Effectiveness of work-related interventions for return to work in people on sick leave: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background Long-term sick leave is a serious concern in developed countries and the cost of sickness absence and disability benefits cause major challenges for both the individual and society as a whole. Despite an increasing body of research reported by existing systematic reviews, there is uncertainty regarding the effect on return to work of workrelated interventions for workers with different diagnoses. The objective of this systematic review was to assess and summarize available research about the effects of work-related interventions for people on long-term sick leave and those at risk of long-term sick leave. Methods We conducted a systematic review in accordance with international guidelines. Campbell Collaboration (Area: Social Welfare), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, MEDLINE, PsycINFO, Scopus, and Sociological Abstracts were systematically searched in March 2021. Two authors independently screened the studies. We conducted risk of bias assessments and meta-analyses of the available evidence in randomized controlled trials (RCTs). The remaining comparisons were synthesized narratively. The certainty of evidence for each outcome was assessed. Results We included 20 RCTs comprising 5753 participants at baseline from 4 different countries. The studies had generally low risk of bias. Our certainty in the effect estimates ranged from very low to moderate. Eight different interventions were identified. Meta-analysis revealed no statistically significant difference between multidisciplinary rehabilitation (MR) and usual care (US) (Risk Ratio [RR] 1.01; Confidence Interval [CI] 95% 0.70-1.48 at 12 months follow-up) and between MR and other active intervention (Risk Ratio [RR] 1.04; Confidence Interval [CI] 95% 0.86-1.25 at 12 months follow-up). Remaining intervention groups revealed marginal, or no effect compared to the control group. The results for the secondary outcomes (self-efficacy, symptom reduction, function, cost-effectiveness) showed varied and small effects in the intervention groups. Conclusion Overall, the present data showed no conclusive evidence of which work-related intervention is most effective for return to work. However, a handful of potential interventions exist, that may contribute to a foundation for future research. Our findings support the need for adequately powered and methodologically strong studies.

What is the volume, quality and characteristics of evidence relating to the effectiveness and cost‐effectiveness of multi‐disciplinary occupational health interventions aiming to improve work‐related outcomes for employed adults? An evidence and gap map of systematic reviews

“…All 30 reviews were concerned with adults of working age, with this stipulated to be from as young as 16 years old (NICE, 2019 ; Schaafsma et al, 2013 ; Schandelmaier et al, 2012 ) up to 70 years old (Heathcote et al, 2019 ). Of the health conditions studied, 12 cast a wide net, seeking studies of participants with a wide range of conditions (Gensby et al, 2014 ; Hoefsmit et al, 2012 ; Lefever et al, 2018 ; NICE, 2019 ; Odeen et al, 2013 ; Schandelmaier et al, 2012 ; Tingulstad et al, 2022 ; Tompa et al, 2008 ; van Vilsteren et al, 2015 ; Venning et al, 2021 ; Vogel et al, 2017 ). Of those that were more focused, there were 11 reviews with a focus on workers with musculoskeletal conditions and/or chronic pain (Bernaers et al, 2022 ; Brewer et al, 2007 ; Carroll et al, 2010; Cochrane et al, 2017 ; Franche et al, 2005 ; Ishimaru et al, 2021 ; Neverdal, 2015 ; Oakman et al, 2016 ; Palmer et al, 2012 ; Schaafsma et al, 2013 ; van Geen et al, 2007 ), three that looked exclusively at mental health conditions (Gaillard et al, 2020 ; Mikkelsen & Rosholm, 2018 ; Nieuwenhuijsen et al, 2020 ), and one which included participants with musculoskeletal and/or mental health conditions (Cullen et al, 2018 ).…”

“…Scores are provided for each item on the AMSTAR‐2 checklist, alongside an overall rating. Of the 30 systematic reviews, 10 were allocated a rating of ‘High’ quality (Gaillard et al, 2020 ; Gensby et al, 2014 ; Heathcote et al, 2019 ; NICE, 2019 ; Nieuwenhuijsen et al, 2020 ; Schaafsma et al, 2013 ; Schandelmaier et al, 2012 ; van Vilsteren et al, 2015 ; Verhoef et al, 2020 ; Vogel et al, 2017 ), four of ‘Moderate’ quality (Bernaers et al, 2022 ; Cochrane et al, 2017 ; Mikkelsen & Rosholm, 2018 ; Tingulstad et al, 2022 ), four of ‘Low’ quality (Cullen et al, 2018 ; Lefever et al, 2018 ; Odeen et al, 2013 ; Tompa et al, 2008 ) and 12 of ‘Critically Low’ quality (Axén et al, 2020 ; Brewer et al, 2007 ; Carroll et al, 2010; Franche et al, 2005 ; Hoefsmit et al, 2012 ; Ishimaru et al, 2021 ; Kojimahara et al, 2020 ; Neverdal, 2015 ; Oakman et al, 2016 ; Palmer et al, 2012 ; van Geen et al, 2007 ; Venning et al, 2021 ).…”

“…However, only two of these reviews were of ‘High’ quality (Heathcote et al, 2019 ; Verhoef et al, 2020 ), with one appraised as ‘Moderate’ quality (Cochrane et al, 2017 ), one as ‘Low’ quality (Brewer et al, 2007 ) and five as ‘Critically Low’ quality (Carroll et al, 2010 ; Franche et al, 2005 ; Kojimahara et al, 2020 ; Neverdal, 2015 ; van Geen et al, 2007 ). The next largest group of evidence was for reviews reporting inconclusive or weak evidence with respect to intervention effectiveness ( n = 7), three were of ‘High’ quality (Gensby et al, 2014 ; NICE, 2019 ; Schaafsma et al, 2013 ), one of ‘Moderate’ quality, (Tingulstad et al, 2022 ) and three were of ‘Critically Low’ quality (Ishimaru et al, 2021 ; Oakman et al, 2016 ; Palmer et al, 2012 ).…”

“…Ten included cost‐effectiveness outcomes (see Tables 4 and 5 ) (Carroll et al, 2010; Cochrane et al, 2017 ; Franche et al, 2005 ; Gaillard et al, 2020 ; Lefever et al, 2018 ; NICE, 2019 ; Oakman et al, 2016 ; Palmer et al, 2012 ; Tingulstad et al, 2022 ; Tompa et al, 2008 ). Four of these reviews indicated that the interventions provided value for money (Carroll et al, 2010 ; Franche et al, 2005 ; Gaillard et al, 2020 ; Tompa et al, 2008 ), although the comparison of interest within one review was workplace‐based interventions versus non‐workplace based, so the findings are not relevant to our research question (Carroll et al, 2010 ).…”

Return-To-Work after mental illness: A qualitative study on factors promoting the reintegration into work

“…This, in turn, puts the focus of RTW measures on the individual, the employer, and the workplace environment. While most RTW interventions address the individual primarily through behaviororiented therapy (e.g., occupational therapy, stress management programs, inpatient or outpatient rehabilitation) (30), only a few interventions combine individual therapy elements with workplace-related measures (31). Despite varying legal requirements and general data protection regulations, this aspect underlines that recommended RTW processes include colleagues and superiors during RTW phases in a cooperative manner (32) Maintaining stability can be considered a foundation of RTW processes of mental illnesses (33), which was also revealed by our results.…”