Finnish stress intervention impact questioned
Most of us would agree that prevention is better than cure. But new results out in the journal Clinical Rehabilitation, published by SAGE, indicate that a costly intervention programme designed to reduce early retirement on health grounds in Finland had no measurable effect.
The research was a large scale evaluative study of vocational rehabilitation, which followed 872 participants and their 2440 matched controls for up to nine years. The participants went through a four-week prevention programme incorporating physical and psychological health education and support. It aimed to help participants adopt a healthier lifestyle, and to achieve greater aerobic capacity, muscle strength and endurance, and to better manage their own stress.
This research was part of the Finnish Public Sector Study, an ongoing prospective study among employees working in 10 towns and 21 hospitals in Finland. Among other data, researchers gathered information on psychosocial factors at work, individual factors, health, and health behaviors. All of the participants were linked to employers' records and national health registers.
When the researchers compared how frequently participants and controls complained suboptimal health, psychological distress, and anxiety, there was no significant difference. After the intervention there was also no significant difference between scores for the groups, either in the short term (on average after 1.7 years) or in the longer term (on average followed up after almost six years or in some cases for up to nine years).
The four week programme is widely used in Finland in a bid to reduce early retirement on health grounds. But this study suggests that the programme had little effect, either in the short or long term, on how those who took part perceived their health. The intervention would typically involve a physician, a physiotherapist, a psychologist, a social worker, and a vocational rehabilitation specialist. Sometimes a nurse, an occupational therapist, an occupational physiotherapist, and a nutritionist would also join the team.
Of the 872 participants who received the intervention, 90 percent were women. The perceived work-related health effects were not limited to particular groups of workers: 36 percent held the highest occupational positions, and 35 percent were in service work or manual jobs.
Although the authors stress that their findings may not hold true beyond Finland, the study will shine a spotlight on similar, work-related interventions. These tend to be either individual-based, offering tools in areas such as healthy lifestyle or stress management; or they are work-directed, and might include changes in working environment or organization. To date, solid evidence for the effectiveness of either type of intervention is limited.
Perceived health is a strong predictor and marker of morbidity, work disability, and mortality. Almost one in three workers complains of psychological distress, tiredness, or anxiety, estimated to cause an annual loss of at least EUR 20 billion in the European states.
This most widely used multidisciplinary inpatient rehabilitation programme in Finland primarily aims to prevent work capacity deteriorating in physically, mentally, or socially stressful occupations at an early stage, before illnesses causing work disability develop. It may be that the programme simply isn't reaching those who need it most - the study authors note that those put forward for the intervention were often highly educated, satisfied employees who are not exposed to severe stress or do not perceive stress-related symptoms.
"Our results suggest that the vocationally oriented, individual-based multidisciplinary prevention programme focused on in this study may not be effective in improving perceived health," said the leading author Mikhail Saltychev, Department of Rehabilitation, Turku University Hospital, Finland. "Future research is needed to examine the reasons for the ineffectiveness of this costly early intervention and to identify more effective preventive measures to improve subjective health in working populations."
Effect of a Multidisciplinary Rehabilitation Programme on Perceived Health among Employees at Increased Risk of Incapacity for Work: a Controlled Study by Mikhail Saltychev, Katri Laimi, Tuula Oksanen, Jaana Pentti, Marianna Virtanen, Mika Kivimaki and Jussi Vahtera will be published today, December 2nd, 2011 in Clinical Rehabilitation.
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