Evidence map›Paper›PMID 42103373›Full record

ArticleBMJ open2026

Co-developing a vocational rehabilitation intervention for individuals with chronic low back pain across a regional spine centre and three municipalities in Denmark: a three-stage intervention development study guided by the Medical Research Council framework.

Gitte Frydenlund, Ole Steen Mortensen, Søren O'Neill, Jens Søndergaard, Anders Hansen

Abstract read
In one paragraph

Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Gitte FrydenlundMedical Research Unit, Spine Centre of Southern Denmark, Hospital Lillebaelt, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark gitte.frydenlund@rsyd.dk.ORCID http://orcid.org/0000-0001-6004-5620
Ole Steen MortensenSection of Social Medicine, University of Copenhagen Department of Public Health, Kobenhavn, Denmark.
Søren O'NeillMedical Research Unit, Spine Centre of Southern Denmark, Hospital Lillebaelt, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark.
Jens SøndergaardResearch Unit for General Practice, Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark.ORCID http://orcid.org/0000-0002-1629-1864
Anders HansenMedical Research Unit, Spine Centre of Southern Denmark, Hospital Lillebaelt, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark.ORCID http://orcid.org/0000-0002-5400-8847

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo co-develop the Stay-At-Work (SAW) intervention, a person-centred, interdisciplinary, cross-sectoral vocational rehabilitation (VR) programme for individuals on, or at risk of, sick leave due to chronic low back pain (CLBP) and to advance methodological understanding of how evidence, qualitative insights, stakeholder input and programme theory can be systematically integrated and operationalised into concrete intervention components.

designA three-stage intervention development study, guided by the Medical Research Council framework for complex interventions, involving evidence review and stakeholder consultation (previously reported); multistakeholder co-design; and prototyping in clinical settings.

settingThe intervention was developed within a Danish public healthcare and welfare context, involving a secondary care spinal service, municipal employment services (n=3), municipal rehabilitation services (n=3) and general practice.

participantsStage 1: 17 individuals on long-term sick leave due to CLBP participated in interviews and focus groups. Stages 2 and 3: The co-design group included individuals living with CLBP (n=2); clinicians from a secondary care spine service (n=2) and municipal rehabilitation services (n=6); general practitioners (n=2); municipal employment service professionals (n=3) and local managers (n=3); and employer and employee representatives (n=2). Participants were purposively recruited based on their roles and experience in VR and return-to-work processes and contributed across different stages of intervention development.

resultsThe SAW intervention consists of eight structured activities, developed through multistakeholder co-design and underpinned by a programme theory with four core mechanisms: (1) strengthened interprofessional and cross-sectoral understanding and collaboration; (2) stronger alignment around functional capacity and work ability; (3) addressing psychological vulnerability through systematic screening and support; and (4) enhanced coordination of care and rehabilitation efforts across services.Stakeholder input from the co-design group informed the intervention's content and procedures, thereby improving alignment with local contexts and strengthening cross-sector collaboration. Some proposals were excluded due to inconsistency with clinical guidelines.

conclusionThis study demonstrates how a structured, theory-informed co-development process can be used to integrate evidence, stakeholder input and programme theory into a coherent, cross-sectoral VR intervention. The approach enhanced transparency, supported alignment with real-world practice, and provides methodological insight to strengthen the reproducibility and transferability of complex interventions.

Indexed as

Chronic PainLow Back PainRehabilitation, VocationalAdultDenmarkFemaleFocus GroupsHumansMiddle AgedProgram DevelopmentReturn to WorkSick LeaveChronic PainHealth ServicesOccupational Health ServicesPUBLIC HEALTHREHABILITATION MEDICINE

Identifiers

PMID42103373
PMCPMC13157791

What Socratic holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.