Work-directed rehabilitation or physical activity to support work ability and mental health in common mental disorders: a pilot randomized controlled trial.

Objective: To evaluate feasibility and potential effectiveness of work-directed rehabilitation in people with common mental disorders.
Design: Pilot randomized controlled trial.
Setting: Primary healthcare, Sweden.
Subjects: Working adults ( n  = 42) of mean age 46.2 ± 11.1 years with depression or anxiety disorder.
Interventions: Eight weeks of work-directed rehabilitation ( n  = 21) or physical activity ( n  = 21). Work-directed rehabilitation included sessions with a physiotherapist and/or an occupational therapist, to develop strategies to cope better at work. Physical activity included a planning session and access to a local gym.
Main Measures: Feasibility: attendance, discontinuation and adverse events. Measurements were the Work Ability Index, the Global Assessment of Functioning, the Montgomery-Asberg Depression Rating Scale, the Beck Anxiety Inventory and the World Health Organization-Five Well-Being Index.
Results: Attendance to rehabilitation sessions was 88% ( n  = 147/167) and discontinuation rate was 14% ( n  = 3/21). No serious adverse events were reported. Within both groups, there was a significant improvement in Work Ability Index score (mean change: 3.6 (95% confidence interval (CI): 0.45, 6.7) in work-directed rehabilitation and 3.9 (95% CI: 0.9, 7.0) in physical activity) with no significant difference between groups. For the other outcomes, significant improvements were found within but not between groups. Per-protocol analysis showed a trend toward the antidepressant effect of work-directed rehabilitation compared to physical activity (mean difference in depression score -3.1 (95% CI: -6.8, 0.4), P  = 0.075).
Conclusion: Work-directed rehabilitation was feasible to persons with common mental disorders and improved their work ability and mental health. Comparable improvements were seen in the physical activity group. Suggested modifications for a larger trial include adding a treatment-as-usual control.