Motivational Interviewing as a method to facilitate return to work: a systematic review
The Norwegian Labour and Welfare Administration (NAV) commissioned this systematic review to study the effect of Motivational Interview
The Norwegian Labour and Welfare Administration (NAV) strives to include as many people as possible in employment. Motivational Interviewing (MI) is suggested to be a suitable method to achieve this goal. Training in MI is already widespread within NAV, despite the lack of solid research evidence about its effects on employment, wherefore NAV commissioned this systematic review.
We found scarce evidence for the effects of MI as a method to facilitate return to work: only five controlled studies (range 29 to 500 participants) met our inclusion criteria.
All studies targeted people with severe and longlasting conditions (i.e. people with severe mental disorders, disability pensioners, HIV-positive people, and drug-related offenders).
MI was in all studies combined with one or more other interventions, and compared either with the same other intervention, another intervention or no intervention. Due to differences across studies we decided against pooling of the results. Median follow up was 12 months.
Results from three of the five studies suggest that using MI to facilitate return to work may lead to more people achieving open employment (low to very low certainty of evidence). The other two studies did not report results for open employment separately. Interpretation of other results was difficult as the study populations constituted a mix of employed and unemployed people.
Only one study reported on work-hindering behavioural factors (e.g. expectancy to return to work). We could not determine the effect of MI on such factors.
Despite the scarce evidence, the results of this systematic review suggest that MI may be an effective method to facilitate return to work. Further investigation, including populations with less severe conditions is required to verify this potential.
One of the main objectives for the Norwegian Labour and Welfare Administration (NAV) is an inclusive job market with as many people as possible in employment. NAV’s Guidance Platform points explicitly to Motivational Interviewing (MI) as a suitable method to achieve this goal. In Norway, training in MI is already widespread within NAV, despite the lack of solid research evidence about its effects on employment.
The overall objective of this project was to summarise the research on the effects of Motivational Interviewing as a method to facilitate return to work for people who for various reasons are not working. We aimed to answer the following questions:
- What is the documented effect of Motivational Interviewing as a method to facilitate return to open paid employment (alternatively to remain in work) for people who are not working?
- What is the documented effect of Motivational Interviewing as a method to help people who are not working overcoming work-hindering factors (e.g. low work-motivation, low self-efficacy or work-readiness etc)?
We conducted a systematic review in accordance with the handbook of the Division of Health Services within the National Institute of Public Health. We searched for primary studies in ten electronic databases up to November 2016. Two people independently screened all titles, and thereafter assessed the full texts of possible eligible studies. One review author extracted data onto a standardised data extraction form, and a second review author checked the correctness of the extracted data. Two authors independently assessed the quality of the included studies using the Cochrane risk of bias tool and the certainty of the included evidence using the GRADE tool (Grading of Recommendations Assessment, Development and Evaluation).
We found five controlled studies (range 29 to 500 participants) that evaluated the effects of MI as a method to facilitate return to work for people who for different reasons are not working. The studies were conducted in England, Australia, the USA (2 studies), and Norway.
Two of the studies reported effects of MI on open paid employment, and one study reported the effects of MI on the composite measure ‘having returned to work or being in the process of returning to work’ (i.e. being at work training or attending an educational course). One study reported no numerical data for open employment, and one reported work status and days in open employment. Only one of the studies reported effects on work-hindering (behavioural) outcomes.
One study showed that MI delivered with individual placement support (IPS) possibly lead to more people with psychosis achieving open paid employment as compared to IPS only (Risk Ratio [RR]: 2.35 [95% CI 1.31 to 4.19]; low certainty of evidence).
It is uncertain whether MI plus an information pack, delivered to people with severe psychiatric conditions, leads to increased open paid employment compared with the mailed information pack only (one study; RR: 7.33 [95% CI 1.04 to 51.67]; very low certainty of evidence).
It is uncertain whether MI delivered as part of a brief vocational intervention to disability pensioners with back pain, leads to increased ‘paid employment or being in a process of returning to work’ rate than control (one study; RR: 1.96 [95% CI 0.73 to 5.26]; very low certainty of evidence). The same study reported similar work capacity, perceived disability, and fear-avoidance behaviour in both groups.
It is uncertain whether MI, skills building and job related skills training delivered to HIV-positive people receiving disability payment, of which some were employed (32%) and some unemployed, leads to improved employment related outcomes as compared to community referral. The effect on a mean summed score of open employment, volunteer work, job training and job seeking, was inconsistent, with better scores in the intervention group at 18 months but not at 6, 12 or 24 months follow-up (no numerical data provided). Open employment was not reported separately.
It is uncertain whether MI delivered as part of a tailored vocational intervention alongside a drug court program to a mixed group of employed (53.6%) and unemployed drug-involved offenders, leads to more people achieving open legal employment than drug court only: around 30% of participants in both groups who were unemployed at baseline had achieved employment at follow up. The intervention may lead to slightly more days of legal employment during the last 12 months (low certainty of evidence).
We found no studies that evaluated MI as a method to facilitate return to work for people who were unemployed, on sick-leave, or people receiving other types of benefits or work assessment allowance. Nor did we find any studies in which MI was used to support individuals on part-time sick leave to remain in work.
We included five studies in this systematic review, of which four were relatively small. Differences across studies prevented us from pooling of the results. The results, which are based on low to very low certainty of evidence, should be interpreted with caution.
In all five studies, MI targeted people with severe long-term conditions only: people with psychiatric conditions, disability pensioners with HIV or back pain, and drug-involved offenders. It may not be possible to generalise the results of this review to people with less severe conditions, or with shorter work absences.
Surprisingly, only one of the included studies reported effects of MI on work-hindering behavioural factors (work capacity, perceived disability, fear avoidance behaviour); and no study reported on self-efficacy, work-motivation, ‘work-readiness’, anxiety, depression or sleeping problems.
There is scarce evidence for the effect of MI as a method to facilitate return to work. This is especially true for people with less serious conditions and shorter work absences.
The results of this review indicate that MI may be a useful method to facilitate return to work. As the certainty of the included evidence is low to very low, we need more evidence from large well-conducted trials to verify this.
Future studies should preferably include behavioural outcomes, and also evaluate the effects of MI targeted at people with less severe conditions.