Persistent musculoskeletal pain and productive employment; a systematic review of interventions

Abstract

A systematic analysis of the literature was undertaken to determine which characteristics of workplace interventions are most effective in assisting people with persistent musculoskeletal pain (PMP) to remain productively employed. Databases of Medline, PsychINFO, CINAHL and Embase were searched using MeSH and other relevant terms. Studies that reported on interventions at, or involving, the workplace were included. Interventions were considered as either focused on the individual or multilevel. Outcome measures assessed included: job loss, productivity, sick leave, pain and cost benefit. A quality assessment was undertaken using GRADE criteria with development of impact statements to synthesise the results. Eighteen relevant articles (14 studies) were identified for inclusion in the review. No high-level evidence for workplace interventions to assist people with PMP were identified. Low numbers of participants and limited studies resulted in downgrading of evidence. However, individually focused interventions will probably reduce job loss and sick leave, but are unlikely to reduce pain. Multilevel focused interventions will probably result in decreased sick leave and provide some cost benefit. The evidence on productivity was limited and of poor quality. Further research is required because sustainable employment for individuals with PMP is important and understanding what works is necessary to ensure effective workplace interventions are developed.

Recurrent back pain during working life and exit from paid employment: a 28-year follow-up of the Whitehall II Study

“…Importantly, there is evidence from a systematic review of intervention studies that individually focused interventions can reduce the risk of health-related exit and job loss, despite having little impact on pain itself. 23 Together, these findings suggest that recurrent back pain is an important risk factor for future exit out of paid employment justifying the development and use of supportive measures to help people continue working despite pain.…”

Recurrent pain and work disability: a record linkage study

“…Adjusted model = additionally adjusted for occupational social class, long-standing illness, painrelated illness, working conditions, part-time work, marital status, common mental disorders, shift work and obesity is an important contributor to work disability and early identification is important so that more effective prevention strategies can be developed. A key aspect of effective prevention will require employers to engage with their workers so that their needs can be identified (Oakman et al 2016a(Oakman et al , b, 2017a. Workplace interventions to enable people with recurrent pain to continue working are an important part of prevention strategies, and relevant to an individual, which will vary depending on their condition and the work being undertaken.…”

“…However, given the recurrent nature of pain, another aspect of workplace management is the provision of appropriate support to enable those with pain (both multisite and single site) to continue working. Workplace accommodations have been identified as an important part of managing musculoskeletal conditions at work and prevention of work disability (Oakman et al 2016a(Oakman et al , b, 2017a. The strongest risks were observed for those with multisite and single-site recurrent pain, whereas a single past episode of pain did not notably increase the risk of work disability.…”

Prevalence and factors associated with shoulder pain in the general population: a cross-sectional study

“…The knowledge of the prevalence of shoulder pain, its clinical aspects, and risk factors are important, since musculoskeletal conditions affect populations of different age groups and sex. Thus, this knowledge will enable health professionals to provide patients with adequate information about the most likely course of their symptoms, prognostic information to distinguish between patients with favorable outcomes and those with a high risk of chronic shoulder pain and disability, and to implement curative and preventive interventions 13 .…”