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Meta-Analysis
. 2012;7(11):e49760.
doi: 10.1371/journal.pone.0049760. Epub 2012 Nov 19.

Return to work coordination programmes for work disability: a meta-analysis of randomised controlled trials

Stefan Schandelmaier  1 , Shanil Ebrahim, Susan C A Burkhardt, Wout E L de Boer, Thomas Zumbrunn, Gordon H Guyatt, Jason W Busse, Regina Kunz
Affiliations
Meta-Analysis

Return to work coordination programmes for work disability: a meta-analysis of randomised controlled trials

Stefan Schandelmaier et al. PLoS One. 2012.

Abstract

Background: The dramatic rise in chronically ill patients on permanent disability benefits threatens the sustainability of social security in high-income countries. Social insurance organizations have started to invest in promising, but costly return to work (RTW) coordination programmes. The benefit, however, remains uncertain. We conducted a systematic review to determine the long-term effectiveness of RTW coordination compared to usual practice in patients at risk for long-term disability.

Methods and findings: Eligible trials enrolled employees on work absence for at least 4 weeks and randomly assigned them to RTW coordination or to usual practice. We searched 5 databases (to April 2, 2012). Two investigators performed standardised eligibility assessment, study appraisal and data extraction independently and in duplicate. The GRADE framework guided our assessment of confidence in the meta-analytic estimates. We identified 9 trials from 7 countries, 8 focusing on musculoskeletal, and 1 on mental complaints. Most trials followed participants for 12 months or less. No trial assessed permanent disability. Moderate quality evidence suggests a benefit of RTW coordination on proportion at work at end of follow-up (risk ratio = 1.08, 95% CI = 1.03 to 1.13; absolute effect = 5 in 100 additional individuals returning to work, 95% CI = 2 to 8), overall function (mean difference [MD] on a 0 to 100 scale = 5.2, 95% CI = 2.4 to 8.0; minimal important difference [MID] = 10), physical function (MD = 5.3, 95% CI = 1.4 to 9.1; MID = 8.4), mental function (MD = 3.1, 95% CI = 0.7 to 5.6; MID = 7.3) and pain (MD = 6.1, 95% CI = 3.1 to 9.2; MID = 10).

Conclusions: Moderate quality evidence suggests that RTW coordination results in small relative, but likely important absolute benefits in the likelihood of disabled or sick-listed patients returning to work, and associated small improvements in function and pain. Future research should explore whether the limited effects persist, and whether the programmes are cost effective in the long term.

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Conflict of interest statement

Competing Interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; asim, the Department of Insurance Medicine at the University Hospital in Basel, is funded in part by donations from public insurance companies and a consortium of private insurance companies (affiliated Authors: SS, SB, WdB, RK); JWB acts as a consultant to Prisma Health Canada, which is a private incorporated company funded by employers and insurers that consults on and manages long-term disability claims; no other relationships or activities that could appear to have influenced the submitted work. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Study selection.
Last update of electronic search to April 2, 2012.
Figure 2
Figure 2. RTW-outcomes.
RTW coord. = return to work coordination.
Figure 3
Figure 3. Patient reported outcomes.
Individual trials’ outcomes expressed on a 0 to 100 scale. RTW coord. = return to work coordination. MID = minimal important difference.
See this image and copyright information in PMC

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