Comprehensive approach to reintegration of disability benefit recipients with multiple problems (CARm) into the labour market: results of a randomized controlled trial

Abstract

Purpose

Although most clients on work disability benefits face multiple problems, most traditional interventions for (re)integration focus on a single problem. The aim of this study was to evaluate the “Comprehensive Approach to Reintegrate clients with multiple problems” (CARm), which provides a strategy for labour experts to build a relationship with each client in order to support clients in their needs and mobilize their social networks.

Methods

This study is a stratified, two-armed, non-blinded randomized controlled trial (RCT), with a 12-month follow-up period. Outcome measures were: having paid work, level of functioning, general health, quality of life, and social support.

Results

We included a total of 207 clients in our study; 97 in the intervention group and 110 in the care as usual (CAU) group. The clients’ mean age was 35.4 years (SD 12.8), 53.1% were female, and 179 (86.5%) reported multiple problems. We found the CARm intervention to have no significant effects superior to those of the CAU group on all outcomes.

Conclusion

As we found no superior effect of the CARm intervention compared to CAU, we cannot recommend widespread adoption of CARm. A process evaluation will give more insight into possible implementation failure of the intervention.

IMPLICATIONS FOR REHABILITATION

• Most traditional interventions for (re)integration into the labour market are problem-centred, i.e., focusing on a single problem, and have limited effectiveness in persons with multiple problems.

• A strength-based intervention may be suitable for vocational rehabilitation and disability settings, since it contains many elements (e.g., being strength-based, focused on clients’ wishes and goals, and involving activation of the social environment) also likely to improve chances of re-employment of persons with multiple problems.

• In this study a strength-based intervention did not show a superior effect on paid employment and functioning within one year follow-up compared to care as usual in people with multiple problems on a work disability benefit.

Keywords:

• Multiple problems
• strength
• disability benefit
• reintegration
• intervention study
• RCT
• return to work
• vocational rehabilitation

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

We thank our former research assistant Jeanique Ham for her contribution in logistics, organization and administration for this study. We also thank the participating labour experts from the Dutch Social Security Institute and their participating clients. Finally, we especially acknowledge our beloved colleague Bert Cornelius. Bert was till his death a major contributor to the design of this study.

Ethics approval

The Medical Ethics Committee of the University Medical Center Groningen (UMCG), the Netherlands, approved recruitment, consent and field procedures. The trial was registered at the Dutch Trial Register (Nederlands Trial Register) (NTR5733). Design and reporting in this study is in line with the “CONSORT 2010 statement: extension to cluster randomized control trials.”

Informed consent

Written informed consent was obtained from all study participants.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the authors on reasonable request.