Workplace interventions to prevent work disability in workers on sick leave

Myrthe van Vilsteren, Sandra H van Oostrom, Henrica C W de Vet, Renée-Louise Franche, Cécile R L Boot, Johannes R Anema, Myrthe van Vilsteren, Sandra H van Oostrom, Henrica C W de Vet, Renée-Louise Franche, Cécile R L Boot, Johannes R Anema

Abstract

Background: Work disability has serious consequences for individuals as well as society. It is possible to facilitate resumption of work by reducing barriers to return to work (RTW) and promoting collaboration with key stakeholders. This review was first published in 2009 and has now been updated to include studies published up to February 2015.

Objectives: To determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions.

Search methods: We searched the Cochrane Work Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO databases on 2 February 2015.

Selection criteria: We included randomised controlled trials (RCTs) of workplace interventions that aimed to improve RTW for disabled workers. We only included studies where RTW or conversely sickness absence was reported as a continuous outcome.

Data collection and analysis: Two review authors independently extracted data and assessed risk of bias of the studies. We performed meta-analysis where possible, and we assessed the quality of evidence according to GRADE criteria. We used standard methodological procedures expected by Cochrane.

Main results: We included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. We judged six studies to have low risk of bias for the outcome sickness absence.Workplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.In subgroup analyses, we found that workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate-quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) -0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).In another subgroup analysis, we did not find evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).Workplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence).

Authors' conclusions: We found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.We found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies.

Conflict of interest statement

Myrthe van Vlisteren: None known.

Sandra van Oostrom: I am an author on van Oostrom 2010a. I did not participate in deciding whether to include or exclude this study nor in extracting data from it or in assessing its risk of bias.

Henrica de Vet: I am an author on Anema/Steenstra 2007. I did not participate in deciding whether to include or exclude this study nor in extracting data from it or in assessing its risk of bias.

Renée‐Louise Franche: I am a private consultant in work disability prevention. I received CAD 800 for giving a keynote address on work disability prevention in a psychology conference in Banff in March 2013.

Cécile Boot: None known.

Johannes Anema: I am an author on Anema/Steenstra 2007, Lambeek 2010a, van Oostrom 2010a and Vlasveld 2012a. I did not participate in deciding whether to include or exclude these studies nor in extracting data or assessing their risk of bias. I am a consultant for Evalua Netherlands LtD that is selling a health checklist to large employers and insurance companies to improve work ability and reduce future work disability. I also own Evalua Netherlands LtD stocks. I regularly receive travel and accommodation costs and sometimes speaker fees to present research results, including those of this review. I supervise a PhD student funded by a grant from Instituut GAK. I have also received a grant and travel support from Instituut GAK. I am an editor of the Handbook of Work Disability that includes part of the review results. I hold a chair (0.4 FTE) endowed by the Dutch Workers Compensation board.