Model of Human Occupation as a framework for implementation of Motivational Interviewing in occupational rehabilitation.

BACKGROUND: A conceptual framework is needed to understand injured workers' decision-making and inform evidence-based interventions to address behavior change regarding return-to-work (RTW). The Model of Human Occupation (MOHO) can help with understanding how an injured worker's characteristics can generate behavior change while Motivational Interviewing (MI) can help facilitate behavior change. OBJECTIVE: This theoretical paper provides an overview of how MOHO and MI can be applied and integrated in occupational rehabilitation. The objectives of this paper are to: (1) evaluate MOHO as a framework for supporting occupational therapists (OTs) in occupational rehabilitation; (2) describe MI as a suitable approach for OTs in occupational rehabilitation; and (3) compare and integrate MOHO and MI. METHOD: Several important works and reviews were used to integrate MOHO and MI with occupational rehabilitation. IMPLICATIONS FOR PRACTICE: The identification of a model and approach to support OT practice in occupational rehabilitation can assist OTs to determine the most appropriate interventions and contribute to standards of best practice. CONCLUSIONS: Integrating MOHO and MI provides a comprehensive framework for understanding impairment and RTW change processes with the potential to reduce work disability and improve RTW outcomes.

Motivational Interviewing Improves Sustainable Return to Work in Injured Workers After Rehabilitation: A Cluster Randomized Controlled Trial.

OBJECTIVE: To examine whether motivational interviewing (MI) leads to more sustainable return-to-work outcomes for injured workers undergoing rehabilitation. DESIGN: Cluster randomized controlled trial. SETTING: Workers' compensation rehabilitation facility. PARTICIPANTS: Claimants (N=728) undergoing rehabilitation for musculoskeletal conditions, who were predominantly employed (529, 72.7%) men (460, 63.2%) with chronic conditions (mean duration, 234d). INTERVENTIONS: MI is a goal-oriented, client-centered counseling approach that facilitates behavioral change through identifying and resolving ambivalence. Treating clinicians at the facility were randomized into 2 groups. One group included 6 clinicians who were trained to conduct MI interventions during rehabilitation, while the control group included 6 clinicians who continued standard procedures. MAIN OUTCOME MEASURES: Outcomes included compensation outcomes over 1 year after discharge. This included reception of disability benefits and recurrence rates. Analysis was stratified by admission employment status and included chi-square test, t test, and multivariable regression. RESULTS: Participants included 728 claimants, of whom 367 (50.4%) were treated with MI. Unemployed claimants in the MI group received significantly more partial temporary disability benefits (mean, 8.2d vs 0.2d; P=.02), indicating return to modified work duties. Employed claimants in the control group had a higher recurrence rate (9.1% vs 4.5%; P=.04). The adjusted odds ratio for benefit recurrence was 2.7 (95% confidence interval, 1.1-6.5) after controlling for age, sex, and number of previous claims. CONCLUSIONS: Use of MI appears to lead to more sustainable return to work after rehabilitation and facilitates transition to modified work duties.