6 February 2019
Occupational rehabilitation: improving attention is associated with return to work
Dr Thomas Johansen from the Norwegian National Advisory Unit on Occupational Rehabilitation talked us through why he chose CANTAB to investgate whether improving cognitive function during occupational rehabilitation improves return to work.
Can you tell us more about your research group?
The Norwegian National Advisory Unit on Occupational Rehabilitation is an interdisciplinary research group investigating the effect and quality of occupational rehabilitation programmes in Norway. Rehabilitation programmes are provided for patients who are on long term sick leave, having been referred by general practitioners or sickness absence insurance offices. Occupational rehabilitation is given as both inpatient and outpatient interventions lasting between 3-4 weeks. The programme is delivered by interdisciplinary clinical teams, which includes an assessment of the work and health situation, physical and functional training, collaboration with the workplace, and the application of evidence based psychological treatment components such as Cognitive Behavioural Therapy (CBT). We collaborate with research groups in Norway, Denmark, Iceland, Germany and Netherlands.
What is the rationale behind your research?
Around 500 000 individuals are currently not in work in Norway. This represents one of the highest average number of working days lost per employee per year due to sickness or injury compared to other OECD countries. The benefits for the welfare state are huge if we are able to return more people to work after sick leave. Occupational rehabilitation is one of many work-related interventions in Norway, and applying a cognitive approach to this rehabilitation is claimed to be efficacious. The cognitive treatment components most commonly applied are CBT, metacognitive therapy, mindfulness, acceptance and commitment therapy, and psychoeducation. The overall goal of our research is to evaluate to what degree occupational rehabilitation, with a strong focus on cognition, is associated with functional changes and return to work.
Which methods did you use?
We have conducted two studies so far, one pre- and post-test and the other a longitudinal study with a 12 month follow up. We employed eight CANTAB tests targeting memory, attention, emotion and executive functioning, where the main aim was to investigate changes in cognitive functioning during rehabilitation and the association between changes in cognitive functioning and return to work. The return to work register data was provided by the Norwegian labour and welfare administration.
What are your key findings?
The results show that improvements in sustained and focused attention and working memory are evident during rehabilitation. Furthermore, improvements in sustained and focused attention are associated with return to work. Interestingly, improvements in memory, emotion and executive functioning did not show an association with return to work in our data.
What are the implications of your research?
Improvements in working memory and attention enhance the ability to stay focused, process information, and shift focus as needed. If an individual experiences increased cognitive control and mental capacity, that is having good mental resources, it often leads to more flexible behaviour and enables individuals to have better control of their thoughts. These are important abilities to succeed in working life, especially considering our finding that improvements in attention are associated with return to work. The treatment success of occupational rehabilitation may depend on influencing cognitive functioning by identifying barriers for return to work and using situations at work in rehabilitation. This may also involve workplace exposure training for individuals reporting symptoms of anxiety and depression, which may affect cognitive functioning, and especially attention, to a greater degree.
Why did you choose CANTAB?
In my previous studies, I have found CANTAB to be user friendly, easy to administer, and able to account for practice effects, so I wanted to continue using CANTAB in my current research. We also welcomed the availability of emotional tests which make it possible to investigate the interaction between cognition and emotion. We also decided to continue using CANTAB because of the good service we have received from the administrative staff.
What are the next steps for your research?
There are some studies showing that work-focused CBT compared to traditional CBT is more effective in getting individuals on sick leave back to work. However, the effect of work-focused CBT on cognition and return to work has not yet been investigated. We aim to investigate this in a randomised controlled trial to better account for the effects of different CBT approaches on cognition and return to work.
Dr Thomas Johansen, Norwegian National Advisory Unit on Occupational Rehabilitation