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. A Cochrane review «van Vilsteren M, van Oostrom SH, de Vet HC ym. Wor...»1 aimed to determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions.
Altogether 14 RCTs with 1897 workers were included in analysis. 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, 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, there was no 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).