Return to Work Expectations of Workers on Long-Term Non-Work-Related Sick Leave A Participatory Return-to-Work Intervention for Temporary Agency Workers and Unemployed Workers Sick-Listed Due to Musculoskeletal Disorders: Results of a Randomized Controlled Trial Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration A two-year follow-up on a program theory of return to work intervention. Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain Early and Late Return to Work After Sick Leave: Predictors in a Cohort of Sick-Listed Individuals with Common Mental Disorders Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions Effectiveness of a Coordinated and Tailored Return-to-Work Intervention for Sickness Absence Beneficiaries with Mental Health Problems The effectiveness of graded activity for low back pain in occupational healthcare A Prospective Study of Return to Work Across Health Conditions: Perceived Work Attitude, Self-efficacy and Perceived Social Support Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial Effect of an intervention to enhance guideline adherence of occupational physicians on return-to-work self-efficacy in workers sick-listed with common mental disorders A Prospective Study of the Effectiveness of Early Intervention with High-risk Back-injured Workers—A Pilot Study Doctor Proactive Communication, Return-to-Work Recommendation, and Duration of Disability After a Workers’ Compensation Low Back Injury Effectiveness of an exposure-based return-to-work program for workers on sick leave due to common mental disorders: a cluster-randomized controlled trial. Integrated Case Management for Work-Related Upper-Extremity Disorders: Impact of Patient Satisfaction on Health and Work Status A workplace intervention for sick-listed employees with distress: results of a randomised controlled trial Effectiveness of an Intervention to Enhance Occupational Physicians’ Guideline Adherence on Sickness Absence Duration in Workers with Common Mental Disorders: A Cluster-Randomized Controlled Trial Guideline-Based Care of Common Mental Disorders by Occupational Physicians (CO-OP study): A Randomized Controlled Trial Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Work-focused treatment of common mental disorders and return to work: a comparative outcome study. One-Year Follow-Up in Employees Sick-Listed Because of Low Back Pain: Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention Return to work after early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial.
Introduction Despite suggestions that worker perception might be the best predictor of return to work ( RTW ) , there still is limited research on time to RTW in workers with lengthy non-work-related sick leave . Methods Prospect i ve cohort study of 663 workers with a current long-term non-work-related sick leave episode recruited during the first medical visit in a mutua ( Spanish health insurance company ) and followed until their sick leave episode ended . Workers completed a baseline question naire regarding their perceptions of sick leave episode and expectations of RTW ( i.e. , health status , work ability , expectations and time required to RTW , self-efficacy and self-perceived connection between health and job ) . Time to RTW  was established based on the mutua ’s register . Cox regression models were used to examine the associations of worker perception and expectation of  RTW  with time to RTW within the study population as a whole as well as in three diagnostic subgroups ( i.e. , musculoskeletal disorders , mental disorders and other physical conditions ) . Results As a whole , time to RTW was longer for workers reporting poor health [ hazard ratio ( HR ) = 0.71 , 95%CI 0.59–0.85 ] , extremely reduced work ability ( HR = 0.69 , 95%CI 0.53–0.88 ) , a longer period of time required to RTW ( HR = 0.36 , 95%CI 0.25–0.52 ) and lack of expectation of returning to the same job ( HR = 0.13 , 95%CI 0.06–0.31 ) . Workers with musculoskeletal and other physical conditions showed a similar pattern to whole study population , while workers with mental disorders did not . Conclusion Self-required time and RTW expectations are important prognostic factors in sick listed workers by all types of health conditions certified as non-work-related . Question ing the workers on their perceptions and expectations of RTW during medical visits could help health care professionals to identify individuals at risk of long-term sickness absence and facilitate triage and management of the patient Introduction Within the labour force workers without an employment contract represent a vulnerable group . In most cases , when sick-listed , these workers have no workplace/employer to return to . Therefore , the aim of this study was to evaluate the effectiveness on return-to-work of a participatory return-to-work program compared to usual care for unemployed workers and temporary agency workers , sick-listed due to musculoskeletal disorders . Methods The workers , sick-listed for 2–8 weeks due to musculoskeletal disorders , were r and omly allocated to the participatory return-to-work program ( n = 79 ) or to usual care ( n = 84 ) . The new program is a stepwise procedure aim ed at making a consensus-based return-to-work plan , with the possibility of a temporary ( therapeutic ) workplace . Outcomes were measured at baseline , 3 , 6 , 9 and 12 months . The primary outcome measure was time to sustainable first return-to-work . Secondary outcome measures were duration of sickness benefit , functional status , pain intensity , and perceived health . Results The median duration until sustainable first return-to-work was 161 days in the intervention group , compared to 299 days in the usual care group . The new return-to-work program result ed in a non-significant delay in RTW during the first 90 days , followed by a significant advantage in RTW rate after 90 days ( hazard ratio of 2.24 [ 95 % confidence interval 1.28–3.94 ] P = 0.005 ) . No significant differences were found for the measured secondary outcomes . Conclusions The newly developed participatory return-to-work program seems to be a promising intervention to facilitate work resumption and reduce work disability among temporary agency workers and unemployed workers , sick-listed due to musculoskeletal disorders Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions OBJECTIVE Validation of a salutogenic theory for return to work ( RTW ) and an associated program process theory . METHODS A longitudinal non-r and omized one-year trial study design was used with a two-year follow-up and with comparison to a reference group . Changes in attitudes and active behaviour in the intervention group and at the workplace were supported by cognitive and behavioural approaches . PARTICIPANTS The intervention group included 118 unskilled Danish public employees and privately employed house-cleaners on sick leave due to musculoskeletal and /or common mental illnesses . RESULTS Significant improvements of work ability index and perceived health ( SF36 subgroups ) were reported . A significantly higher RTW and a shorter sick leave than in the reference group also emerged . Positive predictors of RTW were keeping the pre-sick-leave job and improving work ability index and physical impairment/role physical . Decline in self-efficacy was a negative predictor . CONCLUSIONS Support for the theory and associated program process theory was found . The intervention seemed to influence RTW and the employees ' attitudes , behaviour and health by affecting comprehensibility , meaningfulness and manageability . Sustainable RTW emerged from a synergism of support from the work place and improved personal re sources , especially such as concern mental health . The approach is consistent with integrating health promotion in RTW Objective : To evaluate the cost-effectiveness and cost-utility of a return to work ( RTW ) program for workers on sick-leave due to low back pain ( LBP ) , comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care , and a clinical intervention after 8 weeks of sick-leave with usual care . Design : Economic evaluation alongside a r and omised controlled trial ( RCT ) . Study population : Workers sick-listed for a period of 2 to 6 weeks due to LBP . Interventions : 1 . workplace assessment , work modifications and case management ) . 2 . physiotherapy based on operant behavioural principles . 3 . usual care : provided by an occupational physician . Outcomes : The primary outcome was return to work ( RTW ) . Other outcomes were pain intensity , functional status , quality of life and general health . The economic evaluation was conducted from a societal perspective . Outcomes were assessed at baseline ( after 2–6 weeks on sick-leave ) , and 12 weeks , 26 weeks , and 52 weeks after the first day of sick-leave . Results : The workplace intervention group returned to work 30.0 days ( 95 % CI=[3.1 , 51.3 ] ) earlier on average than the usual care group at slightly higher direct costs ( ratio of 1 day : € 19 ) . Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days ( 95 % CI= [ −74.1 , 29.2 ] ) later on average . The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days ( 95 % CI=[−89.4 , −2.7 ] ) later on average . A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes . A clinical intervention was less effective than usual care and associated with higher costs . Conclusion : The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP Objectives The study aims to identify individual and workplace factors associated with early return to work (RTW)—defined as within 3 months— and factors associated with later RTW — between 3 and 12 months after being sick-listed — in a cohort of newly sick-listed individuals with common mental disorders . Methods In a prospect i ve cohort study , a cross-sectional analysis was performed on baseline measures of patients granted sick leave due to common mental disorders . A total of 533 newly sick-listed individuals fulfilled the inclusion criteria and agreed to participate . A baseline question naire was sent by post within 3 weeks of their first day of certified medical sickness ; 354 ( 66 % ) responded . Those who were unemployed were excluded , result ing in a study population of 319 individuals . Sick leave was recorded for each individual from the Social Insurance Office during 1 year . Analyses were made with multiple Cox regression analyses . Results Early RTW was associated with lower education , better work ability at baseline , positive expectations of treatment and low perceived interactional justice with the supervisor . RTW after 3 months was associated with a need to reduce dem and s at work , and turnover intentions . Conclusions Early RTW among sick-listed individuals with common mental disorders seems to be associated with the individual ’s need to secure her/his employment situation , whereas later RTW is associated with variables reflecting dissatisfaction with work conditions . No health measures were associated with RTW . The study highlights the importance of considering not only health and functioning , but also workplace conditions and relations at the workplace in implementing RTW interventions Objective To identify potentially effective complementary approaches for musculoskeletal (MSK)–mental health ( MH ) comorbidity , by synthesis ing evidence on effectiveness , cost-effectiveness and safety from systematic review s ( SRs ) . Design Scoping review of SRs . Methods We search ed literature data bases , registries and reference lists , and contacted key authors and professional organisations to identify SRs of r and omised controlled trials for complementary medicine for MSK or MH . Inclusion criteria were : published after 2004 , study ing adults , in English and scoring > 50 % on Assessing the Method ological Quality of Systematic Review s ( AMSTAR ) ; quality appraisal checklist ) . SRs were synthesis ed to identify research priorities , based on moderate/good quality evidence , sample size and indication of cost-effectiveness and safety . Results We included 84 MSK SRs and 27 MH SRs . Only one focused on MSK – MH comorbidity . Meditative approaches and yoga may improve MH outcomes in MSK population s. Yoga and tai chi had moderate/good evidence for MSK and MH conditions . SRs reported moderate/good quality evidence ( any comparator ) in a moderate/large population for :  low back pain ( LBP )  ( yoga , acupuncture , spinal manipulation/mobilisation , osteopathy ) , osteoarthritis ( OA ) ( acupuncture , tai chi ) , neck pain  ( acupuncture , manipulation/manual therapy ) , myofascial trigger point pain ( acupuncture ) , depression ( mindfulness-based stress reduction ( MBSR ) , meditation , tai chi , relaxation ) , anxiety ( meditation/MBSR , moving meditation , yoga ) , sleep disorders ( meditative/mind – body movement ) and stress/distress ( mindfulness ) . The majority of these complementary approaches had some evidence of safety — only three had evidence of harm . There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP , and manual therapy/manipulation for neck pain , but few SRs review ed cost-effectiveness and many found no data . Conclusions Only one SR studied MSK – MH comorbidity . Research priorities for complementary medicine for both MSK and MH ( LBP , OA , depression , anxiety and sleep problems ) are yoga , mindfulness and tai chi . Despite the large number of SRs and the prevalence of comorbidity , more high- quality , large r and omised controlled trials in comorbid population s are needed Purpose Sickness absence and exclusion from the labour market due to mental health problems ( MHPs ) is a growing concern in many countries . Knowledge about effective return-to-work ( RTW ) intervention models is still limited , but a multidisciplinary , coordinated and tailored approach has shown promising results in the context of musculoskeletal disorders . The purpose of this study was to assess the effectiveness of this approach as implemented among sickness absence beneficiaries with MHPs . Methods In a quasi-r and omised , controlled trial , we assessed the intervention ’s effect in terms of time to RTW and labour market status after 1 year . We used two different analytical strategies to compare time to RTW between participants receiving the intervention ( n = 88 ) and those receiving conventional case management ( n = 80 ) : ( 1 ) a traditional multivariable regression analysis controlling for measured confounding , and ( 2 ) an instrumental variable ( IV ) analysis controlling for unmeasured confounding . Results The two analytical approaches provided similar results in terms of a longer time to RTW among recipients of the intervention ( HR = 0.50 ; 95 % CI 0.34–0.75 ) , although the estimate provided by the IV- analysis was non-significant ( HR = 0.70 ; 95 % CI 0.23–2.12 ) . After 1 year , more recipients of the intervention than of conventional case management were receiving sickness absence benefits ( p = 0.031 ) . Conclusion The intervention  delayed RTW compared to conventional case management , after accounting for measured confounding . The delayed RTW may be due to either implementation or program failure , or both . It may also reflect the complexity of retaining employees with mental health problems in the workplace Background : Low back pain is a common medical and social problem associated with disability and absence from work . Knowledge on effective return to work ( RTW ) interventions is scarce . Objective : To determine the effectiveness of grade d activity as part of a multistage RTW programme . Design : R and omised controlled trial . Setting : Occupational healthcare . Subjects : 112 workers absent from work for more than eight weeks due to low back pain were r and omised to either grade d activity ( n = 55 ) or usual care ( n = 57 ) . Intervention : Grade d activity , a physical exercise programme aim ed at RTW based on operant-conditioning behavioural principles . Main outcome measures : The number of days off work until first RTW for more then 28 days , total number of days on sick leave during follow up , functional status , and severity of pain . Follow up was 26 weeks . Results : Grade d activity  prolonged RTW . Median time until RTW was equal to the total number of days on sick leave and was 139 ( IQR = 69 ) days in the grade d activity group and 111 ( IQR = 76 ) days in the usual care group ( hazard ratio = 0.52 , 95 % CI 0.32 to 0.86 ) . An interaction between a prior workplace intervention and grade d activity , together with a delay in the start of the grade d activity intervention , explained most of the delay in RTW ( hazard ratio = 0.86 , 95 % CI 0.40 to 1.84 without prior intervention and 0.39 , 95 % CI 0.19 to 0.81 with prior intervention ) . Grade d activity did not improve pain or functional status clinical ly significantly . Conclusions : Grade d activity was not effective for any of the outcome measures . Different interventions combined can lead to a delay in RTW . Delay in referral to grade d activity delays RTW . In implementing grade d activity special attention should be paid to the structure and process of care Background The aim of the present study was to conduct subgroup-analyses in a prospect i ve cohort of workers on long-term sickness absence to investigate whether associations between perceived work attitude , self-efficacy and perceived social support and time to RTW differ across different health conditions . Methods The study was based on a sample of 926 workers on sickness absence ( 6–12 weeks ) . The participants filled out a baseline question naire and were subsequently followed until the tenth month after listing sick .  Perceived work attitude  was measured with a Dutch language version of the Work Involvement Scale .  Perceived social support  was measured with a self-constructed st and ardized scale reflecting a person ’s perception of social support regarding RTW . Self-efficacy was measured with the st and ardised Dutch version of the General self-efficacy scale , assessing the subjects ’ expectations of their general capacities . The sample was divided into three subgroups : musculoskeletal health conditions , other physical health conditions and mental health conditions . Anova analyses and Cox proportional hazards regression analyses were used to identify differences in association between the three factors and the time to RTW between different subgroups . Results The associations between the perceived work attitude , self-efficacy and perceived social support and the time to RTW vary across different health condition subgroups , not only with regard to the strength of the association but also for the type of factor . In the multivariate model , hazard ratios ( HRs ) of 1.33 ( 95 % CI 1.01–1.75 ) in the musculoskeletal subgroup , and 1.26 ( 95 % CI 0.89–1.78 ) in the other physical subgroup were found in perceived work attitude . With regard to perceived social support HRs of 1.39 ( 95 % CI 1.12–1.99 ) respectively 1.51 ( 1.05–2.17 ) in the same subgroups were found . Only self-efficacy remained in the multivariate model in all subgroups with HRs of 1.49 ( 95 % CI 1.12–1.99 ) in the musculoskeletal subgroup , 1.53 ( 95 % CI 1.07–2.18 ) in the other physical subgroup and 1.60 ( 1.07–2.40 ) in the mental subgroup . Conclusions The results of this study show that perceived work attitude , self-efficacy and perceived social support are relevant predictors with regard to the time to RTW in all types of health conditions , but that important differences are observed in type of factor and strengths of the relationships between physical and mental health conditions Background Common mental disorders ( CMD ) have a major impact on both society and individual workers , so return to work ( RTW ) is an important issue . In The Netherl and s , the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW . Evidence -based guidelines are available , but seem not to be effective in improving RTW in people with CMD . An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed . A blended E-health module embedded in collaborative occupational health care is now available , and comprises a decision aid supporting the occupational physician and an E-health module , Return@Work , to support sick-listed workers in the RTW process . The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual . Methods This study is a two-armed cluster r and omized controlled trial , with r and omization done at the level of occupational physicians . Two hundred workers with CMD on sickness absence for 4–26 weeks will be included in the study . Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention . Occupational physicians allocated to the care as usual group will give conventional sickness guidance . Follow-up assessment s will be done at 3 , 6 , 9 , and 12 months after baseline . The primary outcome is duration until RTW . The secondary outcome is severity of symptoms of CMD . An economic evaluation will be performed as part of this trial . Conclusion It is hypothesized that collaborative occupational health care intervention will be more (cost)-effective than care as usual . This intervention is innovative in its combination of a decision aid by email sent to the occupational physician and an E-health module aim ed at RTW for the sick-listed worker Background Since a higher level of self-efficacy in common mental disorders is associated with earlier return-to-work ( RTW ) , it is important to know if work related self-efficacy can be increased by occupational health care . The primary aim of this study was to evaluate whether an intervention to enhance guideline adherence of occupational physicians lead to an increase in RTW self-efficacy in workers three months later . The secondary aim was to evaluate whether the intervention modified the association between RTW self-efficacy and return-to-work three months later . Methods A total of 66 occupational physicians participated in the study . They were r and omized into two groups ; the intervention group received a training , the control group did not . The training aim ed to enhance adherence to a mental health guideline that contained strategies that are supposed to enhance RTW self-efficacy . In 128 sick-listed workers guided by these occupational physicians , RTW self-efficacy , RTW , and personal , health-related and work-related variables were measured at baseline and three months later . Generalized linear mixed models analysis and linear mixed models analysis were used for the evaluations . Results In workers whose occupational physicians had received the training RTW self-efficacy increased significantly more than in workers whose occupational physicians had participated in the control group ( t = −2.626 , p ≤ .05 ) . Higher baseline RTW self-efficacy scores were significantly more often associated with full RTW than with no RTW three months later ( OR 2.20 , 95 % CI 1.18–4.07 ) , but the intervention did not affect this association . Conclusions This study showed that a training to enhance guideline adherence of occupational physicians leads to increased RTW self-efficacy in workers sick-listed with common mental disorders during the first months of sickness absence in a real-life occupational health care setting . This insight is helpful for optimizing the recovery and RTW process , and for underst and ing the role of RTW self-efficacy in this process . Trial registration IS RCT Introduction It was postulated that workers , at the sub-acute stage after injury , respond differently to clinical and occupational interventions offered in a workers ’ compensation environment . Individual worker risk of disability , it was further believed , would influence the effectiveness of early intervention . The objective of the current pilot study was to evaluate return to work ( RTW ) outcomes following proactive , combined clinical , occupational and case management-based interdisciplinary early intervention , provided in a workers ’ compensation environment 4–10 weeks of onset of back pain , to workers with medium and high risk for disability . Methods The project was a controlled study comparing conventional workers ’ compensation case management with integrated , interdisciplinary and multimodal early intervention ( hereinafter referred to as “ EI ” ) . At baseline , risk status was determined by a vali date d Risk for Disability Question naire by Carragee et al. ( Spine 5(1):24–35 , 2005 ) . Seventeen workers at high risk of protracted disability and 20 workers at moderate risk of disability received conventional case management , and 17 workers assessed at high risk of protracted disability and 18 workers at moderate risk of disability received the Early Intervention . Results At 3 months post back pain onset , no statistically significant differences were identified in RTW outcomes between conventional case management and the Early Intervention . However , by 6 months post back pain onset , workers at high risk of work disability who received the Early Intervention were significantly more likely to RTW than high risk workers who received conventional case management . In contrast , moderate risk workers continued to exhibit no statistically significant differences in RTW outcomes . Conclusion Multimodal Early Intervention in the workers ’ compensation case management context is likely effective for workers with sub-acute back pain who are at high risk of occupational disability . The comprehensive Early Intervention is , however , likely redundant for workers who are not at high risk for disability and should not be applied indiscriminately . Further studies are required to determine longer-term Early Intervention outcomes , and to replicate the findings using a r and omized control design . Also , with a larger sample size , it will be possible to determine predictors of occupational outcomes Althoughdoctors are increasingly evaluated on the basis of return-to-work ( RTW ) outcomes , the effect of doctor – patient communication about the workplace and RTW after an occupational injury has received little research attention . The effect of  patient-reported doctor communication on duration of disabilitywas examined retrospectively in a 3-year cohort of 325 cl aim ants with alost-time low back injury . Although doctor proactive communication wasassociated with a greater likelihood of RTW during the acute phase ( < 30days of disability ) , this effect disappeared when injury and workloadcharacteristics were taken into account . A positive RTW recommendation wasassociated with about a 60 % higher RTW rate during the subacute/chronic phase(>30 days of disability ) only . Prospect i ve studies are needed to confirmthis effect . The impact of physician communication on RTW is largelyconfounded by injury and workplacefactors OBJECTIVES In case of long-term sick leave , gradually increasing workload appears to be an effective component of work-directed interventions to reduce sick leave due to common mental disorders ( CMD ) . CMD are defined as stress-related , adjustment , anxiety , or depressive disorders . We developed an exposure-based return-to-work ( RTW-E ) intervention and evaluated the effect on time-to-full return to work ( RTW ) among workers who were on sick leave due to CMD in comparison to those treated with care-as-usual ( CAU ) . CAU is guideline -directed and consists of problem-solving strategies and grade d activities . METHODS Using a two-armed cluster-r and omized trial , we r and omized 56 occupational physicians ( OP ) . Of these , 35 OP treated 160 workers at the start of their sick leave ; 75 workers received RTW-E and 85 workers received CAU .  These workers were followed over a 12-month follow-up period . The time-to-full RTW lasting ≥28 days without recurrence was the primary outcome measure . To evaluate differences between groups , we used intention-to-treat and multilevel Cox 's regression analysis . RESULTS The median time-to-full RTW differed significantly between groups [ hazard ratio ( HR ) 0.55 ; 95 % confidence interval ( 95 % CI ) 0.33 - 0.89 ] . The workers receiving RTW-E ( 209 days ; 95 % CI 62 - 256 ) had a prolonged time-to-full RTW compared to workers receiving CAU ( 153 days ; 95 % CI 128 - 178 ) . CONCLUSIONS Workers on sick leave due to CMD treated with RTW-E showed a prolonged time-to-full RTW compared to those treated with CAU . We recommend that OP do not apply RTW-E but continue counseling workers on sick leave due to CMD according to CAU Compare the effects of integrated case management and usual care on patient satisfaction in employees with work-related upper extremity disorder ( WRUED ) , and consider the implication s of higher levels of satisfaction . Describe those patient-related and work-related factors that predict the severity of upper limb symptoms and the degree of functional limitation 6 and 12 months after intervention . Enumerate the factors influencing the interval before return to work in employees with WRUED who are managed by traditional or integrated case management . An integrated case management ( ICM ) approach ( ergonomic and problem-solving intervention ) to work-related upper-extremity disorders was examined in relation to patient satisfaction , future symptom severity , function , and return to work ( RTW ) .  Federal workers with work-related upper-extremity disorder workers ’ compensation cl aims ( n = 205 ) were r and omly assigned to usual care or ICM intervention .  Patient satisfaction was assessed after the 4-month intervention period . Question naires on clinical outcomes and ergonomic exposure were administered at baseline and at 6- and 12-months postintervention . Time from intervention to RTW was obtained from an administrative data base . ICM group assignment was significantly associated with greater patient satisfaction . Regression analyses found higher patient satisfaction levels predicted decreased symptom severity and functional limitations at 6 months and a shorter RTW . At 12 months , predictors of positive outcomes included male gender , lower distress , lower levels of reported ergonomic exposure , and receipt of ICM . Findings highlight the utility of targeting workplace ergonomic and problem solving skills Objectives To evaluate the effectiveness of a participatory workplace intervention compared with usual care for sick-listed employees with distress , with regard to return to work ( RTW ) within the 12-month follow-up . Methods Employees with distress and sick-listed for 2–8 weeks were r and omised to a  workplace intervention ( n=73 ) or to usual care  ( n=72 ) . The participatory workplace intervention is a stepwise process involving the sick-listed employee and their supervisor , aim ed at reducing obstacles for RTW by reaching consensus about an action plan for RTW . Outcome variables were lasting RTW , cumulative sickness absence and stress-related symptoms . Results Overall , an HR of 0.99 ( 95 % CI 0.70 to 1.39 ) indicated no effect of the workplace intervention on lasting RTW . However , the workplace intervention significantly reduced the time until lasting RTW for employees who at baseline intended to return to work despite symptoms with an HR of 2.05 ( 95 % CI 1.22 to 3.45 ) . Employees who intended to return to work despite symptoms returned to work after 55 days in the workplace intervention group and 120 days in the usual care group . No such effect of the intervention was found for employees without baseline intentions to return to work despite symptoms ( HR=0.78 , 95 % CI 0.47 to 1.28 ) . Conclusions No overall effect of the participatory workplace intervention on lasting RTW was found . The workplace intervention appeared effective on lasting RTW for employees who at baseline intended to return to work despite symptoms . For employees who showed no baseline intention to return to work , the intervention did not have any effect . Other approaches are needed for this subgroup . This trial has been registered at the Dutch National Trial Register IS RCT N92307123 Purpose Evidence -based guidelines in occupational health care improve the quality of care and may reduce sickness absence duration . Notwithst and ing that , guideline adherence of occupational physicians ( OPs ) is limited . Based on the literature on guideline implementation , an intervention was developed that was shown to effectively improve self-reported adherence in OPs . The aim of present study was to evaluate whether this intervention leads to earlier return to work ( RTW ) in workers with common mental disorders ( CMD ) . Methods In a two-armed cluster r and omized controlled trial , 66 OPs were r and omized . The trial included 3379 workers , with 1493 in the intervention group and 1886 in the control group . The outcome measures were : time to full RTW , time to first RTW , and total hours of sickness absence . Cox regression analyses and generalized linear mixed model analyses were used for the evaluations . Results The median time to RTW was 154 days among the 3228 workers with CMD . No significant differences occurred in ( time to ) full RTW between intervention and control group HR 0.96 ( 95 % CI 0.81–1.15 ) nor for first RTW HR 0.96 ( 95 % CI 0.80–1.15 ) . The mean total hours of sickness absence was 478 h in the intervention group and 483 h in the control group . Conclusions The intervention to enhance OPs ’ guideline adherence did not lead to earlier RTW in workers with CMD guided by the OPs . Possible explanations are the remaining external barriers for guideline use , and that perceived guideline adherence might not represent actual guideline adherence and improved care . Trail registration : IS RCT N86605310 Objective : To evaluate the effectiveness of guideline -based care ( GBC ) of workers with mental health problems , which promotes counseling by the occupational physician ( OP ) facilitating return to work ( RTW ) . Methods : In a r and omized controlled trial with police workers on sick leave due to mental health problems ( n = 240 ) , trained OPs delivered GBC in the intervention group .  Time to RTW and recurrences during 1-year follow-up , analyzed using Cox proportional hazards models , were compared with usual care ( UC ) with easy access to a psychologist . Results : GBC by OPs did not result in earlier RTW than UC . Subgroup analysis showed a small effect in favor of GBC for workers with administrative functions and /or “ minor ” stress-related symptoms . Conclusions : GBC did not differ in RTW compared with UC , but may be beneficial for the majority of workers with minor stress-related disorders Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 The aim of this study was to compare the effectiveness of two individual-level psychotherapy interventions : ( a ) treatment as usual consisting of cognitive-behavioral therapy ( CBT ) and ( b ) work-focused CBT ( W-CBT ) that integrated work aspects early into the treatment . Both interventions were carried out by psychotherapists with employees on sick leave because of common mental disorders ( depression , anxiety , or adjustment disorder ) . In a quasi-experimental design , 12-month follow-up data of 168 employees were collected . The  CBT group consisted of 79 clients , the W-CBT group of 89 . Outcome measures were duration until return to work ( RTW ) , mental health problems , and costs to the employer . We found significant effects on duration until RTW in favor of the W-CBT group : full RTW occurred 65 days earlier . Partial RTW occurred 12 days earlier . A significant decrease in mental health problems was equally present in both conditions . The average financial advantage for the employer of an employee in the W-CBT group was estimated at $ 5,275 U.S. dollars compared with the CBT group . These results show that through focusing more and earlier on work-related aspects and RTW , functional recovery in work can be substantially speeded up within a regular psychotherapeutic setting . This result was achieved without negative side effects on psychological complaints over the course of 1 year . Integrating work-related aspects into CBT is , therefore , a fruitful approach with benefits for employees and employers alike Study Design . R and omized clinical trial comparing two interventions in employees sick-listed 3 to 16 weeks because of low back pain ( LBP ) . Objective . To compare 1-year return to work ( RTW ) , pain , disability and physical and mental health dimensions in subjects offered a hospital-based multidisciplinary intervention or a brief intervention .  Summary of Background Data . Previous studies in sick-listed employees with LBP have indicated efficacy of both brief and more comprehensive multidisciplinary interventions . However , it remains unknown , which is the more effective , and which elements are instrumental in furthering RTW , and improving health . Methods . The brief intervention comprised clinical examination and advice offered by a rehabilitation physician and a physiotherapist . In the multidisciplinary intervention , this intervention was supplemented with the expertise of a team and the assignment of a case manager who drew up a rehabilitation plan in collaboration with the patient and the multidisciplinary team . One-year RTW was estimated by data from a comprehensive national data base of social transfer payments . Question naires were used to obtain baseline and 1-year data on Rol and Morris disability score , LBP Rating Scale , SF36 , and fear-avoidance . Results . A total of 351 patients were included and r and omized and 344 ( 98 % ) patients participated in all the consultations according to the study protocol . RTW was achieved by 125 ( 71.0 % ) participants in the multidisciplinary and 133 ( 76.0 % ) participants in the brief intervention group . The hazard ratio was 0.84 after adjustment for sex , age , smoking , compensation cl aims , disability score , and diagnosis ( 95 % confidence interval [ CI ] : 0.65–1.08,P = 0.18 ) . Multiple linear regression analysis displayed no differences in secondary outcomes , except for the mental health score ( SF36 ) , which was a little higher in the multidisciplinary intervention group than in the brief intervention group . Conclusion . Hospital-based multidisciplinary intervention may be no better than brief intervention to increase RTW and improve health in sick-listed employees with low back pain OBJECTIVES The purpose of this study was to assess the effects of early part-time sick leave on return to work ( RTW ) and sickness absence among patients with musculoskeletal disorders . METHODS A r and omized controlled trial was conducted in six occupational health units of medium- and large-size enterprises . Patients aged 18 - 60 years with musculoskeletal disorders ( N=63 ) unable to perform their regular work were r and omly 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 . RESULTS 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 adjusted for age was 1.60 [ 95 % confidence interval ( 95 % CI ) 0.98 - 2.63 ] and 1.76 ( 95 % CI 1.21 - 2.56 ) after further adjustment for 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 . Compliance with the intervention was high with no discontinuations of part-time sick leave due to musculoskeletal reasons . CONCLUSIONS Early part-time sick leave may provide a faster and more sustainable return to regular duties than full-time sick leave among patients with musculoskeletal disorders . This is the first study to show that work participation can be safely increased with early part-time sick leave
There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains .
There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes .
There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW .
Evidence for the effectiveness of other single-domain interventions was mixed , with some studies reporting positive effects and others reporting no effects on lost time and work functioning .
Purpose The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work ( RTW ) interventions and work disability management ( DM ) interventions that assist workers with musculoskeletal ( MSK ) and pain-related conditions and mental health ( MH ) conditions with RTW .