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Meta-Analysis
. 2017 Mar 30;3(3):CD011618.
doi: 10.1002/14651858.CD011618.pub2.

Return-to-work coordination programmes for improving return to work in workers on sick leave

Nicole Vogel  1   2 , Stefan Schandelmaier  3   4 , Thomas Zumbrunn  5 , Shanil Ebrahim  6 , Wout El de Boer  1 , Jason W Busse  7 , Regina Kunz  1
Affiliations
Meta-Analysis

Return-to-work coordination programmes for improving return to work in workers on sick leave

Nicole Vogel et al. Cochrane Database Syst Rev. .

Abstract

Background: To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people's return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncertain. We conducted a systematic review to determine the long-term effectiveness of return-to-work coordination programmes compared to usual practice in workers at risk for long-term disability.

Objectives: To assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11), MEDLINE, Embase, CINAHL and PsycINFO up to 1 November 2016.

Selection criteria: We included randomised controlled trials (RCTs) that enrolled workers absent from work for at least four weeks and randomly assigned them to return-to-work coordination programmes or usual practice.

Data collection and analysis: Two review authors independently screened titles, abstracts and full-text articles for study eligibility; extracted data; and assessed risk of bias from eligible trials. We contacted authors for additional data where required. We conducted random-effects meta-analyses and used the GRADE approach to rate the quality of the evidence.

Main results: We identified 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.We found no benefits for return-to-work coordination programmes on return-to-work outcomes.For short-term follow-up of six months, we found no effect on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) -16.18 work days per year, 95% CI -32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95% CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95% CI 0.63 to 1.19, very low-quality evidence).For long-term follow-up of 12 months, we found no effect on time to return to work (HR 1.25, 95% CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD -14.84 work days per year, 95% CI -38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95% CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95% CI 0.97 to 1.09, moderate-quality evidence).For very long-term follow-up of longer than 12 months, we found no effect on time to return to work (HR 0.93, 95% CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95% CI -15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95% CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95% CI 0.88 to 1.02, low-quality evidence).We found only small benefits for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID).

Authors' conclusions: Offering return-to-work coordination programmes for workers on sick leave for at least four weeks results in no benefits when compared to usual practice. We found no significant differences for the outcomes time to return to work, cumulative sickness absence, the proportion of participants at work at end of the follow-up or the proportion of participants who had ever returned to work at short-term, long-term or very long-term follow-up. For patient-reported outcomes, we found only marginal effects below the MID. The quality of the evidence ranged from very low to moderate across all outcomes.

PubMed Disclaimer

Conflict of interest statement

Regina Kunz: EbIM, Evidence‐based 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 without restrictions on how the donations are used.

Nicole Vogel: None known.

Stefan Schandelmaier: None known.

Thomas Zumbrunn: employer received payment for the statistical analyses he conducted for the publication on which this review is based.

Shanil Ebrahim: None known.

Wout de Boer: None known.

Jason Busse: acts as a consultant to Prisma Health Canada, a private incorporated company funded by employers and insurers that consults on and manages long‐term disability claims.

Figures

1
1
PRISMA Study flow diagram
2
2
Risk of bias graph: review author's judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: time to return to work. RTWCP = return‐to‐work coordination programmes
5
5
Forest plot of comparison: cumulative sickness absence in work days. RTWCP = return‐to‐work coordination programmes
6
6
Forest plot of comparison: proportion at work at end of the follow‐up. RTWCP = return‐to‐work coordination programmes
7
7
Forest plot of comparison: proportion who had ever returned to work. RTWCP = return‐to‐work coordination programmes
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD011618

References

References to studies included in this review

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Kittel 2008 {published data only}
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Rebergen 2009a {published data only}
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Ross 2006 {published data only}
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Shu‐Kei 2007 {published data only}
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Sjöström 2012 {published data only}
    1. Sjöström R, Asplund R, Alricsson M. Back to work: evaluation of a multidisciplinary rehabilitation program with emphasis on mental symptoms; A two‐year follow up. Journal of multidisciplinary healthcare 2012;5:145‐51. [DOI: 10.2147/JMDH.S32372] - DOI - PMC - PubMed
Skouen 2002 {published data only}
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Skouen 2006 {published data only}
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Stapelfeldt 2015 {published data only}
    1. Stapelfeldt CM, Labriola M2 Jensen AB, Andersen NT, Momsen AM, Nielsen CV. Municipal return to work management in cancer survivors undergoing cancer treatment: a protocol on a controlled intervention study. BMC Public Health 2015;15:720. [DOI: 10.1186/s12889-015-2062-1] - DOI - PMC - PubMed
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    1. Steenstra IA, Anema JR, Bongers PM, de‐Vet HC, van MW. Cost effectiveness of a multi‐stage return to work program for workers on sick leave due to low back pain, design of a population based controlled trial [ISRCTN60233560]. BMC Musculoskeletal Disorders 2003;4:26. - PMC - PubMed
Steenstra 2006 {published data only}
    1. Steenstra IA, Anema JR, van‐Tulder MW, Bongers PM, de‐Vet HC, van MW. Economic evaluation of a multi‐stage return to work program for workers on sick‐leave due to low back pain. Journal of Occupational Rehabilitation 2006;16(4):557‐78. - PubMed
Steenstra 2007 {published data only}
    1. Steenstra IA, Anema JR, Bongers PM, Vet‐de HC, Knol DL, Loisel P, et al. Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine 2007;32(3):299‐300. - PubMed
Steenstra 2009 {published data only}
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Streibelt 2008 {published data only}
    1. Streibelt M, Blume C, Thren K, Müller FW. Economic evaluation of medically occupationally orientated rehabilitation in patients with musculoskeletal disorders‐‐a cost‐benefit analysis from the perspective of the German statutory pension insurance scheme [Ökonomische Evaluation einer medizinisch‐beruflich orientierten Maßnahme bei Patienten mit muskuloskeletalen Erkrankungen ‐ Eine Kosten‐Nutzen‐Analyse aus Rentenversicherungsperspektive]. Die Rehabilitation 2008;47(3):150‐7. - PubMed
Streibelt 2014 {published data only}
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Sundberg 2009 {published data only}
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Svendsen 2014 {published data only}
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Tamminga 2016 {published data only}
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Thunnissen 2008 {published data only}
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Van Beurden 2012 {published data only}
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Van der Klink 2003 {published data only}
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Van Oostrom 2008 {published data only}
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Van Oostrom 2010 {published data only}
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Varekamp 2011 {published data only}
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Vermeulen 2010 {published data only}
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Vermeulen 2011 {published data only}
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Vlasveld 2013 {published data only}
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References to studies awaiting assessment

Norén 2015 {published data only}
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