returned to work to some extent at the end of the follow-up period . The increase in RTW in the control group came to a halt after six months , and only 73 % had returned to work to some extent at the end of the 1.5-year follow-up . Conclusions We conclude that the present study demonstrated an improvement of long-term RTW after a workplace-oriented intervention for patients on long-term sick leave due to burnout . Trial registration Current Controlled Trials NCT01039168 BACKGROUND Occupational health guidelines recommend a biopsychosocial approach to manage  sickness absence due to musculoskeletal disorders ( MSDs ) , with a primary focus on early intervention through provision of a supportive network . AIMS To investigate the implementation of a guidelines -based intervention ( early contact of absentees ; addressing psychosocial obstacles ; offering temporary modified work ; communicating among the players ) , and to determine whether this is effective for reducing return-to-work times and duration of future absence . METHODS A non-r and omized controlled trial was conducted within a UK company . Occupational health nurses at two experimental sites ( 1,435 workers ) were trained to deliver the intervention to workers taking absence due to MSDs ( low back and upper limb disorders ) , while usual care was delivered at three control sites ( 1,483 workers ) .  Company-recorded absence data were collected over a 12-month follow-up period . RESULTS The implementation of the experimental intervention was impeded by unforeseen organizational obstacles at one site ( policies , procedures and individual approaches ) which had a detrimental effect on uptake and delivery . At the site where the intervention was delivered per protocol , absence was significantly less compared with controls ; 6.5 and 10.8 days , respectively . However , the duration of future absence was not significantly different ( 13.0 and 25.1 days , respectively ) . CONCLUSIONS An early intervention addressing psychosocial obstacles to recovery can be effective for reducing absence due to MSDs . Successful implementation , where the key players are onside and organizational obstacles are overcome , is difficult to achieve Background Common mental disorders , such as depression , anxiety disorder , and adjustment disorder , have emerged as a major public and occupational health problem in many countries . These disorders can have severe consequences such as absenteeism and work disability . Different interventions have been developed to improve the return-to-work of employees with common mental disorders , but still a large proportion of employees experiences health and work problems after their return-to-work . For this reason , the SHARP-at work intervention is developed to prevent a relapse of sickness absence among employees who have returned to work after a period of sickness absence because of common mental disorders . We aim to evaluate the effectiveness , cost-benefit and process of the intervention compared to care as usual . Methods / Design The study is design ed as a cluster-r and omised controlled trial with r and omisation at the level of the occupational physician . Employees who have returned to work after a period of sickness absence because of a common mental disorder are included in the study . Employees in the intervention group will receive the SHARP-at work intervention . The intervention focusses on active guidance of employees by occupational physicians  during the first weeks of work after sickness absence . Employees in the control group  will receive care as usual . Outcomes will be assessed at baseline and at 3 , 6 , and 12 months follow-up . The primary outcome is cumulative recurrent sickness absence days . Secondary outcome measures are mental health , work functioning , and coping . Adherence to the protocol , communication between stakeholders , and satisfaction with the treatment are the process measures assessed in both study groups . Cost-benefit is calculated from a societal perspective . Finally , prognostic factors for a relapse of sickness absence are investigated . Discussion This study goes beyond return-to-work by focussing on the prevention of recurrent sickness absence . The study incorporates not only outcomes on sickness absence and mental health but also on health-related work functioning . The results of this study can contribute to a further development of practice guidelines and the promotion of sustainable work participation . Trial registration R and omised controlled trial to evaluate the effectiveness of collaborative care in a Dutch occupational healthcare setting : 126 workers on sick leave with major depressive disorder were r and omised to usual care ( n = 61 ) or collaborative care ( n = 65 ) . After 3 months , collaborative care was more effective on the primary outcome measure of treatment response ( i.e. reduction in symptoms of ≥50 % ) on the Patient Health Question naire-9 ( PHQ-9 ) . However , the groups did not differ on the PHQ-9 as a continuous outcome measure . Implication s of these results are discussed Background To describe the design of a population based r and omized controlled trial ( RCT ) , including a cost-effectiveness analysis , comparing participative ergonomics interventions between 2–8 weeks of sick leave and Grade d Activity after 8 weeks of sick leave with usual care , in occupational back pain management . Methods Design : An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain . Interventions used are 1 . Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist . 2 . Grade d Activity based on cognitive behavioural principles by a physiotherapist . 3 . Usual care , provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain . The primary outcome measure is return to work . Secondary outcome measures are pain intensity , functional status and general improvement . Intermediate variables are kinesiophobia and pain coping . The cost-effectiveness analysis includes the direct and indirect costs due to low back pain . The outcome measures are assessed before r and omization ( after 2–6 weeks on sick leave ) and 12 weeks , 26 weeks and 52 weeks after first day of sick leave . Discussion The combination of these interventions has been subject of earlier research in Canada . The results of the current RCT will : 1 . crossvali date the Canadian findings in an different sociocultural environment ; 2 . add to the cost-effectiveness on treatment options for workers in the sub acute phase of low back pain . Results might lead to alterations of existing (inter)national guidelines Background The importance of staying active instead of bed rest has been acknowledged in the management of musculoskeletal disorders ( MSDs ) . This emphasizes the potential benefits of adjusting work to fit the employee 's remaining work ability . Despite part-time sick leave being an official option in many countries , its effectiveness has not been studied yet . We have design ed a r and omized controlled study to assess the health effects of early part-time sick leave compared to conventional full-day sick leave . Our hypothesis is that if work time is temporarily reduced and work load adjusted at the early stages of disability , employees with MSDs will have less disability days and faster return to regular work duties than employees on a conventional sick leave . Methods / Design The study population will consist of 600 employees , who seek medical advice from an occupational physician due to musculoskeletal pain . The inclusion requires that they have not been on a sick leave for longer than 14 days prior to the visit . Based on the physician 's judgement , the severity of the symptoms must indicate a need for conventional sick leave , but the employee is considered to be able to work part-time without any additional risk . Half of the employees are r and omly allocated to part-time sick leave group and their work time is reduced by 40–60 % , whereas in the control group work load is totally eliminated with conventional sick leave . The main outcomes are the number of days from the initial visit to return to regular work activities , and the total number of sick leave days during 12 and 24 months of follow-up . The costs and benefits as well as the feasibility of early part-time sick leave will also be evaluated . Conclusion This is the first r and omised trial to our knowledge on the effectiveness of early part-time sick leave compared to conventional full-time sick leave in the management of MSDs . The data collection continues until 2011 , but preliminary results on the feasibility of part-time sick leave will be available already in 2008 . The increased knowledge will assist in better decision making process regarding the management of disability related to MSDs . Trial Registration International St and ard R and omised Controlled Trial Number Register , register number IS RCT 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 . Tri 
    Output:
    