Musculoskeletal disorders are the main cause to sickness absence and disability benefits in Norway and are the single leading cause of disability worldwide. Facilitating return to work (RtW) and preventing long-term sickness absence are critical concerns for the Norwegian Labour and Welfard Administration (NAV), as well as future health service. Using Motivational Interviewing (MI) in the dialogue with sick-listed people has become a popular strategy in NAV offices in Norway despite that there is limited scientific evidence for the effect of MI on RtW outcomes. Providing MI interviews to all sick-listed people requires large resources from the NAV offices. One way around this challenge is to use a Stratified Primary Care approach based on screening and targeting of individuals with a high risk for long-term sickness absence. Stratified Primary Care for musculoskeletal disorders enables to identify the right people for the right treatment at the right time. This approach has succeeded in reducing time off work with 50% and lowered the levels of sickness absence among people with low back pain.

The main objective of this project is, therefore, to compare the effects of MI, either provided alone by NAV employees or combined with Stratified Primary Care, provided by GPs or physiotherapists in primary health care, with usual NAV practice on RtW among people sick-listed due to a musculoskeletal disorder. Secondary objectives include to investigate: 1)the scientific evidence for the use of MI and the current NAV practice on counseling approaches in meetings with sick-listed people with musculoskeletal disorders; 2) the precision of a simple 9-item screening tool in identifying risk profiles among Norwegian people sick-listed due to musculoskeletal disorders; 3)the cost-effectiveness of the two interventions against usual NAV practice; and 4) evaluate the effect of self-efficacy, work-readiness, workability and change in risk profile as potential mediators on RtW.

The project consists of 3 work packages (WP); in WP1 the current practice of NAV in dealing with sick-listed people due to a musculoskeletal disorder will be explored, as well as the current evidence for using MI to facilitate RtW in musculoskeletal disorders. In WP2 a brief screening tool to identify the risk profile of the musculoskeletal disorders population will be tested among Norwegian people. In WP3 a randomized controlled trial with 3 arms will be conducted comparing the effects of a MI-intervention and MI plus Stratified Primary Care with ordinary NAV practice. A complete health-economy and mediation analysis will be included.