Introduction
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Timing of intervention: early, initiated in the first 6 weeks of absence or not;
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Care professionals involved: multidisciplinary, including multiple professionals (care providers) from more than one discipline or not;
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Planning of activities to support RTW: time contingent, in which activities are performed according to a pre-defined schedule or not;
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Target population: all employees on sickness absence irrespective of their specific medical diagnosis (generic) or only to employees with a specific diagnosis (specific);
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Character of activities to support RTW: interventions including explicit actions to stimulate the employee to RTW, which are A: whether or not a decision was made as to when and/or how RTW will take place; B: whether or not there was gradual exposure to the workplace; and C: whether or not workplace adaptations were implemented;
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Intensity: a high (≥10 h divided over multiple sessions), moderate (<10 h divided over multiple sessions) or low intensity (once);
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Employee and employer role: decision latitude of the employee and/or employer about activities to support medical recovery or RTW and the timing of RTW or no decision latitude of the employee and/or employer.
Methods
Search
Database | Key words | Number of hits | Number included |
---|---|---|---|
Pubmed (MeSH) | Sick leave | 310 | 6 |
Sick leave AND intervention studies | 8 | 0 | |
Absenteeism | 214 | 0 | |
Absenteeism AND intervention studies | 7 | 0 | |
Pubmed | Return to work | 4560 | 7 |
Sickness absence | 1065 | 2 | |
Cinahl | Return to work | 248 | 1 |
Cochrane library | Return to work | 63 | 1 |
Google scholar | Return to work | About 625.000 | 3 |
Return AND to AND work AND intervention | About 111.000 | 2 | |
Early AND return AND to AND work | About 190.000 | 1 | |
Total | 23 |
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Covered the effectiveness of interventions on RTW;
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Described interventions tested in a population of workers on sickness absence;
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Were full text articles;
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Were written in English and published in the last 16 years (from 1994 to 2010);
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Were empirical studies or systematic literature reviews.
Analyses
Research | Criteria | Evaluation | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Quantitativea
| Design (A), measurements (B) | A | Randomized controlled trial (++) | Cluster randomized trial (++) | Controlled trial or quasi-experiment (+) | Longitudinal observational study (+) | Cross sectional study (−+) | Ex-post facto chart review (−+) | Case/case series study (−+) | |||
B | >1 pre or post (++) | 1 pre or post (+) | Multiple (+) | No (−+) | ||||||||
Study population | ≥100 respondents (yes: ++, no: −+) | Heterogeneous: respondents of different ages, gender and/or educational levels (yes: ++, no: −+) | ||||||||||
When applicable: control group | Description (yes: ++/no: −+) | Appropriate to draw conclusions: control group received nothing or care as usual differed from the intervention (yes: ++/no: −+) | Expected group difference described (yes: ++/no: −+) | |||||||||
Outcomes, measurement instruments | Outcomes described (yes: +/no: −+) | Outcomes match study aims (yes: +/no: −+) | Instruments described (yes: +/no: −+) | Validity and reliability of instruments described or logically no description (yes: ++/no: −+) | Instruments are likely to be accepted in the profession under concern (yes: +/no: −+) | References given for instruments (yes: +/no: −+) | ||||||
Data analysis (scoring of most advanced method applied in study under concern) | Hierarchical regression with all variables measured at all moments (++) | Hierarchical regression without measurement of all variables at all moments (+) | Multiple regression analysis or multivariate analysis of variance (+) | Survival analysis (+) | Ex-post factor chart (+) | Descriptive statistics (−+) | Logistical regression (−+) | Regression analysis or analysis of variance (−+) | Correlation (−+) | Chi-square (−+) | T-test (−+) | |
Reviewb
| Research question includes | Patient (yes: ++/no: −) | Intervention (yes: ++/no: −) | Comparison (yes: ++/no: −) | Outcome (yes: ++/no: −) | |||||||
Search, selection | Sufficient terms (yes: ++/no: −) | Terms relevant for research question (yes: ++/no: −) | Search in databases as Medline (yes: ++/no: −) | Restrictions described (yes: ++/no: −) | Inclusion criteria described (yes: ++/no: −) | Inclusion criteria match research question (yes: ++/no: −+) | Selection by multiple researchers (yes: ++/no: −+) | Multiple researchers selected the articles independently (yes: ++/no: −+) | Selection process well described (yes: ++/no: −) | |||
Quality rating | Quality rated (yes: ++/no: −) | Rating criteria described (yes: ++/no: −) | Multiple researchers (yes: ++/no: −+) | Multiple researchers rated the articles independently (yes: ++/no: −+) | Consensus seeking process between researchers described (yes: ++/no: −+) | Results reported for each included article separately (yes: ++/no: −) | ||||||
Data extraction | Described (yes: ++/no: −) | Multiple researchers (yes: ++/no: −+) | ||||||||||
Description original methods | Study population (yes: ++/no: −+) | Intervention (yes: ++/no: −+) | Outcomes (yes: ++/no: −+) | Confounders (yes: ++/no: −+) | Results (yes: ++/no: −+) | |||||||
Description meta-analysis | Meta-analysis performed or heterogeneity described (yes: ++/no: −) | Potential sources of heterogeneity described (yes: ++/no: −) |
Intervention characteristic | Evaluation | |||
---|---|---|---|---|
1. Timing of intervention, early which starts within first 6 weeks of absence | Yes | No or timing not restricted | ||
2. Care professionals involved, multidisciplinary, involving multiple professionals (care providers) from more than one discipline | Yes | No | ||
3. Planning of activities to support RTW, time-contingent, activities followed pre-defined time schedule | Yes | No | ||
4. Target population | Generic: all employees on sickness absence irrespective of their specific medical diagnosis | Specific: only employees with specific diagnosis | ||
5. Character of activities to support RTW, interventions including explicit actions to stimulate the employee to RTW | A: making decisions about actual RTW (when and/or how) | B: gradual exposure to the workplace (for example when employees resume work for a limited but increasing number of hours per week) | C: implemented work-related adaptations, e.g. workplace (such as ergonomic improvements of furniture) | |
Yes/no | Yes/no | Yes/no | ||
6. Intensity | High: ≥10 h divided over multiple sessions | Moderate: <10 h, multiple sessions | Low: once | Variable |
7. Employee and employer role, decision latitude of the employee and/or employer about activities to support medical recovery or RTW and (the timing of) RTW | Yes | No |
Results
Methodological Quality of the Studies
Quantitative study (in order of quality) | Design | Population | Control group | Outcomes, instruments | Data analysis | Scorea
|
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Brouwers et al. [11] | ++ | ++ | ++ | + | + | 8 (Good) |
van der Feldtz-Cornelis et al. [12] | ++ | ++ | ++ | + | + | 8 (Good) |
Mortelmans et al. [13] | ++ | ++ | ++ | + | + | 8 (Good) |
Bogefeldt et al. [18] | ++ | ++ | + | + | + | 7 (Good) |
Bültmann et al. [20] | ++ | ++ | ++ | + | −+ | 7 (Good) |
Fleten and Johnsen [24] | ++ | ++ | + | + | + | 7 (Good) |
van der Klink et al. [16] | ++ | ++ | + | + | + | 7 (Good) |
Arnetz et al. [19] | ++ | ++ | + | + | −+ | 6 (Good) |
Bakker et al. [29] | ++ | + | + | + | + | 6 (Good) |
Drews et al. [32] | + | ++ | + | + | + | 6 (Good) |
Hagen et al. [30] | ++ | ++ | + | + | −+ | 6 (Good) |
Nystuen and Hagen [31] | ++ | ++ | + | + | −+ | 6 (Good) |
Braathen et al. [25] | + | ++ | + | + | −+ | 5 (Moderate) |
Marhold et al. [23] | ++ | −+ | + | + | + | 5 (Moderate) |
Grossi and Santell [22] | ++ | −+ | + | + | −+ | 4 (Moderate) |
Godges et al. [26] | + | + | −+ | + | −+ | 3 (Moderate) |
Matheson and Brophy [21] | −+ | ++ | −+ | + | −+ | 3 (Moderate) |
Weiler et al. [15] | + | −+ | −+ | + | + | 3 (Moderate) |
Review (in order of quality) | Research question | Search | Quality evaluation | Data extraction | Description methods original studies | Meta-analysis | Scorea
|
---|---|---|---|---|---|---|---|
van Oostrom et al. [14] | ++ | ++ | ++ | ++ | ++ | ++ | 12 (Very good) |
Carroll et al. [17] | ++ | ++ | + | ++ | ++ | ++ | 11 (Very good) |
Meijer et al. [7] | + | + | + | − | ++ | ++ | 6 (Good) |
Norlund et al. [27] | + | + | −+ | − | ++ | ++ | 5 (Good) |
Tveito et al. [28] | + | − | ++ | − | + | − | 1 (Insufficient) |
Intervention Characteristics and Their Effect on RTW
Study | Target population | Intervention and care as usual | Study outcomes most relevant for this review (operationalisation of return to work/sickness absence) | Effectiveness (on outcomes relevant to this study) |
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Brouwers et al. [11] | Specific: only employees with specific diagnosis (emotional and stress related complaints) | Activating counselling/control group: care as usual | Sick leave duration (days): period between first day of absence and return to work | No effect on sick leave duration |
van der Feldtz-Cornelis et al. [12] | Specific: only employees with specific diagnosis (depressive, anxiety and somatoform disorders) | (1) Training of occupational physicians in diagnosis and treatment (2) supportive psychiatric consultations (3) training of psychiatrist/Control group: care as usual | Time to return to work: period between onset of sickness leave due to mental disorder and full return to work, for at least 4 weeks without relapse | Full RTW at 3 months follow up** survival analysis: return to work occurred 122 (intervention) and 190 days (control) after intervention |
Mortelmans et al. [13] | Generic: all employees on sickness absence irrespective of their specific medical diagnosis | Structured and circular information exchange by communication form/control group: occupational physician filled out the communication form and delivered to the researcher. | Return to work rate/median gradual return to work duration in days | No effect on return to work rate. Relative risk: 1.03 (95% CI 0.93–1.13)/no effect on gradual return to work rate. Relative risk: 1.24 (95% CI 0.52–2.97). No difference in median duration of gradual return to work (62 days) |
Bogefeldt et al. [18] | Specific: only employees with specific diagnosis (low back pain) |
Group 1: stay active therapy (e.g. exercise), stretching, manual therapy. Group 2: stay active therapy, stretching, manual therapy, corticosteroid injections/control Group 1: stay active therapy Group 2: stay active therapy, stretching | Return to work rate./Sick leave in days (number of days times sick leave extent) | Increase return to work after 10 weeks** (hazard ratio 1.62, 95% CI, 1.006–2.60, P < 0.05) and among those on sick leave at baseline, significantly fewer were still on sick leave** (ratio 0.35, 95% CI, 0.13–0.97, P < 0.05)/(no effect after 2 years) |
Bültmann et al. [20] | Specific: only employees with specific diagnosis (musculoskeletal complaints or low back pain) | Systematic multidisciplinary work disability screening, development and implementation of work rehabilitation plan/control group: care as usual | Cumulative sickness absence hours, time intervals: 0–3, 3–6, 6–12, 0–6, 0–12 months | Lower number of sickness absence hours during intervals 0–6, 6–12 and 0–12**/no effect during intervals 0–3–3–6 |
Fleten and Johnsen [24] | Specific: only employees with specific diagnosis (musculoskeletal or mental disorders) | General information letter on possible work related measures if sick-listed/control group: care as usual | Length of sick leaves in calendar days | Reduction mean length of sick leaves in subgroups with mental disorders, rheumatic disorders, arthritis and in overall sick leaves lasting 12 weeks or more** |
van der Klink et al. [16] | Specific: only employees with specific diagnosis (adjustment disorders) | Graded activity/control group: care as usual by the occupational physician | Return to work rate: percentage return to work (partial or full) at 3 months/duration of sick leave: days lost until full return to work with correction for partial return to work | Increase return to work rate at 3 months*** shorter duration of sick leave** rate ratio: 2.39 (95% CI 1.15–4.95) |
Arnetz et al. [19] | Specific: only employees with specific diagnosis (musculoskeletal complaints) | (A) Semistructured interview with employee on social and occupational situation. (B) worksite visits by team for ergonomic assessment and improvements and/or personal vocational training schedule/control group: care as usual | Sick leave: number of sick days at 6 months and at 12 months | Shorter sick leave***/likelihood return to work (odds ratio, OR) at 6 months: 1.9; 95% C.I. 1.0; 3.6, P = 0.06/likelihood return to work (OR) at 12 months: 2.5; 1.2; 5.1, P < 0.01 |
Bakker et al. [29] | Specific: only employees with specific diagnosis (emotional and stress related complaints) | Communications by general practitioner to promote functional recovery (e.g. in informing and advising the employee)/control group: care as usual | Sick leave duration (calendar days) from the first day of sick leave until full RTW | No effect on sickness absence duration/hazard ratio: 1.06 (95% CI 0.87–1.29) |
Drews et al. [32] | Generic: all employees on sickness absence irrespective of their specific medical diagnosis | Social medicine examination and counselling/control group: care as usual | Duration of sick leave period from first day until at least 315 days/regular employment 1 year after intervention | No effect on sickness absence duration/no effect on likelihood of regular employment at follow up/odds ratio intervention group: 0.76 (95% CI 0.45–1.28) |
Hagen et al. [30] | Specific: only employees with specific diagnosis (low back pain) | Physical exercise program, besides control treatment/control group: control treatment | Length of sick leave | No (additional) effect on sick leave |
Nystuen and Hagen [31] | Specific: only employees with specific diagnosis (musculoskeletal complaints) | Solution-focused intervention/control group: care as usual | Sick leave: mean length after 12 months/work status (at work or not) 6 months after intervention | No effect on sick leave/no effect on work status |
Braathen et al. [25] | Generic: all employees on sickness absence irrespective of their specific medical diagnosis | Multidisciplinary rehabilitation programme/control group: treatment of persons’ own choice | Return to work: percentage of population who resumed work | No effect on return to work |
Marhold et al. [23] | Specific: only employees with specific diagnosis (musculoskeletal complaints) | Pain coping skills training, focus on: how to return to work and apply coping skills to occupational risk factors/control group: care as usual | Sick leave (days) over periods of 2 months (2 months before treatment and 6 months follow up) | Patients short-term sick leave (2–6 months): shorter sick leave**/patients long-term sick leave (>12 months): no effect on sick leave |
Grossi and Santell [22] | Specific: only employees with specific diagnosis (females on sick leave due to work-related psychological complaints) | Coping with psychological/somatic symptoms of stress/control group: standard individual treatment for stress | Return to work rate: percentage of population who resumed work | No effect on return to work rate |
Godges et al. [26] | Specific: only employees with specific diagnosis (low back pain) | Education, counselling on pain management tactics and value of physical activity besides conventional physical therapy/control group: conventional physical therapy | Sick leave duration (days) | Shorter sickness absence duration** |
Matheson and Brophy [21] | Specific: only employees with specific diagnosis (low back pain) | Early return to work in transitional light duty work, immediate identification and treatment during work hours/Control group: not applicable | Return to work rate: percentage of population who resumed work/days lost from work | Within 30 days, 94% of all subjects had return to work/increase return to work rate compared to other studies/mean number of days lost from work: 8.8 |
Weiler et al. [15] | Specific: only employees with specific diagnosis (musculoskeletal complaints) | Outpatient rehabilitation and determination of return to work (regular, assisted or individualised procedure), multidisciplinary team conferences (therapists and Airbus health professionals)/control group: not described | Return to work ratios/annual sick leave days (as compared to before sick leave period) | 97% of the Patients returned to their original job at the workplace. Reduction annual sick leave days from 48.8 ± 32.8 days to 34.2 ± 37.3 days***. Intervention stabilised low level annual sick leave days during first 2 years of follow-up |
van Oostrom et al. [14] | Specific: only employees with specific diagnosis (musculoskeletal complaints, mental and other health problems) | Interventions directed at work/control group: care as usual or clinical interventions | Time until a lasting return to work: a period of absence from the first day of sick leave to full return to work in previous or equal work for at least 4 weeks without dropping out/Time until first return to work: period of absence from work because of sickness, preceded and followed by period of at least 1 day at work/Cumulative duration of sickness absence: total days of sick leave during follow-up period | Shorter sickness absence duration among workers with musculoskeletal disorders (moderate evidence)/no conclusions on effectiveness in mental health problems and other conditions due to lack of studies/workplace interventions: days until lasting return to work, relative effect hazard ratio 1.70 (CI 95% 1.23–2.35), days until first return to work, relative effect hazard ratio 1.55 (CI 95% 1.32–2.16)/mean cumulative duration of sickness absence: −39.06 days |
Carroll et al. [17] | Specific: only employees with specific diagnosis (back pain) | Interventions involving workplace/control group: interventions not involving workplace | Multiple operationalisations of return to work among which time to return to work | Interventions involving employee, health practitioner and employer working together to implement work modifications, were more consistently effective than other workplace-linked interventions |
Meijer et al. [7] | Specific: only employees with specific diagnosis (non-specific musculoskeletal complaints) | Several interventions/control group: care as usual or control treatment | Difference in sick leave after treatment as compared to sick leave preceding treatment | Shorter sick leave duration (significance not described): 7 out of 22 treatment programs (inconsistent findings). Essential to effective treatment: knowledge, psychological, physical and work conditioning, possibly supplemented with relaxation exercises |
Norlund et al. [27] | Specific: only employees with specific diagnosis (low back pain) | Multidisciplinary interventions/control group: variable | Return to work (measured either directly or indirectly as days of sick leave after start of rehabilitation, with the opportunity to turn sick leave into RTW) | Return to work: difference of effect 21%, relative risk 1.21, 95% CI in favour of the intervention groups (only Scandinavian studies) |
Tveito et al. [28] | Specific: only employees with specific diagnosis (low back pain) | Workplace interventions/control group: not described | Lost work days or sick leave due to low back pain | Exercise significantly reduced sick leave duration (limited evidence, level of significance not described)/interventions to treat low back pain have positive effects on sick leave (moderate evidence, levels of significance not described)/no evidence of effect on sick leave from educational intervention, pamphlet, back belts/limited evidence that multidisciplinary interventions have no effect on sick leave (level of significance not described) |
Study | Timing of intervention, early intervention: starts within 6 weeks of absence | Care professionals involved, multidisciplinary | Planning of activities to support RTW, time contingency, activities followed time schedule | Target population | Character of activities to support RTW, explicit actions to stimulate RTWa
| Intensityb
| Employee and employer role, decision authority |
---|---|---|---|---|---|---|---|
Brouwers et al. [11] | No/no restrictiction | No | Yes | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | Moderate | Yes |
van der Feldtz-Cornelis et al. [12] | No/no restrictiction | Yes | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | Low or variable | No |
Mortelmans et al. [13] | No/no restrictiction | Yes | No | Generic: all absent employees | Decision RTW: no Gradual exposure: no Work-related adaptations: no | Low or variable | No |
Bogefeldt et al. [18] | No/no restrictiction | Yes | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | Low or variable | No |
Bültmann et al. [20] | No/no restrictiction | Yes | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: yes | High | Yes |
Fleten and Johnsen [24] | No/no restrictiction | No | Yes | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | Low or variable | Yes |
van der Klink et al. [16] | Yes | Yes | Yes | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | High/moderate | Yes |
Arnetz et al. [19] | No/no restrictiction | Yes | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: yes | Low or variable | No |
Bakker et al. [29] | No/no restrictiction | No | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | High | Yes |
Drews et al. [32] | No/no restrictiction | No | No | Generic: all absent employees | Decision RTW: no Gradual exposure: no Work-related adaptations: no | Low or variable | Yes |
Hagen et al. [30] | No/no restrictiction | Uncertain | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | High | No |
Nystuen and Hagen [31] | No/no restrictiction | No | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | High | Yes |
Braathen et al. [25] | No/no restrictiction | Yes | Yes | Generic: all absent employees | Decision RTW: no Gradual exposure: no Work-related adaptations: no | High | Yes |
Marhold et al. [23] | No/no restrictiction | No | Yes | Specific diagnosis | Decision RTW: yes Gradual exposure: no Work-related adaptations: no | High | No |
Grossi and Santell [22] | No/no restrictiction | Yes | Yes | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | High | Yes |
Godges et al. [26] | No/no restrictiction | No | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | Low or variable | No |
Matheson and Brophy [21] | No/no restrictiction | Yes | Yes | Specific diagnosis | Decision RTW: yes Gradual exposure: yes Work-related adaptations: no | Low or variable | No |
Weiler et al. [15] | No/no restrictiction | Yes | Yes | Specific diagnosis | Decision RTW: yes Gradual exposure: no Work-related adaptations: yes | High | No |
van Oostrom et al. [14] | No/no restrictiction | Yes | No | Specific diagnosis | Decision RTW: yes Gradual exposure: yes Work-related adaptations: yes | Low or variable | No |
Carroll et al. [17] | Yes | Yes | No | Specific diagnosis | Decision RTW: yes Gradual exposure: yes Work-related adaptations: no | Low or variable | No |
Meijer et al. [7] | No/no restrictiction | Uncertain | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | Low or variable | No |
Norlund et al. [27] | No/no restrictiction | Uncertain | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | Low or variable | No |
Tveito et al. [28] | No/no restrictiction | Uncertain | No | Specific diagnosis | Decision RTW: no Gradual exposure: no Work-related adaptations: no | Low or variable | No |