Abstract
Background: Sick absence is a broad and complex problem. Multidisciplinary occupational rehabilitation programs and cognitive behavioral therapies such as Acceptance and Commitment Therapy (ACT) have been developed to treat this issue. However, few studies have been done to study what works for whom and why. We therefore wanted to study possible processes and our first hypothesis was that baseline psychological flexibility (PF) and inflexibility (PI) would be associated with improvement in self-reported outcome measures at all timepoints following a multidisciplinary occupational rehabilitation (OR) program. Our second hypothesis was that the pre-post treatment change in PF and PI would be associated with changes found in all self-reported outcome measures. Method: In this non-controlled study participants (n = 21), on partial or full sick leave, received a 3 week multidisciplinary occupational rehabilitation program. Participants completed questionnaires about mental, physical and social functioning and PF and PI, before, at arrival, at departure and four weeks after departure from the program. The questionnaires used were the PROMIS-29 and the newly translated Norwegian version of the MPFI-24. Both questionnaires were given as digital forms to the participants. To test the hypotheses we used a single subject quasi-experimental ABA-design and performed non-parametric Spearman Rank Order Correlation analysis to test for associations. All data was consecutively collected by the authors for the purpose of this paper in collaboration with CatoSenteret. Data might be used in the future in further research done by CatoSenteret. Results: Results showed that baseline PF was significantly associated with self-reported levels of anxiety and depression at all timepoints. Baseline PI was significantly associated with anxiety 2 at all time points. Levels of baseline PI were also significantly associated with depression at two timepoints (at arrival and at four weeks follow-up). When studying pre-post-treatment changes, only PI was significantly associated with the change observed in anxiety and the ability to participate in social roles and activities. Conclusion: Significant associations between baseline PF and PI, and symptom measures such as anxiety and depression can indicate that PF and PI can potentially be predisposing factors as to what can work for whom and why within ACT in the OR field. However, we lack evidence to explain the pre-post changes found when studying our second hypothesis. We are also mindful of the limitations of the current study and the complex nature of the rehabilitation field. Therefore, we cannot draw inferences as to the causality of our findings, as well as the external validity. Bearing this in mind, future studies should be done to test and elaborate on these associations and assumptions.