Return to Work Coordination Programmes for Work Disability: A Meta-Analysis of Randomised Controlled Trials
Open Access
- 19 November 2012
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 7 (11), e49760
- https://doi.org/10.1371/journal.pone.0049760
Abstract
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. 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). 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.This publication has 50 references indexed in Scilit:
- Assembling the evidence jigsaw: insights from a systematic review of UK studies of individual-focused return to work initiatives for disabled and long-term ill peopleBMC Public Health, 2011
- Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss: a systematic reviewRheumatology, 2011
- An integrated care program to prevent work disability due to chronic low back pain: a process evaluation within a randomized controlled trialBMC Musculoskeletal Disorders, 2009
- Psychological Intervention for Premenstrual Syndrome: A Meta-Analysis of Randomized Controlled TrialsPsychotherapy and Psychosomatics, 2009
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendationsBMJ, 2008
- Using administrative sickness absence data as a marker of future disability pension: the prospective DREAM study of Danish private sector employeesOccupational and Environmental Medicine, 2008
- Interpreting Change Scores for Pain and Functional Status in Low Back PainSpine, 2008
- Assessing clinically meaningful change following a programme for managing chronic painClinical Rehabilitation, 2007
- Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651]BMC Public Health, 2007
- Clinically important outcomes in low back painBest Practice & Research Clinical Rheumatology, 2005