Effectiveness and cost-effectiveness of an exposure-based return-to-work programme for patients on sick leave due to common mental disorders: design of a cluster-randomized controlled trial Coordinated and Tailored Work Rehabilitation: A Randomized Controlled Trial with Economic Evaluation Undertaken with Workers on Sick Leave Due to Musculoskeletal Disorders Promoting work ability in a structured national rehabilitation program in patients with musculoskeletal disorders: outcomes and predictors in a prospective cohort study Cost effectiveness of two rehabilitation programmes for neck and back pain patients: A seven year follow-up Costs of Inflammatory Bowel Disease in Germany Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Cost-utility analysis of a one-time supervisor telephone contact at 6-weeks post-partum to prevent extended sick leave following maternity leave in The Netherlands: results of an economic evaluation alongside a randomized controlled trial NICE guidance on long-term sickness and incapacity. Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness Can we enhance the ability to return to work among workers with stress-related disorders? Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial A web-based intervention to promote applications for rehabilitation: a study protocol for a randomized controlled trial Health-related effects of early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Effectiveness of a multidisciplinary care program on recovery and return to work of patients after gynaecological surgery; design of a randomized controlled trial Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain Work Disability After Robot-assisted or Open Radical Prostatectomy: A Nationwide, Population-based Study. Prevention program at construction worksites aimed at improving health and work ability is cost-saving to the employer: results from an RCT. [Coronary intervention and occupational rehabilitation--a prospective, randomized intervention study]. Diagnosis and duration of sickness absence as predictors for disability pension: Results from a three-year, multi-register based* and prospective study An intervention program with the aim to improve and maintain work productivity for workers with rheumatoid arthritis: design of a randomized controlled trial and cost-effectiveness study Effectiveness of early part-time sick leave in musculoskeletal disorders Motivating disability pensioners with back pain to return to work--a randomized controlled trial. Predictors of productivity loss in early rheumatoid arthritis: a 5 year follow up study.
Background To reduce the duration of sick leave and loss of productivity due to common mental disorders ( CMDs ) , we developed a return-to-work programme to be provided by occupational physicians ( OPs ) based on the principles of exposure in vivo ( RTW-E programme ) . This study evaluates this programme 's effectiveness and cost-effectiveness by comparing it with care as usual ( CAU ) . The three research questions we have are : 1 ) Is an RTW-E programme more effective in reducing the sick leave of employees with common mental disorders , compared with care as usual ? 2 ) Is an RTW-E programme more effective in reducing sick leave for employees with anxiety disorders compared with employees with other common mental disorders ? 3 ) From a societal perspective , is an RTW-E programme cost-effective compared with care as usual ? Methods / design This study was design ed as a pragmatic cluster-r and omized controlled trial with a one-year follow-up and r and omization on the level of OPs . We aim ed for 60 OPs in order to include 200 patients . Patients in the intervention group received the RTW-E programme .  Patients in the control group received care as usual .  Eligible patients had been on sick leave due to common mental disorders for at least two weeks and no longer than eight weeks . As primary outcome measures , we calculated the time until full return to work and the duration of sick leave . Secondary outcome measures were time until partial return to work , prevalence rate of sick leave at 3 , 6 , 9 , and 12 months ' follow-up , and scores of symptoms of distress , anxiety , depression , somatization , and fatigue ; work capacity ; perceived working conditions ; self-efficacy for return to work ; coping behaviour ; avoidance behaviour ; patient satisfaction ; and work adaptations . As process measures , we used indices of compliance with the intervention in the intervention group and employee-supervisor communication in both groups . Economic costs were calculated from a societal perspective . The total costs consisted of the costs of consuming health care , costs of production loss due to sick leave and reduced productivity , and out-of-pocket costs of patients for travelling to their OP . Discussion The results will be published in 2009 . The strengths and weaknesses of the study protocol are discussed . Trial registration IS RCT Introduction In Denmark , the magnitude and impact of work disability on the individual worker and society has prompted the development of a new “ coordinated and tailored work rehabilitation ” ( CTWR ) approach . The aim of this study was to compare the effects of CTWR with conventional case management ( CCM ) on return-to-work of workers on sick leave due to musculoskeletal disorders ( MSDs ) . Methods The study was a r and omized controlled trial with economic evaluation undertaken with workers on sick leave for 4–12 weeks due to MSDs . CTWR consists of a work disability screening by an interdisciplinary team followed by the collaborative development of a RTW plan . The primary outcome variable was registered cumulative sickness absence hours during 12 months follow-up . Secondary outcomes were work status as well as pain intensity and functional disability , measured at baseline , 3 and 12 months follow-up . The economic evaluation ( intervention costs , productivity loss , and health care utilization costs ) was based on administrative data derived from national registries . Results For the time intervals 0–6 months , 6–12 months , and the entire follow-up period , the number of sickness absence hours was significantly lower in the CTWR group as compared to the control group . The total costs saved in CTWR participants compared to controls were estimated at US $ 1,366 per person at 6 months follow-up and US $ 10,666 per person at 12 months follow-up . Conclusions Workers on sick leave for 4–12 weeks due to MSD who underwent “ CTWR ” by an interdisciplinary team had fewer sickness absence hours than controls . The economic evaluation showed that — in terms of productivity loss — CTWR seems to be cost saving for the society Background Musculoskeletal disorders ( MSDs ) are a major reason for impaired work productivity and sick leave . In 2009 , a national rehabilitation program was introduced in Sweden to promote work ability , and patients with MSDs were offered multimodal rehabilitation . The aim of this study was to analyse the effect of this program on health related quality of life , function , sick leave and work ability . Methods We conducted a prospect i ve , observational cohort study including 406 patients with MSDs attending multimodal rehabilitation .  Changes over time and differences between groups were analysed concerning function , health related quality of life , work ability and sick leave . Regression analyses were used to study the outcome variables health related quality of life ( measured with EQ-5D ) , and sick leave . Results Functional ability and health related quality of life improved after rehabilitation . Patients with no sick leave/disability pension the year before rehabilitation , improved health related quality of life more than patients with sick leave/disability pension the year before rehabilitation ( p = 0.044 ) . During a period of −/+ four months from rehabilitation start , patients with EQ-5D ≥ 0.5 at rehabilitation start , reduced their net sick leave days with 0.5 days and patients with EQ-5D < 0.5 at rehabilitation start , increased net sick leave days with 1.5 days ( p = 0.019 ) . Factors negatively associated with sick leave at follow-up were earlier episodes of sick leave/disability pension , problems with exercise tolerance functions and mobility after rehabilitation . Higher age was associated with not being on sick leave at follow-up and reaching an EQ-5D ≥ 0.5 at follow-up . Severe pain after rehabilitation , problems with exercise tolerance functions , born outside of Sweden and full-time sick leave/disability pension the year before rehabilitation were all associated with an EQ-5D level < 0.5 at follow-up . Conclusions Patients with MSDs participating in a national work promoting rehabilitation program  significantly improved their health related quality of life and functional ability , especially those with no sick leave . This shows that vocational rehabilitation programs in a primary health care setting are effective . The findings of this study can also be valuable for more appropriate patient selection for rehabilitation programs for MSDs ABSTRACT The cost effectiveness of work‐oriented rehabilitation for persons on long‐term sick leave needs to be assessed . This prospect i ve observational study presents a follow‐up seven years after rehabilitation using two different evidence ‐based work‐oriented regimens . Individuals on sick leave for neck and back pain were referred to two rehabilitation programmes in Sweden . The first programme was a relatively low‐intensity programme based on orthopaedic manual therapy and exercise programme ( OMTP ) . The second programme was a full‐time multidisciplinary programme ( MDP ) . The primary outcome was sickness absence seven years after intervention . Cost effectiveness was calculated on the basis of loss of production due to sickness absence . The results show that participants referred to MDP and with less than 60 sick days before rehabilitation have reduced sickness absence after intervention as compared to matched controls . This corresponds to a cost reduction of about 94,494 EUR per referred individual . Further , the results indicate that participants of the OMTP who have more than 60 sick days before rehabilitation have a statistically significant increased risk of disability pension . This means increased cost in terms of loss of production of 44,593 EUR per referred individual . The results of this study show that MPD but not OMTP achieves the goal of working life‐oriented rehabilitation . A direct comparison between the rehabilitation programmes strengthened the assumption that long‐term sickness absence prior to rehabilitation is associated with more days on sick leave after rehabilitation . This analysis also indicated the importance of participants  ’ pain self‐efficacy beliefs and recovery beliefs on rehabilitation outcome Abstract Introduction : Inflammatory bowel disease ( IBD ) is a chronic condition that afflicts young adults in their economically productive years . The goal of this study was to determine the costs of IBD in Germany from a societal perspective , using cost diaries . Methods : Members of the German Crohn ’s Disease and Ulcerative Colitis Association who had IBD were recruited by post , and those who agreed to participate documented their IBD-associated costs prospect ively in a diary over 4 weeks . They documented their use of healthcare facilities , medications , sick leave and out-of-pocket expenditures , as well as general demographic information , the status and history of their IBD , and long-term disability . Item costs were calculated according to national sources . Cost data were calculated using non-parametric bootstrapping and presented as mean costs ( year 2004 ) over 4 weeks . Results : The cost diaries were returned by 483 subjects ( Crohn ’s disease : n = 241 , ulcerative colitis : n = 242 ) with a mean age of 42 years and an average disease duration of 13 years ( SD ± 8.09 ) . The cost diaries were regarded as ‘ easy to complete ’ by 89 % of participants . The mean 4-week costs per subject were € 1425 ( 95 % CI 1201 , 1689 ) for Crohn ’s disease and € 1015 ( 95 % CI 832 , 1258 ) for ulcerative colitis . Of the total costs for Crohn ’s disease , 64 % were due to indirect costs such as early retirement or sick leave and 32 % were due to direct medical costs . In contrast , of the total costs for ulcerative colitis , 41 % were due to direct medical costs and 54 % to indirect costs . Conclusions : This is the first comprehensive cost study for Crohn ’s disease and ulcerative colitis in Germany . The most important economic factors that influenced the cost profiles of both diseases were the long-term productivity losses due to an ongoing inability to work and the cost of medications . Results indicate significant cost differences between Crohn ’s disease and ulcerative colitis . This data provides initial cost estimates that can be analysed further with respect to cost determinants and disease-specific costs in the future OBJECTIVE To investigate 1 ) the magnitude of indirect costs , 2 ) changes in cost components , and 3 ) correlations between changes in cost and social , clinical , and occupational variables within the first 3 years of rheumatoid arthritis ( RA ) . METHODS We evaluated the indirect costs  per person-year in 133 consecutive gainfully employed out- patients with early RA , in a prospect i ve multicenter followup study . Costs due to RA-related sick leave , work disability , and other work loss were assessed using the human capital approach . Variables associated with reduction in lost productivity were tested by multivariate logistic regression analysis . RESULTS Mean + /- SEM annual indirect costs were $ 11,750 + /- 1,120 per person . During the 3-year period of observation , a marked reduction in the costs associated with sick leave was seen , which exceeded the increase in costs due to work disability and other work loss . This phenomenon result ed in an overall reduction in indirect costs of 21 % . The final logistic regression model of reduced loss of productivity included 3 variables : no problems with st and ing ( odds ratio [ OR ] 7.1 ) , no problems with working speed ( OR 4.1 ) , and no problems with outdoor work ( OR 3.1 ) . CONCLUSION High indirect costs in early RA were demonstrated . An overall decrease of costs can be seen in the first 3 years , due to the reduction in sick leave . Since the absence of problems due to strenuous working conditions was found to be associated with a reduction in indirect costs , it is assumed that early intensified vocational rehabilitation , apart from controlling disease activity by adequate treatment , might help to reduce indirect costs Background Working women of childbearing age are a vital part of the population . Following childbirth , this group of women can experience a myriad of physical and mental health problems that can interfere with their ability to work . Currently , there is little known about cost-effective post-partum interventions to prevent work disability . The purpose of the study was to evaluate whether supervisor telephone contact ( STC ) during maternity leave is cost-effective from a societal perspective in reducing sick leave and improving quality -adjusted life years ( QALYs ) compared to common practice ( CP ) . Methods We conducted an economic evaluation alongside a r and omized controlled trial . QALYs were measured by the EuroQol 5-D , and sick leave and presenteeism by the Health and work Performance Question naire . Re source use was collected by question naires . Data were analysed according to intention-to-treat . Missing data were imputed via multiple imputation . Uncertainty was estimated by 95 % confidence intervals , cost-utility planes and curves , and sensitivity analyses . Results 541 working women from 15 companies participated . Response rates were above 85 % at each measurement moment . At the end of the follow-up , no statistically significant between-group differences in QALYs , mean hours of sick leave or presenteeism or costs were observed . STC was found to be less effective and more costly . For willingness-to-pay levels from € 0 through € 50,000 , the probability that STC was cost-effective compared to CP was 0.2 . Overall re source use was low . Mean total costs were € 3678 ( 95 % CI : 3386 ; 3951 ) . Productivity loss costs represented 37 % of the total costs and of these costs , 48 % was attributable to sick leave and 52 % to work presenteeism . The cost analysis from a company 's perspective indicated that there was a net cost associated with the STC intervention . Conclusions STC was not cost-effective compared to common practice for a healthy population of working mothers ; therefore , implementation is not indicated . The cost-utility of STC for working mothers with more severe post-partum health problems , however , needs to be investigated . Work presenteeism accounted for half of the total productivity loss and warrants attention in future studies .Trial registration numberIS RCT N : IS RCT Long-term  sickness absence and incapacity benefits ( disability pension ) rates have increased across industrialised countries . Effective measures are needed to support return to work . The recommendations of this guidance were informed by the most appropriate available evidence of effectiveness and cost-effectiveness . Public health evidence was provided by research using a variety of study design s that attempted to determine the outcome of a particular intervention by evaluating status before and after the intervention had been effected , and was not limited to r and omised control trials . Where the evidence base was depleted or underdeveloped , expert witnesses were called to give their opinion on the best available evidence and emerging interventions . The process enabled challenge and contestability from stakeholder groups at different points as the guidance was developed . Forty-five heterogeneous studies were included in the review of interventions to reduce long-term sickness absence and transitions from short-term to long-term absence ( mainly covering the former and also mainly examining musculoskeletal conditions ) . The analysis of evidence was restricted to descriptive synthesis . Three general themes emerged from an analysis of the studies that were more likely to report positive results : early interventions ; multidisciplinary approaches ; and interventions with a workplace component . Two further review s were undertaken , one on interventions to reduce the re-occurrence of sickness absence , which identified seven studies on lower back pain , and concluded that early intervention and direct workplace input are important factors . The final evidence review focused on six studies of interventions for those in receipt of incapacity benefit . The evidence was that work-focused interviews coupled with access to tailored support are effective and cost-effective interventions . Practitioners should consider the impact of interventions and management options on work ability for patients of working age . Work ability should be considered a key outcome for future intervention studies Background Low back pain ( LBP ) and neck pain ( NP ) are a major public health problem with considerable costs for individuals , companies and society . Therefore , prevention is imperative . The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics ( PE ) to prevent LBP and NP among workers . Methods In a r and omised controlled trial ( RCT ) , a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline . The departments consisting of about 150 workers are pre-stratified and r and omised . The control departments receive usual practice and the intervention departments receive PE . Within each intervention department a working group is formed including eight workers , a representative of the management , and an occupational health and safety coordinator . During a one day meeting , the working group follows the steps of PE in which the most important risk factors for LBP and NP , and the most adequate ergonomic measures are identified on the basis of group consensus . The implementation of ergonomic measures at the department is performed by the working group . To improve the implementation process , so-called ' ergocoaches ' are trained . The primary outcome measure is an episode of LBP and NP . Secondary outcome measures are actual use of ergonomic measures , physical workload , psychosocial workload , intensity of pain , general health status , sick leave , and work productivity . The cost-effectiveness analysis is performed from the societal and company perspective . Outcome measures are assessed using question naires at baseline and after 6 and 12 months . Data on the primary outcome as well as on intensity of pain , sick leave , work productivity , and health care costs are collected every 3 months . Discussion Prevention of LBP and NP is beneficial for workers , employers , and society . If the intervention is proven (cost-)effective , the intervention can have a major impact on LBP and NP prevention and , thereby , on work disability prevention . Results are expected in 2010.Trial registration IS RCT Background Stress-related disorders are widespread and responsible for high societal costs e.g. sick leave payment and reduced productivity . The aim of this study was to evaluate the effect of an intervention program on return to work or labour market . Methods In a controlled interventional study design we compared 72 emotionally distressed patients , who received support during 2006 , with 89 control individuals who had also been sick listed for emotional distress .  Intervention was provided by trained psychologists and social workers who were in continuous dialog with the patients , providing counselling e.g. on decisions concerning resumption of work , support to families , participation in meetings with the workplace . Basically , the controls and the intervention group share the same access to welfare benefits . The main outcome was time to return to labour market ( TTR ) . Results The baseline characteristics were similar in the two groups . There were no differences in the rate of resuming work between the two groups . About 80 % in both groups had returned to the labour market after one year . Conclusion An intervention program with psychological stress management and case management did not improve work capability compared to usual care . Work resumption as a single outcome probably is an insensitive parameter of intervention management quality , and should be supplemented by other data on different aspects of treatment Background Considering the high costs of sick leave and the consequences of sick leave for employees , an early return-to-work of employees with mental disorders is very important . Therefore , a workplace intervention is developed based on a successful return-to-work intervention for employees with low back pain . The objective of this paper is to present the design of a r and omized controlled trial evaluating the cost-effectiveness of the workplace intervention compared with usual care for sick-listed employees with common mental disorders . Methods The study is design ed as a r and omized controlled trial with a follow-up of one year . Employees eligible for this study are on sick leave for 2 to 8 weeks with common mental disorders . The workplace intervention will be compared with usual care . The workplace intervention is a stepwise approach that aims to reach consensus about a return-to-work plan by active participation and strong commitment of both the sick-listed employee and the supervisor . Outcomes will be assessed at baseline , 3 , 6 , 9 and 12 months . The primary outcome of this study is lasting return-to-work , which will be acquired from continuous registration systems of the companies after the follow-up . Secondary outcomes are total number of days of sick leave during the follow-up , severity of common mental disorders , coping style , job content , and attitude , social influence , and self-efficacy determinants . Cost-effectiveness will be evaluated from the societal perspective . A process evaluation will also be conducted . Discussion Return-to-work is difficult to discuss in the workplace for sick-listed employees with mental disorders and their supervisors . Therefore , this intervention offers a unique opportunity for the sick-listed employee and the supervisor to discuss barriers for return-to-work . Results of this study will possibly contribute to improvement of disability management for sick-listed employees with common mental disorders . Results will become available in 2009.Trial registration IS RCT Background The German welfare system follows the principle “ rehabilitation rather than pension , ” but more than the half of all disability pensioners did not utilize medical rehabilitation before their early retirement . A major barrier is the application procedure . Lack of information about the opportunity to utilize rehabilitation services restricts the chance to improve work ability and to prevent health-related early retirement by rehabilitation programs . The establishment of new access paths to medical rehabilitation services was , therefore , identified as a major challenge for rehabilitation research in a recent expertise . Thus , a web-based information guide was developed to support the application for a medical rehabilitation program . Methods / Design For this study , the development of a web-based information guide was based on the health action process approach . Four modules were established . Three modules support forming an intention by strengthening risk perception ( module 1 ) , positive outcome expectancies ( module 2 ) and self-efficacy ( module 3 ) . A fourth module aims at the realization of actual behavior by offering instructions on how to plan and to push the application process . The study on the effectiveness of the web-based information guide will be performed as a r and omized controlled trial . Persons aged 40 to 59 years with prior sick leave benefits during the preceding year will be included . A sample of 16,000 persons will be r and omly drawn from the registers of 3 pension insurance agencies . These persons will receive a question naire to determine baseline characteristics . Respondents of this first survey will be r and omly allocated either to the intervention or the control group . Both study groups will then receive letters with general information about rehabilitation . The intervention group will additionally receive a link to the web-based information guide . After 1 year , a second survey will be conducted . Additionally , administrative data will be used to determine if participants apply for rehabilitation and finally start a rehabilitation program . The primary outcomes are the proportion of applied and utilized medical rehabilitation services . Secondary outcomes are cognitions on rehabilitation , self-rated work ability , health-related quality of life and perceived disability , as well as days with sick leave benefits and days of regular employment . Discussion The r and omized controlled trial will provide highest ranked evidence to clarify whether theory-driven web-based information supports access to rehabilitation services for people with prior sickness benefits .Trial registration German Clinical Trials Register ( Identifier : DRKS00005658 , 16 January 2014 ) OBJECTIVE Previously we reported that early part-time sick leave enhances return to work ( RTW ) among employees with musculoskeletal disorders ( MSD ) . This paper assesses the health-related effects of this intervention . METHODS Patients aged 18 - 60 years who were unable to perform their regular work due to MSD were r and omized to part- or full-time sick leave groups . In the former , workload was reduced by halving working time . Using vali date d question naires , we assessed pain intensity and interference with work and sleep , region-specific disability due to MSD , self-rated general health , health-related quality of life ( measured via EuroQol ) , productivity loss , depression , and sleep disturbance at baseline , 1 , 3 , 8 , 12 , and 52 weeks . We analyzed the repeated measures data ( 171 - 356 observations ) with the generalized estimating equation approach . RESULTS The intervention ( part-time sick leave ) and control ( full-time sick leave ) groups did not differ with regard to pain intensity , pain interference with work and sleep , region-specific disability , productivity loss , depression , or sleep disturbance . The intervention group reported better self-rated general health ( adjusted P=0.07 ) and health-related quality of life ( adjusted P=0.02 ) than the control group . In subgroup analyses , the intervention was more effective among the patients whose current problem began occurring < 6 weeks before baseline and those with ≤30 % productivity loss at baseline . CONCLUSIONS Our findings showed that part-time sick leave did not exacerbate pain-related symptoms and functional disability , but improved self-rated general health and health-related quality of life in the early stage of work disability due to MSD Background Return to work after gynaecological surgery takes much longer than expected , irrespective of the level of invasiveness . In order to empower patients in recovery and return to work , a multidisciplinary care program consisting of an e-health intervention and integrated care management including participatory workplace intervention was developed . Methods / Design We design ed a r and omized controlled trial to assess the effect of the multidisciplinary care program on full sustainable return to work in patients after gynaecological surgery , compared to usual clinical care . Two hundred twelve women ( 18 - 65 years old ) undergoing hysterectomy and /or laparoscopic adnexal surgery on benign indication in one of the 7 participating ( university ) hospitals in the Netherl and s are expected to take part in this study at baseline . The primary outcome measure is sick leave duration until full sustainable return to work and is measured by a monthly calendar of sickness absence during 26 weeks after surgery . Secondary outcome measures are the effect of the care program on general recovery , quality of life , pain intensity and complications , and are assessed using question naires at baseline , 2 , 6 , 12 and 26 weeks after surgery . Discussion The discrepancy between expected physical recovery and actual return to work after gynaecological surgery contributes to the relevance of this study . There is strong evidence that long periods of sick leave can result in work disability , poorer general health and increased risk of mental health problems . We expect that this multidisciplinary care program will improve peri-operative care , contribute to a faster return to work of patients after gynaecological surgery and , as a consequence , will reduce societal costs considerably . Trial registration Netherl and s Trial Register ( NTR ) : 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 BACKGROUND Robot-assisted radical prostatectomy ( RARP ) has been associated with reduced bleeding and shorter hospital stays than open retropubic radical prostatectomy ( RRP ) , but it is unclear whether these differences translate into shorter absence from work . OBJECTIVE To investigate short- and long-term rates of work disability following RARP and RRP . DESIGN , SETTING , AND PARTICIPANTS We conducted a nationwide population -based cohort study of 2571 men of working age treated with RARP or RRP between 2007 and 2009 identified in the National Prostate Cancer Register of Sweden . Information about physician-certified sick leave and disability pension was retrieved from the Swedish Social Insurance Agency through 2012 . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used Cox regression to calculate time to return to work ( RTW , or duration of sick leave ) after surgery and used generalised estimating equations to analyse days lost from work ( because of sick leave and disability pension ) after RTW . RESULTS AND LIMITATIONS Men treated with RARP returned to work after a median of 35 d , whereas the corresponding time for RRP was 48 d ( p<0.001 ) . The difference was seen early ; within the first month , men treated with RARP returned to work nearly four times faster than men treated with RRP ( adjusted relative RTW rate 3.76 ; 95 % confidence interval [ CI ] , 3.04 - 4.66 ) . During a median of 3.6 yr after return to work , men treated with RARP lost fewer days from work per person-year than men treated with RRP-12 d versus 15 d-but the association was not statistically significant ( p=0.10 ) . The adjusted rate ratio was 1.08 ( 95 % CI , 0.82 - 1.42 ) . One limitation is the nonr and omised design of this study . CONCLUSIONS RARP was associated with a faster RTW compared with RRP , but the surgical method did not influence long-term rates of work disability in terms of days lost from work after RTW . PATIENT SUMMARY We compared disease-related absence from work between two surgical methods for the removal of the prostate . Robot-assisted surgery was associated with a faster return to work compared with open surgery but did not influence absence from work in a long-term perspective BACKGROUND To prolong sustainable healthy working lives of construction workers , a prevention program was developed which aim ed to improve the health and work ability of construction workers . The objective of this study was to analyze the cost-effectiveness and financial return from the employers ' perspective of this program . METHODS A total of 293 workers in 15 departments were r and omized to the intervention ( n = 8 departments ) or control group ( n = 7 ) . Data on work ability and health were collected using question naires . Sick leave data were obtained from the companies . Both the cost-effectiveness analyses and return on investment analyses were performed . RESULTS After 12 months , the absenteeism costs were significantly lower in the intervention group than in the control group . At 12-month follow-up , no significant differences were found with respect to the primary outcomes ( work ability , mental and physical health status ) and secondary outcomes ( musculoskeletal symptoms ) , meaning that the intervention was not cost-effective in comparison with the control group . The net-benefit was € 641 per worker , and the intervention generated a positive financial return to the employer . CONCLUSION The intervention in the present study was cost-saving to the employer due to reduced sickness absenteeism costs in the intervention group compared with the control group . However , the intervention can not be regarded as cost-effective as no significant effects were found for work ability and health Coronary catheter revascularisation is less costly than bypass surgery due to lower direct ( medical ) and indirect costs ( loss of work ) . Many studies show that the time patients stay out of work following coronary intervention is much longer than necessary . This leads to a considerable increase of indirect costs , which can far exceed the medical costs of the treatment . This prospect i ve r and omised study was done to determine whether specific information to patient and family doctor results in an earlier return to work .  After catheter revascularisation 100 working patients ( mean age 52.4 years ) were r and omised either to the intervention group ( information to patient and family doctor ) or to the control group ( no specific information about return to work ) . Four months later 81 patients had returned to their previous jobs ( mean sick leave 18.9 + /- 24.8 days ) while 19 were still out of work . In the control group , the rate was 79 % and the mean sick leave was 16.4 + /- 22.0 days ( median 7 ) ; in the intervention group 83 % had returned to work after a mean of 21.5 + /- 27.4 days ( median 10 ) . There was no significant difference between the two groups , neither according to the rate of returned workers nor to the duration of sick leave . In the subgroup of patients with a private insurance ( 23 % of all ) 96 % started to work again ( mean sick leave 5.7 + /- 5.1 days median 3.5 ) , while the rate was 77 % in the group of panel patients ( mean sick leave 23.7 + /- 27.4 days , median 11 ) . The difference in sick leave between these two groups was highly significant ( p = 0.0003 ) . Specific information to the patient and family doctor has no effect on the time patients stay out of work following catheter revascularisation . It seems that the observed delay depends on social and psychological factors that can not be influenced directly Aim : A study was undertaken to identify predictors for the transition from long-term sickness absence into disability pension with special emphasis on routinely collected medical information ( e.g. diagnoses on sickness certificates ) and the duration of sickness-absence spells . Methods : The study used a 10 % r and om sample of the Norwegian population of working age ( the KIRUT data base ) . Individuals below 60 years of age , with spells of long-term sickness absence starting in 1990 - 91 , where the medical diagnoses on the sickness certificates were known , were identified . This group ( 4,432 men and 5,645 women ) was followed up for three years after the end of sickness absence with regard to disability pension and working status . Results : In logistic regression the following predictors significantly increased the risk of obtaining disability pension during the first three years after the long-term sickness spell : age , part-time employment , and duration of absence > 197 days . Higher education and having children < 11 years significantly decreased the risk . Having the medical diagnoses ` ` mental problems ' ' and diseases in the nervous system , respiratory system , and circulatory systems indicated high risk ( compared with musculoskeletal disease ) . The diagnostic groups ` ` pregnancy-related disease ' ' and ` ` injuries ' ' implied low risk for disability pension . In separate regressions for both genders the ` ` protective effect ' ' of having small children remained only for women . High risk for sickness absence caused by ` ` mental problems ' ' reached significance only for men . Conclusions and implication s : Several risk factors for transition from long-term sickness absence into disability pension were identified . The finding that spells of sickness absence with duration up to seven months did not imply increased risk of disability during the first three years may have implication s for interventions aim ed at long-term sickness absentees Background Workers with rheumatoid arthritis ( RA ) often experience restrictions in functioning at work and participation in employment . Strategies to maintain work productivity exist , but these interventions do not involve the actual workplace . Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA . Methods / design This study is a r and omized controlled trial ( RCT ) in specialized rheumatology treatment centers in or near Amsterdam , the Netherl and s. R and omisation to either the control or the intervention group is performed at patient level . Both groups will receive care as usual by the rheumatologist , and patients in the intervention group will also take part in the intervention program . The intervention program consists of two components ; integrated care , including a participatory workplace intervention . Integrated care involves a clinical occupational physician , who will act as care manager , to coordinate the care . The care manager has an intermediate role between clinical and occupational care . The participatory workplace intervention will be guided by an occupational therapist , and involves problem solving by the patient and the patients ’ supervisor . The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work . Data collection will take place at baseline and after 6 and 12 months by means of a question naire . The primary outcome measure is work productivity , measured by hours lost from work due to presenteeism . Secondary outcome measures include sick leave , quality of life , pain and fatigue . Cost-effectiveness of the intervention program will be evaluated from the societal perspective . Discussion Usual care of primary and outpatient health services is not aim ed at improving work productivity . Therefore it is desirable to develop interventions aim ed at improving functioning at work . If the intervention program will be (cost)effective , substantial improvements in work productivity might be obtained among workers with RA at lower costs . Results are expected in 2015.Trial registration Background The importance of staying active instead of bed rest has been acknowledged in the management of musculoskeletal disorders ( MSDs ) . This emphasizes the potential benefits of adjusting work to fit the employee 's remaining work ability . Despite part-time sick leave being an official option in many countries , its effectiveness has not been studied yet . We have design ed a r and omized controlled study to assess the health effects of early part-time sick leave compared to conventional full-day sick leave . Our hypothesis is that if work time is temporarily reduced and work load adjusted at the early stages of disability , employees with MSDs will have less disability days and faster return to regular work duties than employees on a conventional sick leave . Methods / Design The study population will consist of 600 employees , who seek medical advice from an occupational physician due to musculoskeletal pain . The inclusion requires that they have not been on a sick leave for longer than 14 days prior to the visit . Based on the physician 's judgement , the severity of the symptoms must indicate a need for conventional sick leave , but the employee is considered to be able to work part-time without any additional risk . Half of the employees are r and omly allocated to part-time sick leave group and their work time is reduced by 40–60 % , whereas in the control group work load is totally eliminated with conventional sick leave . The main outcomes are the number of days from the initial visit to return to regular work activities , and the total number of sick leave days during 12 and 24 months of follow-up . The costs and benefits as well as the feasibility of early part-time sick leave will also be evaluated . Conclusion This is the first r and omised trial to our knowledge on the effectiveness of early part-time sick leave compared to conventional full-time sick leave in the management of MSDs . The data collection continues until 2011 , but preliminary results on the feasibility of part-time sick leave will be available already in 2008 . The increased knowledge will assist in better decision making process regarding the management of disability related to MSDs . Trial Registration International St and ard R and omised Controlled Trial Number Register , register number IS RCT OBJECTIVE To investigate the outcome of a brief vocational-oriented intervention aim ing to motivate disability pensioners with back pain to return to work , and to evaluate prognostic factors for having entered a return to work process during the following year . DESIGN A r and omized controlled trial was conducted . SUBJECTS Participants ( n = 89 ) ( mean age 49 years , 65 % women ) who had received disability pension for more than one year were r and omized into an intervention group ( education , reassurance , motivation , vocational counselling , n = 45 ) and a control group ( n = 44 ) . METHODS Primary outcome measures were return to work or having entered a return to work process . Secondary outcome measures were life satisfaction , disability , fear avoidance behaviour and expectancy . RESULTS The intervention had no statistically significant effect on return to work or having entered a return to work process at 1-year follow-up . Twice as many in the intervention group ( n = 10 , 22 % ) had entered a return to work process compared with the controls ( n = 5 , 11 % ) . The number needed to treat was 9.2 ( 95 % confidence interval ( CI ) = 3.4 , Inf ) . Only minor differences in secondary outcome measures were demonstrated . Positive expectancy , better physical performance and less pain were related to return to work . CONCLUSION The effort of returning disability pensioners to work by a brief vocational-oriented intervention may be of clinical relevance . The effect needs to be explored further in larger sample s of disability pensioners OBJECTIVE To explore baseline risk factors for productivity loss and work disability over 5 years in patients with early , active RA . PATIENTS AND METHODS In the FIN-RACo trial , 195 patients with recent onset RA were r and omised to receive either a combination of DMARDs with prednisolone or a single DMARD for 2 years . At baseline , 162 patients were working or available for work . After 5 years ' follow up , data on sick leave and retirement were obtained from social insurance registers or case records . The cumulative duration of sick leaves and RA related disability pensions was counted for each patient . To analyse predictors of productivity loss , the patients were divided into four groups according to duration of work disability per patient year . RESULTS Patient 's and physician 's global assessment of RA severity > or = 50 and HAQ score > or = 1.0 were risk factors for extension of productivity loss ( OR ( 95 % ( CI ) 1.77 ( 1.00 to 3.16 ) , 1.85 ( 1.03 to 3.32 ) , and 1.78 ( 1.01 to 3.14 ) , respectively ) . Additional risk factors were low education level ( 2.40 ( 1.18 to 4.88 ) ) and older age ( 1.03 ( 1.00 to 1.06 ) ) ; combination treatment was a protective factor ( 0.59 ( 0.35 to 0.99 ) ) . CONCLUSION At baseline , the risk of future productivity loss is best predicted by education level , age , global assessment s of RA severity , and HAQ score
The majority of the studies reported a high burden of work-related outcomes among inflammatory bowel disease patients regardless of the methodology used .
Inflammatory bowel disease patients experience a high burden in work-related outcomes .
BACKGROUND & AIMS Inflammatory bowel disease has considerable effects on work-related outcomes and leads to high societal costs due to sick leave and disability pension .
The aims of this study were to systematic ally review evidence on work-related outcomes that are relevant to productivity losses and to evaluate whether medical or surgical interventions have a positive impact on patients ' work ability .