Structured occupational physician consultation

Jorma Komulainen

Level of evidence: C

Early structured occupational physician consultation (before sickness absence) may reduce sickness absence duration and proportion of those with long-term sickness absence in employees with high risk for long-term sickness absence in 1-year follow-up.

The objective of the Dutch RCT study «Kant I, Jansen NW, van Amelsvoort LG ym. Structure...»1 was to examine the efficacy of structured early consultation among employees at high risk for future long-term sickness absence, in the prevention and/or reduction of sickness absence. Employees at high risk for long-term sickness absence were selected based on responses to a 34-item screening questionnaire including demographic, workplace, health and psychosocial factors associated with long-term sickness absence (>28 days). A total of 299 subjects at risk for future long-term sickness absence were randomized in an experimental group (n = 147) or in a control group (n = 152). Subjects in the experimental group received a structured early consult (before the sickness absence) with their occupational physician (OP), in some cases followed by targeted intervention. The control group received care as usual. Sickness absence was assessed objectively through record linkage with the company registers on sickness absence over a 1-year follow-up period.

Modified intention-to-treat analysis revealed substantial and statistically significant differences (p = 0.007) in total sickness absence duration over 1-year follow-up between the experimental (mean 18.98; SD 29.50) and control group (mean 31.13; SD 55.47). Per-protocol analysis showed that the proportion of long-term sickness absence spells (>28 days) over 1-year follow-up was significantly (p = 0.048) lower in the experimental (9.1 %) versus control group (18.3 %).

  • Study quality: High
  • Applicability: Due to differences in occupational health care and social insurance between Netherlands and Finland, the results may not be directly applicable to Finland.
  • Comment: Intention-to-treat analysis did not, before modification, show statistically significant differences between the groups. After modification, i.e. exclusion of those 21 patients in intervention group, who did not fulfil the criteria of early intervention, differences turned out to be significant.


  1. Kant I, Jansen NW, van Amelsvoort LG ym. Structured early consultation with the occupational physician reduces sickness absence among office workers at high risk for long-term sickness absence: a randomized controlled trial. J Occup Rehabil 2008;18:79-86 «PMID: 18196446»PubMed