Implementation of a rehabilitation model for employees on long-term sick leave in the public sector: difficulties, counter-measures, and outcomes.

Objective: The aim was threefold: 1) to describe the experiences of driving and implementing a workplace-based rehabilitation intervention in cooperation with the occupational health service (OHS); 2) to investigate which people received multimodal and/or vocational rehabilitation measures; 3) to find predictors of return to work (RTW).

Participants: Altogether 779 employees on sick leave for 90 days or more with mainly musculoskeletal or psychological/stress-related problems, 90% women.

Methods: The HAKuL model was introduced, implying an early team assessment at the OHS and good access to rehabilitation measures. The study is a prospective three-year study with a two-year follow-up.

Results: The rehabilitation intervention encountered challenges. Counter-measures were taken to facilitate coordination and communication. People with musculoskeletal problems often received both multimodal and vocational rehabilitation. Vocational rehabilitation was advocated for people who were under 55 years of age, and for those with stress-related problems. The strongest predictive factors for RTW were: having received only vocational rehabilitation and being under 45 years of age.

Conclusion: The HAKuL model can be used in a wider context, but the study shows the need for coordination between multiple stakeholders. Supervisors should pay attention to people who have musculoskeletal problems and are older, as soon as problems emerge.