Takaisin

Return-to-work coordination programmes

Näytönastekatsaukset
Jorma Komulainen
25.6.2019

Level of evidence: C

Offering return-to-work coordination programmes for workers on sick leave for at least four weeks seems to result in no benefits when compared to usual practice.

To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people's return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncertain. Therefore, a systematic review «Vogel N, Schandelmaier S, Zumbrunn T ym. Return-to...»1 to determine the long-term effectiveness of return-to-work coordination programmes compared to usual practice in workers at risk for long-term disability was conducted.

Randomised controlled trials (RCTs) that enrolled workers absent from work for at least four weeks and randomly assigned them to return-to-work coordination programmes or usual practice were included.

Altogether 14 studies from nine countries that enrolled 12,568 workers were analysed. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.

There were no benefits for return-to-work coordination programmes on return-to-work outcomes.

For short-term follow-up of six months, there was no effect on time to return to work (hazard ratio (HR) 1.32, 95 % confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) -16.18 work days per year, 95 % CI -32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95 % CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95 % CI 0.63 to 1.19, very low-quality evidence).

For long-term follow-up of 12 months, there was no effect on time to return to work (HR 1.25, 95 % CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD -14.84 work days per year, 95 % CI -38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95 % CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95 % CI 0.97 to 1.09, moderate-quality evidence).

For very long-term follow-up of longer than 12 months, there was no effect on time to return to work (HR 0.93, 95 % CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95 % CI -15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95 % CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95 % CI 0.88 to 1.02, low-quality evidence).

There were only small benefits for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID).

  • Study quality: High
  • Applicability: Due to specific features of Finnish occupational health services and contracts of employment, the results may not be directly suitable to Finland.
  • Comment: Programmes initiated by the employers (standard practice in Finland) were not included in the analysis.

References

  1. Vogel N, Schandelmaier S, Zumbrunn T ym. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database Syst Rev 2017;(3):CD011618 «PMID: 28358173»PubMed