Changes at the workplace for preventing disability in workers on sick leave

Background

Changes at the workplace such as working less hours or lifting less can help workers who are on sick leave get back to work earlier. Helping workers on sick leave get back to work earlier prevents long-term disability. Because there is still uncertainty about the effectiveness of workplace changes, we evaluated whether workplace interventions decrease time to return to work more than usual care or clinical interventions.

Studies

We searched the literature until 2 February 2015. We included 14 randomised controlled trials involving 1897 workers with a follow-up time of one year or more. In eight studies the workers had musculoskeletal disorders, in five studies they had mental health problems, and in one study they had cancer.

Key results

Considering all causes of work disability together, results showed that workplace interventions are effective in helping workers get back to work and in reducing duration of sickness absence. The effectiveness of workplace interventions is questionable regarding lasting return to work and recurrences of sick leave. The effectiveness of workplace interventions differs based on cause of work disability. We found moderate-quality evidence to support the use of workplace interventions in reducing sickness absence among workers with musculoskeletal disorders when compared to usual care. Workplace interventions were also effective in improving pain and functional status among workers with musculoskeletal disorders. The effectiveness of workplace interventions on sickness absence was not evident for workers with mental health problems or cancer. Furthermore, it was not clear whether a workplace intervention should be offered alone or in combination with a cognitive behavioural intervention.

Quality of the evidence

We found moderate-quality evidence that workplace interventions help workers get back to work and reduce duration of sickness absence. However, we also found very low-quality evidence of the effectiveness of workplace interventions on lasting return to work, because the results differed based on whether the workers suffered from musculoskeletal disorders, mental health problems, or cancer.

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.

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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 strategy: 

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).

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