Abstract
BackgroundIndependent medical evaluations are used to evaluate degree and reason for work disability, uncertainty around the functional status, and/or the employee’s rehabilitation potential in several jurisdictions, but not in Norway. The main aim of this trial was to test the return to work effect of independent medical evaluation (IME) (summoning and consultation) compared to treatment as usual (TAU) in Norway, for workers who have been on continuous sick leave for 6 months.MethodsThis was a pragmatic randomised controlled trial including all employees aged 18–65 years, sick-listed by their general practitioner and on full or partial sick leave for the past 26 weeks in Hordaland County, Norway in 2015/16. Trial candidates were drawn from a central register at the Norwegian Labour and Welfare Administration at 22 weeks of sick leave. Pregnant women, individuals with cancer or dementia diagnoses, those with secret address, employed by NAV or sick listed by the specialist health services were excluded. Separate regression analyses were conducted to investigate the “intention-to-treat” and “treatment on the treated” effects, using the ordinary least squares and instrumental variable methods, respectively.ResultsAfter exemption based on predefined exclusion criteria, 5888 individuals were randomised to either IME (n = 2616) or TAU (n = 2599). The final intervention group constitutes 1698 individuals, of which 937 attended the IME consultation. No baseline differences were found between the IME and TAU group regarding gender, age, and previous sick leave. Individuals attending the IME were older than those who cancelled the appointment ((47/45), p = 0.006) and those who did not show up without cancelling ((47/42), p < 0.001). Mainly the IME physician agreed with the regular GP upon level of sick leave. In cases with different assessments, the difference tended to be towards a lower sick leave level. There were no intention to treat or treatment on the treated effect on days of sick leave after randomisation during follow up.ConclusionsOverall, the analyses showed no effect of IME on changes in sick leave for sick listed employees. This result was consistent for those who were offered an IME consultation (intention to treat) and those who undertook an IME consultation (treatment on the treated).Trial registrationClinicalTirals.gov trial number NCT02524392 first registration 14.08.2015.
Highlights
Independent medical evaluations (IME) are common in several jurisdictions and used to evaluate degree and reason for work disability, uncertainty around the functional status and/or the employee’s rehabilitation potential [1]
Overall, the analyses showed no effect of independent medical evaluation (IME) on changes in sick leave for sick listed employees
Participants This was a pragmatic randomised controlled trial (RCT) conducted in close collaboration with NAV. It included all employees aged 18–65 years, sick-listed in 2015/16 with an International Classification of Primary Care 2nd edition (ICPC-2) diagnosis, living in Hordaland County in Norway, and whose sickness absence spell had lasted for 26 weeks
Summary
Independent medical evaluations (IME) are common in several jurisdictions and used to evaluate degree and reason for work disability, uncertainty around the functional status and/or the employee’s rehabilitation potential [1]. The general practice scheme in Norway entitles all citizens to have a regular general practitioner (GP) and most GPs are self-employed on a contract with the local authorities They issue and manage 80% of all sickness certificates [4] and are a key stakeholder in sickness absence and return to work (RTW) followup. The employer and employee have the main responsibility of effecting adjustments, follow-up actions and workrelated activity within the first 8 weeks In this phase and extending up to 26 weeks of sickness absence the workplace, health and insurance stakeholders does not have a formalized dialogue before NAV summon a mandatory dialogue meeting at 26 weeks. The main aim of this trial was to test the return to work effect of independent medical evaluation (IME) (summoning and consultation) compared to treatment as usual (TAU) in Norway, for workers who have been on continuous sick leave for 6 months
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