Return to work after part-time sick leave

Jorma Komulainen

Level of evidence: C

In middle-aged female patients with musculoskeletal disorders, requiring sick leave, a part-time sick leave may increase the possibility of sustained (4 weeks or more) return to work.

To assess the effects of early part-time sick leave on return to work (RTW) and sickness absence among patients with musculoskeletal disorders, a randomized controlled trial «Viikari-Juntura E, Kausto J, Shiri R ym. Return to...»1 was conducted in six occupational health units of medium- and large-size enterprises in Finland. Patients aged 18–60 years with musculoskeletal disorders (N=63; 97 % of those females; mean age 44 years) unable to perform their regular work were randomly allocated to part- or full-time sick leave. In the former group, workload was reduced by restricting work time by about a half. Remaining work tasks were modified when necessary, as specified in a "fit note" from the physician. The main outcomes were time to return to regular work activities and sickness absence during 12-month follow-up.

The inclusion criteria were: employees 18–60 years of age with a permanent or long-term contract, working full-time (37–38 hours per week) or nearly full-time (≥30 hours per week), who had not been on sick leave due to their musculoskeletal health problem for >2 weeks during the preceding month and >30 days during the preceding 3 months. A further inclusion criterion was that there were no plans for surgical treatment requiring >1 week of sickness absence and no plans for other longer absence.

Subjects were excluded if they experienced acute infections, symptoms due to a major accidental injury, suspected occupational injury or disease, active inflammatory arthritis, malignant tumor diagnosed or treated during the preceding year, coexisting severe mental disorder, or pregnancy. Also subjects with very severe pain (>7 on a scale from 0–10) or pain interfering severely with sleep (>7 on a scale from 0–10) were excluded.

Time to RTW sustained for ≥4 weeks was shorter in the intervention group (median 12 versus 20 days, P=0.10). Hazard ratio of RTW was 1.76 (95 % CI 1.21–2.56) when adjusted for age, pain interference with sleep and previous sickness absence at baseline. Total sickness absence during the 12-month follow-up was about 20 % lower in the intervention than the control group (16 vs. 20 % of follow-up time; NS).

  • Study quality: moderate
  • Applicability: Good for those female middle-aged patients fulfilling the inclusion criteria and not fulfilling the exclusion criteria.
  • Comment: The study was underpowered to show clinically important differences between groups. The level of evidence is downgraded due to inaccuracy of the outcomes.


  1. Viikari-Juntura E, Kausto J, Shiri R ym. Return to work after early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Scand J Work Environ Health 2012;38:134-43 «PMID: 22033811»PubMed