The MI-NAV project is a large NFR-funded research project with three work packages and several project collaborators. The overall aim is to evaluate the effectiveness and cost-effectiveness of usual case management alone with usual case management plus Motivational Interviewing (MI), provided by case managers in the NAV system in Norway, or usual case management plus Stratified Vocational Advice Intervention (SVAI), provided by physiotherapists working in primary care, to people on sick leave due to MSK disorders. The primary outcome is number of sickness days and time to return-to-work (RtW).
Musculoskeletal (MSK) disorders are the main cause of sickness absence and disability benefits in Norway, and the single leading cause of disability worldwide. Facilitating return to work (RTW) and preventing long-term sickness absence are critical concerns for the Norwegian Labour and Welfare Administration (NAV).
Using Motivational Interviewing (MI) in the dialogue with people on sick leave has become a popular strategy in NAV, despite limited scientific evidence for the effectiveness of MI on RTW. Providing MI to all people on sick leave requires large resources from NAV.
One way around this challenge is to use a stratified approach, based on screening, to target individuals with a high risk for long-term sickness absence. Stratified primary care enables us to identify the right people for the right treatment.
The main objective of this MI-NAV project (2018-2023) was therefore to evaluate the effectiveness and cost-effectiveness of usual case management alone with usual case management plus MI or usual case management plus Stratified Vocational Advice Intervention (SVAI) on RTW among people on sick leave due to MSK disorders.
Secondary objectives were to investigate
- the scientific evidence for the use of MI and the current NAV practice on counseling approaches in meetings with people on sick leave with musculoskeletal disorders
- the precision of a simple 9-item screening tool in identifying risk profiles among Norwegian people on sick leave due to musculoskeletal disorders
- the cost-effectiveness of the two interventions against usual NAV practice
- the mediating effect of self-efficacy, work ability and change in risk profile as potential mediators on RtW
- potential predictors for successful outcome at 12 months follow-up
All data collection in the MI-NAV project has been completed, and a summary for the status for each of the three work packages (WP) is as follows:
In WP 1, the scientific evidence for the use of MI and the current NAV practice on counseling approaches in meetings with people on sick leave with MSK disorders were investigated by conducting a systematic mapping review and a survey and focus group interview of NAV caseworkers on their experiences of the RTW process among people with MSK disorders.
Three papers have been published on results from WP1.
In WP2, we have explored the most accurate screening tool to identify people at a high risk of prolonged sickness absence due to MSK disorder, and investigated MSK health, health-related quality-of-life, health care consumption, and costs across different risk profiles in individuals on sick leave due to MSK disorders.
This was a prospective cohort study of people on sick leave due to MSK disorder of 4 weeks or more and they are followed in one year by NAV registry data as well as registry data on health care utilization. The study protocol is registered in ClinicalTrials.gov ID: NCT04196634,27.11.2019 and published (6). Three papers have been published from the WP2.
In WP3 a multi-arm randomised controlled trial (RCT) is conducted within the NAV system in Norway. The trial is registered in ClinicalTrials.gov ID: NCT03871712. The protocol is published as well as statistical analysis plan for the main analyses (1).
By autumn 2021 the 6 months follow-up of 450 included participants, aged 18-67 years, on 50-100% sick leave for >7 weeks due to MSK disorders have been completed.
The primary outcome is the number of sick leave days from randomization to 6 months follow-up, and the primary analysis is in process and has been completed. A draft from the primary results has been submitted to an international referee-based journal with high impact.
Two process evaluations, one for each intervention, have been conducted, including fidelity of the interventions, and have been published in two papers during 2021.
Cost-utility evaluated by the EuroQoL 5D-5L and cost-benefit analyses will be performed on the 6 months follow-up data and is in process.
Other secondary outcomes are number of sick leave days and time until sustainable RTW (≥4 weeks of at least 50% of their usual working hours) at 12 months, proportions of participants receiving sick leave benefits during 12 months of follow-up, and MSK symptoms influencing health at 12 months. The 12 months follow-up will be completed in April 2022.
This project will provide important knowledge regarding the effectiveness of today’s case management in NAV, as well as two promising new approaches provided by case managers in NAV and municipality/primary health care. If MI and/or SVAI show to be effective the new approaches will be implemented in education programs within social welfare and health.
NAV and representatives from user organisations involved in the MI-NAV Study consider the results to be of high relevance to stakeholders involved in the follow-up of people on sick leave due to musculoskeletal disorders.
The results of the RCT, which also will provide evidence of the cost-effectiveness of MI and SVAI, will be important for policy and decision makers in health and social services.