Workplace interventions did not improve health, but reduced sickness absence among workers with musculoskeletal disorders

Abstract

Objective of the review: To evaluate the effectiveness of workplace intervention compared with usual care or clinical interventions on work-related outcomes and health outcomes.Search strategy: Search in electronic databases until November 2007 (CENTRAL, MEDLINE, EMBASE, PsycINFO, Cochrane Occupational Health Field Trials Register), hand search of reference lists and contacts with experts in the field.Selection criteria: Types of studies: Randomised controlled trials (RCT). Participants: Working age adults (18–65 years) on sick leave (full- or part-time). Types of interventions: Workplace intervention focussing on changes in the workplace or equipment, work design and organisation, working conditions or work environment, and occupationalmanagement with active stakeholder involvement by the worker and the employer. Only interventions with the main goal of returning to work, which were linked closely to the workplace and where the workplace intervention was a structural part of the intervention, were included. Primary outcomes: Sickness absence was measured continuously, which also allowed results on the outcome return to work (RTW). Secondary outcomes: Pain, symptoms, quality of life, functional status and costs of work disability.Methods of the review: Two authors independently selected and extracted data, and assessed risk of bias.Meta-analysis was used where possible. GRADE levels of evidence were performed to assess study design, limitations of the study, consistency of results, directness, precision and publication bias.Main findings: A total of 1350 references were found. Of these, six RCTs (749 workers) were included; three on low back pain, one on upper extremity, one on musculoskeletal and one on adjustment disorders. Five studies were rated as having low risk of bias for the sickness absence outcome. Change in the workplace and equipment was used in all six studies, changes to work design and organisation in five, and case management with the worker and employer in four studies. Changes to working conditions and work environment were used less often. The meta-analysis measured time until first RTW from five of the studies containing workers with both musculoskeletal disorders and mental problems. Workplace intervention was significantly more effective than usual care (hazards ratio: 1.55; 95% confidence interval (CI): 1.20–2.01). Three studies reported the cumulative duration of sicknessabsence, and the meta-analysis revealed a significant advantage of the workplace intervention compared with usual care, with a mean difference of 39.06 days (95% CI: )61.86 to )16.26). For the three studies on low back pain, the pooling did not reveal a significant difference in pain between workplace interventions and usual care (mean difference: )0.19; 95% CI: )0.41 to 0.03).Authors’ conclusion: The GRADE analysis revealed that there was a moderate quality evidence to support the use of workplace intervention to reduce sickness absence among workers with musculoskeletal disorders comparedwith usual care.