Effectiveness of Interventions on Work Outcomes After Road Traffic Crash-Related Musculoskeletal Injuries: A Systematic Review and Meta-analysis

Abstract

Background: Musculoskeletal injuries are common after road traffic crash (RTC) and can lead to poor work-related outcomes. This review evaluated the impact of interventions on work-related (e.g. sick leave), health, and functional outcomes in individuals with a RTC-related musculoskeletal injury, and explored what factors were associated with work-related outcomes.

Methods: Searches of seven databases were conducted up until 9/03/2023. Eligible interventions included adults with RTC-related musculoskeletal injuries, a comparison group, and a work-related outcome, and were in English. Meta-analyses were conducted using RevMan and meta-regressions in Stata.

Results: Studies (n = 27) were predominantly conducted in countries with third-party liability schemes (n = 26), by physiotherapists (n = 17), and in participants with whiplash injuries (94%). Pooled effects in favour of the intervention group were seen overall (SMD = - 0.14, 95% CI: - 0.29, 0.00), for time to return to work (- 17.84 days, 95% CI: - 24.94, - 10.74), likelihood of returning to full duties vs. partial duties (RR = 1.17, 95% CI: 1.01, 1.36), decreased pain intensity (- 6.17 units, 95% CI: - 11.96, - 0.39, 100-point scale), and neck disability (- 1.77 units, 95% CI: - 3.24, - 0.30, 50-point scale).

Discussion: Interventions after RTC can reduce time to return to work and increase the likelihood of returning to normal duties, but the results for these outcomes were based on a small number of studies with low-quality evidence. Further research is needed to evaluate a broader range of interventions, musculoskeletal injury types, and to include better quality work-related outcomes.

Keywords: Interventions; Musculoskeletal injury; Occupational outcomes; Return to work; Road traffic crash; Whiplash.

Fig. 1

Study flow chart

Fig. 2

Forest plots for the meta-analyses: days to return to work (2A), percentage of participants who returned to work or were employed at follow-up (2B), days of sick leave (2C), percentage of participants with sick leave (2D), percentage of participants returning to full or normal duties out of those who had returned to work (2E), and standardised effects for return to work and sick leave outcomes (2F)

Fig. 2

Forest plots for the meta-analyses: days to return to work (2A), percentage of participants who returned to work or were employed at follow-up (2B), days of sick leave (2C), percentage of participants with sick leave (2D), percentage of participants returning to full or normal duties out of those who had returned to work (2E), and standardised effects for return to work and sick leave outcomes (2F)