A Naturalistic Trial of Nudging Clinicians in the Norwegian Sickness Absence Clinic. The NSAC Nudge Study

NCT05006976 | Active Not Recruiting

• 1 other identifier: NSAC Nudge
• Study Type: interventional
• Target: 1,180
• Locations: 1 country
• Sites: 5

Brief Summary

The Norwegian Sickness Absence Clinic (NSAC) Nudge Study is a naturalistic randomized controlled multicentre trial which aim is to measure the efficacy of nudging clinicians' attention towards patients' motivation for work, barriers for return to work and work environment challenges, on functional recovery as primary outcome, and health outcomes as secondary outcome. Patients will be recruited in five different NSACs across northern Norway. In total 1100 patients will be randomized to two equal probability treatment arms: 1) NSAC with the nudge, and 2) NSAC without the nudge. The nudge is tailored to the individual patient's needs using survey, and the clinicians are presented with a summary of this patient survey prior to consultations highlighting health problems and challenges as reported by the patient in the survey.

Conditions

Musculoskeletal Disorder; Anxiety Disorders; Depression; Fatigue; Pain; Occupational Exposure; Work Related Stress; Workplace Bullying; Employment; Sickness Absence; Return to Work

Keywords

Return to work; Sickness absence; Nudge; Barriers for return to work; Motivation for work; Demand and control; Work/family conflict; Bullying

Outcome Measures

Primary Outcomes (4)

• Functional recovery: status, plan and prognosis for employment versus sickness absence

  Clinician report at last consultation of current status, plan and prognosis for patient employment versus sickness absence. Status is current employment versus sickness absence, plan refers to patients own ambition and plans for employment versus sickness absence short term, while prognosis refers to the clinicians assessment of prognosis for employment versus sickness absence in 12 months.

  At last appointment at NSAC (can vary substantially between patients, but generally < 3 months after first appointment at NSAC)

• Functional recovery: sickness absence self-report

  Employment, sickness absence and application for rehabilitation benefits between Time 0 and Time 2, based on patient self-report.

  Up to 31 months post baseline survey

• Functional recovery: sickness absence registry data

  Employment, sickness absence and application for rehabilitation benefits during first 365 days post baseline survey, based on registry data.

  12 months post baseline survey

• Functional recovery: disability benefits

  Employment, sickness absence, rehabilitation benefits and disability benefits during 5-year period post baseline survey, all based on registry data.

  60 months post baseline survey

Secondary Outcomes (15)

• Mental health

  Up to 31 months post baseline survey

• Anxiety

  Up to 31 months post baseline survey

• Depressive symptoms

  Up to 31 months post baseline survey

• Sleep

  Up to 31 months post baseline survey

• Health Anxiety

  Up to 31 months post baseline survey

Other Outcomes (16)

• Preventive effect of sickness absence

  Up to 31 months post baseline survey

• Health economic evaluation: self report

  Up to 31 months post baseline survey

• Health economic evaluation: labour costs

  12 months post baseline survey

Study Arms (2)

NSAC health only

ACTIVE COMPARATOR

Treatment as usual (TAU) at NSAC, following a digital survey of health problems and the provision of a condensed report of this survey to clinician prior to consultation.

Other: NSAC health only

NSAC health + MBW

EXPERIMENTAL

Treatment as usual (TAU) at NSAC, following a digital survey of health problems as well as Motivation, Barriers for return to work and Work environment (MBW), and the provision of a condensed report of this survey to clinician prior to consultation.

Other: NSAC health + MBW

Interventions

NSAC health only OTHER

NSAC is an outpatient service delivered under the auspices of the specialist health care sector to patients currently on sick leave or at risk for long-term sickness absence. The service is staffed by medical doctors specialising in musculoskeletal health, physiotherapists, psychologists and welfare sector counsellors, and aims to provide patients with multi-disciplinary treatment with the intent of functional recovery. In "NSAC health only", clinicians are provided survey information on potential health problems only.

NSAC health only

NSAC health + MBW OTHER

NSAC is an outpatient service delivered under the auspices of the specialist health care sector to patients currently on sick leave or at risk for long-term sickness absence. The service is staffed by medical doctors specialising in musculoskeletal health, physiotherapists, psychologists and welfare sector counsellors, and aims to provide patients with multi-disciplinary treatment with the intent of functional recovery. In "NSAC health + MBW" clinicians are provided survey information on potential health problems as well as information on motivation for work, barriers for return to work and work environment factors.

NSAC health + MBW

Eligibility Criteria

• Age: 23 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may not qualify if:

• Aged younger than 23 years at time of referral. The NSACs have guidelines that describe eligibility for treatment, and excludes patients that are either too healthy for the measure, too sick for the measure, not relevant diagnosis or otherwise not considered being in the target group for the measure.

Sponsors & Collaborators

• Opptreningssenteret i Finnmark (Alta, Norway): collaborator
• Helgeland Hospital Trust: collaborator
• Finnmarkssykehuset HF (Kirkenes, Norway): collaborator
• UiT The Arctic University of Norway: collaborator
• Nordlandssykehuset HF: lead
• University Hospital of North Norway: collaborator

Study Sites (5)

Helse I Arbeid Nordlandssykehuset

Bodø, Nordland, 8092, Norway

Location

Helse I Arbeid Helgelandssykehuset

Sandnessjøen, Nordland, 8800, Norway

Location

Opptreningssenteret i Finnmark

Alta, Troms Og Finnmark, 9510, Norway

Location

Helse I Arbeid Finnmarkssykehuset

Kirkenes, Troms Og Finnmark, 9915, Norway

Location

Helse I Arbeid Universitetssykehuset Nord-Norge

Tromsø, Troms Og Finnmark, 9019, Norway

Location

Related Publications (3)

• Myhrer M, Brinchmann B, Trichet L, Aars NA, Mykletun A. Barriers for return to work as an iatrogenic effect of sickness absence: a proposed conceptual framework and questionnaire based on a cross-sectional study. BMC Public Health. 2026 Feb 12. doi: 10.1186/s12889-026-26584-1. Online ahead of print.

  PMID: 41680726 DERIVED

• Bardal I, Aars NAP, Trichet LO, Brandseth OL, Terjesen C, Irgens E, Hansen BO, Kristoffersen A, Hoper A, Jenssen OR, Brinchmann B, Mykletun A. Expanding the Focus on Work Factors in an Outpatient Setting: Does a Nudge of Patients and Clinicians have an Effect on Return-to-Work and Benefits? Findings from the NSAC Nudge Multicentre Randomised Controlled Trial. J Occup Rehabil. 2025 Dec 12. doi: 10.1007/s10926-025-10343-x. Online ahead of print.

  PMID: 41385138 DERIVED

• Aars NA, Bardal I, Brinchmann B, Mykletun A. Naturalistic trial of nudging patients and clinicians in the Norwegian sickness absence clinics: a study protocol for the NSAC Nudge Study. BMJ Open. 2025 Mar 3;15(3):e089758. doi: 10.1136/bmjopen-2024-089758.

  PMID: 40032398 DERIVED

MeSH Terms

Conditions

Musculoskeletal Diseases; Anxiety Disorders; Depression; Fatigue; Pain; Occupational Stress; Bullying

Condition Hierarchy (Ancestors)

Mental Disorders; Behavioral Symptoms; Behavior; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Neurologic Manifestations; Occupational Diseases; Stress, Psychological; Aggression; Harassment, Non-Sexual; Social Behavior

Study Officials

• Arnstein Mykletun, PhD

  UiT The Arctic University of Norway

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: The participant is masked to which questionnaire he/she fills out. The primary outcome is functional recovery, operationalized in the short term as prevention of sickness absence or return to work, and in the long term as employment or disability benefits. To this end, registry data on employment status or qualification for disability benefits is applied. Clinicians (usually the patient's general practitioner) and case managers involved in decisions on medically certified sickness absence and disability benefits are blinded to randomization.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Patients are randomized in equal proportions to fill out either of two different questionnaires, consisting either of 1) health related questions only or 2) health related questions as well as questions concerning motivation for work, barriers for return to work and work environment. In both treatment arms, clinicians receive a summary of patient survey information on mental health and musculoskeletal pain. In the intervention arm, clinicians are nudged to have particular attention towards motivation for work, barriers for return to work and work environment.

Study Record Dates

• First Submitted: August 9, 2021
• First Posted: August 16, 2021
• Study Start: September 6, 2021
• Primary Completion (Estimated): April 12, 2028
• Study Completion (Estimated): January 12, 2033
• Last Updated: April 13, 2026

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share

Locations

NO (5)