Return-to-work Interventions Research Articles

Subgroups of Long-Term Sick-Listed Based on Prognostic Return to Work Factors Across Diagnoses: A Cross-Sectional Latent Class Analysis

Comorbidity is common among long-term sick-listed and many prognostic factors for return to work (RTW) are shared across diagnoses. RTW interventions have small effects, possibly due to being averaged across heterogeneous samples. Identifying subgroups based on prognostic RTW factors independent of diagnoses might help stratify interventions. The aim of this study was to identify and describe subgroups of long-term sick-listed workers, independent of diagnoses, based on prognostic factors for RTW. Latent class analysis of 532 workers sick-listed for eight weeks was used to identify subgroups based on seven prognostic RTW factors (self-reported health, anxiety and depressive symptoms, pain, self-efficacy, work ability, RTW expectations) and four covariates (age, gender, education, physical work). Four classes were identified: Class 1 (45% of participants) was characterized by favorable scores on the prognostic factors; Class 2 (22%) by high anxiety and depressive symptoms, younger age and higher education; Class 3 (16%) by overall poor scores including high pain levels; Class 4 (17%) by physical work and lack of workplace adjustments. Class 2 included more individuals with a psychological diagnosis, while diagnoses were distributed more proportionate to the sample in the other classes. The identified classes illustrate common subgroups of RTW prognosis among long-term sick-listed individuals largely independent of diagnosis. These classes could in the future assist RTW services to provide appropriate type and extent of follow-up, however more research is needed to validate the class structure and examine how these classes predict outcomes and respond to interventions.

Role of a Digital Return-To-Work Solution for Individuals With Common Mental Disorders: Qualitative Study of the Perspectives of Three Stakeholder Groups.

BackgroundAlthough effective return-to-work (RTW) interventions are not widely available for individuals with common mental disorders on sick leave, there is potential for transforming such interventions into a digital solution in an effort to make them more widely available. However, little is currently known about the viewpoints of different stakeholder groups, which are critical for successful development and implementation of a digital RTW intervention in health care services.ObjectiveThe aim of this study was to examine stakeholder groups’ perspectives on the role and legitimacy of a digital RTW solution called mWorks for individuals with common mental disorders who are on sick leave.MethodsA purposeful snowball sampling method was utilized to recruit respondents. Semistructured individual and focus group interviews were conducted for stakeholder groups of service users, RTW professionals, and influential managers regarding their experiences, needs, and preferences for mWorks. Content analysis generated themes and categories that constituted the main findings.ResultsThe legitimacy of a digital RTW solution was high among all stakeholder groups since such a tool was perceived to enable service users to take control over their RTW process. This was mainly a product of accessible support and promotion of service user decision making, which had the potential to empower service users. All respondents stressed the importance of fostering a positive user experience with usability and emphasis on service user resources and strengths, as opposed to various limitations and shortcomings. Stakeholder groups highlighted critical content to facilitate RTW, such as the need to clarify a back-to-work plan, accompanied by an accessible RTW network and strategies for handling mental health problems. Implementation challenges primarily involved influential managers’ concern of legislation incompatibility with innovative technology, and RTW professionals’ concern of the possibility that digital solutions may replace them to a certain extent.ConclusionsThis formative research emphasizes the importance of shifting power from RTW professionals to service users. mWorks can play a role in mediating service user control over the RTW process, and thereby increase their empowerment. A digital RTW solution may facilitate the circumvention of implementation barriers associated with introducing evidence-based RTW interventions in a traditional RTW context.

Return to Work Pathways Following Injury in Road Traffic Crashes: A Retrospective Cohort Study.

To determine: 1) different return to work (RTW) pathways among road traffic crash (RTC) survivors; 2) RTW differences between RTC and workers' compensation schemes, and; 3) factors associated with relapse and attempting graduated RTW. Administrative income support data from RTC survivors with compensated work absence in Victoria, Australia were arranged as daily income payments, pattern recognition determined RTW pathways. Multivariable logistic regression showed odds of relapse or attempting graduated RTW by covariate. Most had successful RTWs without relapse (66.7% full, 7.2% graduated), 22% relapsed at least once, and 17% attempted gradual RTW. Sex, injury type, length of hospital stay, road user group, and compensation scheme were associated with relapse and graduated RTW attempt likelihood. Results help identify people likely to benefit from RTW interventions, such as programs that incentivise graduated RTW.

Economic evaluations of mental health interventions: A systematic review of interventions with work-focused components

Mental health disorders represent a major and increasing public health issue and economic burden to employers, workers and health insurance systems.The aim of this systematic review was to analyze the cost-benefit, cost-effectiveness and cost-utility results of interventions intended to improve employees' mental health, prevent common mental disorders (CMD) or promote return-to-work (RTW) after an absence due to CMD, thus encompassing primary, secondary and tertiary prevention. Given the interactions between work and mental health, we restricted our selection to interventions with work-focused components: the interventions had to address employees’ specific working situations and actions had to be tailored to take account of the specific difficulties or challenges encountered by them.Studies were searched for in eight electronic databases and through backward citation tracking (2007–2019). Two researchers independently performed screening, data extraction and scientific quality assessment.Our systematic review included 11 economic evaluation studies. We found strong evidence of positive economic results for RTW interventions from the employer’s and societal perspectives. These interventions could take different forms: structured guidance with individualized support in order to implement problem-solving treatment and elaborate an action plan, which could be accompanied by cognitive-behavioural therapy; training for managers to enhance their skills in RTW communication with employees; and an internet-based module with occupational physicians guidance. There were not enough studies in the other categories combining the type of prevention (primary, secondary or tertiary) with the economic perspective (employers’, societal, employees’, healthcare system’s) to produce evidence concerning the economic balance of interventions.Our results have important practical implications for the orientation of investments in prevention for employers as well as for society.

Evidence for the Cost-Effectiveness of Return-to-Work Interventions for Mental Illness Related Sickness Absences: A Systematic Literature Review.

Purpose The purpose of this systematic literature review (SLR) is to examine the state of knowledge about the cost-effectiveness of return-to-work (RTW) interventions targeted at workers with medically certified sickness absences related to mental disorders. Our SLR addresses the question, "What is the evidence for the cost-effectiveness of RTW interventions for mental illness related sickness absences?" Methods This SLR used a reviewer pair multi-phase screening of publically available peer-reviewed studies published between 2002 and 2019. Five electronic databases were searched: (1)MEDLINE 1946-Present, (2) MEDLINE: Epub-Ahead of Print and In-Process, (3)PsycINFO, (4)Econlit, and (5) Web of Science. Results 6138 unique citations were identified. Ten articles were included in the review. Eight of the ten studies were conducted in the Netherlands, one in Sweden, and one in Canada. Results of this SLR suggest there is evidence that RTW interventions for workers with medically certified sickness absences can be cost-effective. Conclusions Although this SLR's results suggest that economic evaluations of RTW interventions can be cost-effective, the use of economic evaluations for studies of these program types is in its infancy. Some jurisdictions (e.g., the Netherlands) seem to have recognized the need for economic evaluations. However, more research is needed in different disability system contexts. Furthermore, use of the standard economic evaluation approaches for healthcare interventions may limit the usefulness of results if the end-user is an employer or non-health organization. This may present the opportunity to introduce newer approaches that include work-related measures of effectiveness and analytical approaches.

Return to work interventions for chronic pain: a systematic review.

Chronic pain (CP) remains the second commonest reason for being off work. Tertiary return to work (RTW) interventions aim to improve psychological and physical capacity amongst workers already off sick. Their effectiveness for workers with CP is unclear. To explore which tertiary interventions effectively promote RTW for CP sufferers. We searched eight databases for randomized controlled trials evaluating the effectiveness of tertiary RTW interventions for CP sufferers. We employed the Cochrane Risk of Bias (ROB) and methodological quality assessment tools for all included papers. We synthesized findings narratively. Meta-analysis was not possible due to heterogeneity of study characteristics. We included 16 papers pertaining to 13 trials. The types, delivery format and follow-up schedules of RTW interventions varied greatly. Most treatments were multidisciplinary, comprising psychological, physical and workplace elements. Five trials reported that tertiary interventions with multidisciplinary elements promoted RTW for workers with CP compared to controls. We gave a high ROB rating for one or more assessment criteria to three out of the five successful intervention trials. Two had medium- and low-risk elements across all categories. One compared different intensity multidisciplinary treatment and one comprised work-hardening with a job coach. Seven trials found treatment effects for secondary outcomes but no RTW improvement. There is no conclusive evidence to support any specific tertiary RTW intervention for workers with CP, but multidisciplinary efforts should be considered. Workers' compensation is an important area for RTW policymakers to consider.

Smart Work Injury Management (SWIM) System: Artificial Intelligence in Work Disability Management.

This paper aims to illustrate an example of how to set up a work injury database: the Smart Work Injury Management (SWIM) system. It is a secure and centralized cloud platform containing a set of management tools for data storage, data analytics, and machine learning. It employs artificial intelligence to perform in-depth analysis via text-mining techniques in order to extract both dynamic and static data from work injury case files. When it is fully developed, this system can provide a more accurate prediction model for cost of work injuries. It can also predict return-to-work (RTW) trajectory and provide advice on medical care and RTW interventions to all RTW stakeholders. The project will comprise three stages. Stage one: to identify human factors in terms of both facilitators and barriers RTW through face-to-face interviews and focus group discussions with different RTW stakeholders in order to collect opinions related to facilitators, barriers, and essential interventions for RTW of injured workers; Stage two: to develop a machine learning model which employs artificial intelligence to perform in-depth analysis. The technologies used will include: 1. Text-mining techniques including English and Chinese work segmentation as well as N-Gram to extract both dynamic and static data from free-style text as well as sociodemographic information from work injury case files; 2. Principle component/independent component analysis to identify features of significant relationships with RTW outcomes or combine raw features into new features; 3. A machine learning model that combines Variational Autoencoder, Long and Short Term Memory, and Neural Turning Machines. Stage two will also include the development of an interactive dashboard and website to query the trained machine learning model. Stage three: to field test the SWIM system. SWIM ia secure and centralized cloud platform containing a set of management tools for data storage, data analytics, and machine learning. When it is fully developed, SWIM can provide a more accurate prediction model for the cost of work injuries and advice on medical care and RTW interventions to all RTW stakeholders. The project has been approved by the Ethics Committee for Human Subjects at the Hong Kong Polytechnic University and is funded by the Innovation and Technology Commission (Grant # ITS/249/18FX).

Effects of cognitive behavioural therapy and return-to-work intervention for patients on sick leave due to stress-related disorders: Results from a randomized trial.

The aim of this study was to evaluate specific effects for patients with adjustment or exhaustion disorder, the Stress subgroup (n=152), regarding symptom severity and sick leave after CBT, a return-to-work intervention (RTW-I), and a combination of them (COMBO), using data from a randomized trial. In the original study, primary care patients on sick leave (N=211) were randomized to CBT (n=64), RTW-I (n=67), or COMBO (n=80). Blinded Clinician Severity Rating (CSR) of symptoms and sick leave registry data were primary outcomes. Subgroup analyses showed that for the Stress subgroup, CBT led to greater reduction of symptoms than RTW-I posttreatment, but COMBO did not differ from CBT or RTW-I. Regarding sick leave, there was no difference between treatments in the Stress subgroup. An exploratory analysis of the treatment effects in a subgroup of patients with depression, anxiety or insomnia indicates that RTW-I reduced sick leave faster than CBT. We conclude that CBT may be promising as an effective treatment of stress and exhaustion disorder.

Obstacles to returning to work with chronic pain: in-depth interviews with people who are off work due to chronic pain and employers

BackgroundThe global burden of chronic pain is growing with implications for both an ageing workforce and employers. Many obstacles are faced by people with chronic pain in finding employment and returning to work after a period of absence. Few studies have explored obstacles to return-to-work (RTW) from workers’ and employers’ perspectives. Here we explore views of both people in pain and employers about challenges to returning to work of people who are off work with chronic pain.MethodsWe did individual semi-structured interviews with people who were off work (unemployed or off sick) with chronic pain recruited from National Health Service (NHS) pain services and employment services, and employers from small, medium, and large public or private sector organisations. We analysed data using the Framework method.ResultsWe interviewed 15 people off work with chronic pain and 10 employers. Obstacles to RTW for people with chronic pain spanned psychological, pain related, financial and economic, educational, and work-related domains. Employers were concerned about potential attitudinal obstacles, absence, ability of people with chronic pain to fulfil the job requirements, and the implications for workplace relationships. Views on disclosure of the pain condition were conflicting with more than half employers wanting early full disclosure and two-thirds of people with chronic pain declaring they would not disclose for fear of not getting a job or losing a job. Both employers and people with chronic pain thought that lack of confidence was an important obstacle. Changes to the job or work conditions (e.g. making reasonable adjustments, phased return, working from home or redeployment) were seen by both groups as facilitators. People with chronic pain wanted help in preparing to RTW, education for managers about pain and supportive working relationships.ConclusionsPeople with chronic pain and employers may think differently in terms of perceptions of obstacles to RTW. Views appeared disparate in relation to disclosure of pain and when this needs to occur. They appeared to have more in common regarding opinions about how to facilitate successful RTW. Increased understanding of both perspectives may be used to inform the development of improved RTW interventions.

Reintegrating Employees Undergoing Cancer Treatment into the Workplace: A Qualitative Study of Employer and Co-worker Perspectives.

Purpose The purpose of this study was to explore how employers and co-workers experience the return to work (RTW) process of employees undergoing cancer treatment. Methods Sixteen semi-structured individual interviews and participant observations at seven workplaces took place, involving seven employers and nine co-workers with different professions. A phenomenological-hermeneutic analytic approach was applied involving coding, identification of themes, and interpretation. Results We identified three employer themes: call for knowledge, Making decisions, and Feeling helpless. Also, three co-worker themes were identified: understanding and sympathy, extra work and burden, and Insecurity about future work tasks. Early initiated RTW, e.g. less work hours and work accommodations, did neither constitute challenges for employers nor co-workers in the beginning of the RTW process. However, when the RTW process was prolonged employers encountered difficulties in finding suitable work tasks, whereas co-workers were burdened by extra work. Conclusions Overall, cancer survivors' RTW process was welcomed and encouraged at the workplace level. However, employer and co-worker experiences suggested that RTW initiation parallel with cancer treatment raised challenges at the workplace level, when the RTW process was extended beyond the initial RTW plan; increased workload and difficulties in balancing the needs of the cancer survivor and co-workers. Mechanisms that support cancer survivors' RTW without introducing strain on co-workers should be investigated in future research. Furthermore, support for employers in their RTW management responsibilities needs to be addressed in general and in particular in future RTW interventions.

Return to Work Interventions for Cancer Survivors: A Systematic Review and a Methodological Critique

Cancer patients are more at risk of being unemployed or having difficulties to return to work (RTW) compared to individuals without health concerns, and is thus a major public health issue. The aim of this systematic review is to identify and describe the interventions developed specifically to help cancer patients to RTW after treatment. Two researchers independently screened the articles for inclusion and Critical Appraisal Skills Program (CASP) checklists were used to assess the methodology of the included studies. Ten manuscripts met the inclusion criteria. The type of studies were three quasi-experimental studies, three longitudinal studies, three randomized controlled trials (RCTs) and a qualitative study. RTW interventions were conducted in or outside the hospital (n = 6 and 3 respectively), or both (n = 1). Improvements in RTW were only observed in quasi-experimental studies. No improvement in RTW was noted in RCTs, nor in other measures (e.g., quality of life, fatigue). Lack of statistically significant improvement does not necessarily reflect reality, but may be attributed to non-adapted research methods. This systematic review underscores the need for researches in the RTW field to reach a consensus on RTW criteria and their assessment. Recommendations to this effect are suggested.

Health-care providers' perspectives on factors influencing return-to-work after surgery for nontraumatic conditions of the upper extremity

Study DesignThis study is a descriptive survey. IntroductionHealth care providers (HCPs) are key stakeholders who facilitate workers’ return to work (RTW) following upper extremity surgery. Hand therapists play a major role in this process, yet we do not know if and/or how their perspectives differ from other HCPs. Purpose of the StudyThis study examined HCPs’ opinion on factors that influence RTW after surgery for nontraumatic upper extremity conditions and whether HCPs from different disciplines differed in their opinion. MethodsHCPs (occupational therapists, physiotherapists, hand therapists, exercise physiologists, psychologists, surgeons, and general practitioners) completed a survey rating 50 factors on a worker’s ability to RTW. Each factor was scored using a 5-point Likert scale from “not” to “extremely” influential, which was later dichotomised. Agreement was indicated at 75%. The level of disagreement between disciplines was examined. ResultsRespondents (n = 787) identified 20 factors being influential on RTW. They are (in order from highest to lowest) poor pain coping (the highest, >85% of respondents), postoperative psychological state, RTW self-efficacy, employer/supervisor’s support, employer’s unwillingness for job modification, recovery expectations, job satisfaction, suitable duties availability, whether the job can be modified, and mood disorder diagnosis. There was agreement that two factors do not influence RTW, gender, and preemployment medical assessment. There was disagreement (P < .05) between HCP disciplines on six factors (obesity, comorbidities, doctors’ RTW recommendation, diagnosis, fitness, income). There were no consistent patterns with respect to which professions disagreed across all six factors. Hand therapists differed from the other disciplines for three of the factors including diagnosis, comorbidities, and doctor’s recommendation for RTW. DiscussionThe factors that stakeholders agreed as having the greatest influence were mainly related to the worker (pain and psychological factors) and the workplace and are amenable to RTW interventions. ConclusionInterventions facilitating RTW and future research should consider the factors identified by HCPs in this study.

Exploration of the contexts surrounding the implementation of an intervention supporting return-to-work after breast cancer in a primary care setting: starting point for an intervention development.

BackgroundMany recommendations have been made regarding survivorship care provided by teams of primary care professionals. However, the nature of that follow-up, including support for return-to-work (RTW) after cancer, remains largely undefined. As implementation problems are frequently context-related, a pilot study was conducted to describe the contexts, according to Grol and Wensing, in which a new intervention is to be implemented. This pilot study is the first of three steps in intervention development planning.MethodIn-depth semi-structured interviews (n=6) were carried out with stakeholders selected for their knowledgeable perspective of various settings, such as hospitals, primary care, employers, and community-based organizations. Interviews focused on participants’ perceptions of key contextual facilitators and barriers to consider for the deployment of an RTW intervention in a primary care setting. Data from interviews were transcribed and analyzed. A content analysis was performed based on an iterative process.ResultsAn intervention supporting the process of RTW in primary care makes sense for participants. Results suggest that important levers are present in organizational, professional, and social settings. However, many barriers, mainly related to organizational settings, have been identified, eg, distribution of tasks for survivor follow-up, continuity of information, and coordination of care between specialized oncology care and general primary care.ConclusionTo develop and deploy the intervention, recommendations that emerged from this pilot study for overcoming barriers were identified, eg, training (professionals, survivors, and employers), the use of communication tools, and adopting a practice guide for survivor care. The results were also helpful in focusing on the relevance of an intervention supporting the RTW process as a component of primary care for survivors.

Return-to-work intervention during cancer treatment - The providers' experiences.

To explore in-depth understanding of providers' experiences when involved in a return-to-work (RTW) intervention offered during cancer treatment. Semi-structured individual interviews and participant observations at a hospital department and two municipal job centers were carried out, including ten providers (physicians, nurses and social workers). A phenomenological-hermeneutic approach was applied, involving coding, identification of themes and interpretation of findings. Three major themes were identified: Treatment first, Work as an integrated component in cancer rehabilitation, and Challenges in bringing up work issues. Differences in providers' experiences of the RTW intervention offered to cancer patients were found: in the hospital setting RTW was a second priority, whereas in the municipality job centers it was an integrated component. Further studies are needed to investigate how and when occupational rehabilitation services can be implemented across sectors to support cancer patients' RTW. In the future, work issues ought to be systematically presented by providers across sectors as early as possible to support cancer patients' RTW. Cancer patients' individual needs and thoughts about RTW are to be identified by both health care providers during treatment and social workers at the municipality level and shared across sectors.

Rehabilitation coordination for Return to Work, as extended role for Health Professionals– Results from a Randomized Controlled Trial

Background: Long-term sick leave is rising at considerable speed in Sweden, and it is associated with reduced quality of life as well as high societal cost. Within longstanding pain and mental illness the overall direct cost is approximately 6000 EUR per patient and year in Stockholm County[1]. To improve return to work (RTW), new models with extended roles for health professionals are under development across Europe [2]. For instance, with RTW coordination Schandelmaier [3] found moderate quality evidence on RTW and Bewley [4] showed good effects in trials but when the intervention was widely adopted results dropped. In Sweden several ongoing initiatives uses a well-educated health professional to coordinate the process of rehabilitation and patient coaching, however little is known on the total effects on RTW, costs and QoL [5]. Objectives: The objective of the ongoing RCT is to develop an evidence-based model for RTW coordination and evaluate the effects for patients with high risk of long periods of sick leave within longstanding pain and mild/moderate mental illness. Method: Study design: Health professionals with specific competence as RTW coordinators were recruited and trained for the study. The extended role requiring indept knowledge and focus on work capability, supply of care and rehabilitation, counseling skills and sick-leave regulations and processes. Patients with high risk for long-term sick-leave are identified within primary care. Included patients are randomized to two groups; A) standard care B) standard care + RTW intervention. Intervention: RTW coordination (individually adapted patient coaching and coordination of rehabilitation activities, work place efforts and health care). Outcomes measured: RTW, cost of care and claims, QoL by SF36, interviews with patients, physicians and RTW coordinators Results: Sick-leave consumption: Average sick-claim rates are reduced and intervention patients return to work faster, corresponding to 29 fewer days on sick-leave compared to standard care. Health-care consumption non-effects on total healthcare consumption Patient reported quality of life and satisfaction: improved QoL (SF36), high patient satisfaction with intervention, coordination and coaching. Change in care delivery: physicians report increased adherence to treatment and reduced administrative work. Conclusion: RTW coordination is a promising new extended role. Results show faster RTW, improve QoL and reduced costs for sick-leave claims. More research is needed to evaluate long-term effects. To be effective the model needs to enable early identification of high-risk patients, thorough root-cause analysis, individual adjustments based on work capability, close cooperation with employer and primary care. The challenges for the RTW coordinators are mainly return to work focus, framework adherence, root-cause analysis and structured follow-ups of effects to make sure optimized total effects. At the conference, the new extended role will be discussed and results from 48 months of study with approximately 1100 patients will be presented.

Sequence analysis to assess labour market participation following vocational rehabilitation: an observational study among patients sick-listed with low back pain from a randomised clinical trial in Denmark

IntroductionThe return-to-work (RTW) process after long-term sickness absence is often complex and long and implies multiple shifts between different labour market states for the absentee. Standard methods for examining RTW...

Perspectives of unemployed workers with mental health problems: barriers to and solutions for return to work

Purpose: To evaluate the barriers to and solutions for return to work (RTW) from the perspective of unemployed workers who were sick-listed due to mental health problems.Methods: We conducted semi-structured interviews with 25 sick-listed unemployed workers with mental health problems. Qualitative data analysis was performed, using a process of identifying, coding, and categorising the patterns in data.Results: All workers experienced multiple problems in different domains of life related to their disease, personal circumstances (e.g., divorced, debts) and their environment (e.g., labour market problems, issues with the Social Security Agency). Workers differed in the way they perceived their RTW process and in the extent to which they were able to envision and implement the solutions for RTW, thus resulting in three types of workers’ attitudes towards their own RTW process: (1) “frozen”; (2) “insightful though passive”; and (3) “action mode”.Conclusions: We conclude that the sick-listed unemployed workers with mental health problems have to deal with multiple problems, of which medical problems are only a part. These workers need help aimed at their coping methods according to one of the three types of workers’ characteristics. Moreover, they need specific help organising and structuring their problems, getting their life back on track, and finding employment.Implications for RehabilitationUnemployed workers with mental health problems face considerable challenges which impede their return to work. Evaluating the workers’ attitude may provide useful information on their own return-to-work process.In many cases, workers indicate a need for coaching to help them with problem-solving, planning, gaining structure, getting their life back on track, and finding employment.Rehabilitation professionals should tailor RTW interventions to the needs of these workers, aimed at their specific problems and taking into account the workers’ coping methods according to one of three types of workers’ attitudes towards their own RTW process.

Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials.

Common mental disorders (CMDs) are highly prevalent in the working population, and are associated with long-term sickness absence and disability. Workers on sick leave with CMDs would benefit from interventions that enable them to successfully return to work (RTW). However, the effectiveness of RTW interventions for workers with a CMD is not well studied. The objective of this review is to assess the effectiveness of existing workplace and clinical interventions that were aimed at enhancing RTW. A systematic review of studies of interventions for improving RTW in workers with a CMD was conducted. The main outcomes were proportion of RTW and sick-leave duration until RTW. Randomized controlled trials (RCTs) were identified from Medline/PubMed, PsycINFO, EMBASE, SocINDEX, and Human resource and management databases from January 1995 to 2016. Two authors independently selected studies, assessed risk of bias and extracted data. We pooled studies that we deemed sufficiently homogeneous in different comparison groups and assessed the overall quality of the evidence. We reviewed 2347 abstracts from which 136 full-text articles were reviewed and 16 RCTs were included in the analysis. Combined results from these studies suggested that the available interventions did not lead to improved RTW rates over the control group [pooled risk ratio 1.05, 95% confidence interval (CI) 0.97-1.12], but reduced the number of sick-leave days in the intervention group compared to the control group, with a mean difference of -13.38 days (95% CI -24.07 to -2.69).

Perspectives from Employers, Insurers, Lawyers and Healthcare Providers on Factors that Influence Workers' Return-to-Work Following Surgery for Non-Traumatic Upper Extremity Conditions.

Return-to-work (RTW) stakeholders have varied roles and may therefore hold their own perspectives regarding factors that may influence outcomes. This study aimed to determine stakeholders' perspectives on factors influencing RTW following surgery for non-traumatic upper extremity conditions. A questionnaire was distributed to RTW stakeholders via gatekeeper organizations. Stakeholders rated 50 potential prognostic factors from 'not' to 'extremely' influential. Data were dichotomized to establish stakeholders' level of agreement. Disagreements between stakeholder groups were analyzed using χ 2. The relationship between stakeholder demographic variables and rating of a factor was determined via regression analysis. One thousand and eleven stakeholders completed the survey: healthcare providers (77.8%); employer representatives (12.2%); insurer representatives (6.8%); and lawyers (3.2%). Factors with the highest stakeholder agreement for influencing RTW were: self-efficacy (92.2%); post-operative psychological status (91.8%); supportive employer/supervisor (91.4%); employer's willingness to accommodate job modifications (90.7%); worker's recovery expectations (88.3%); mood disorder diagnosis (86.6%); post-operative pain level (86.4%); and whether the job can be modified (86.3%). Disagreements between stakeholder groups were found for 19 (36%) factors. The strongest disagreements were for: age; gender; obesity; doctor's RTW recommendation; and presence of a RTW coordinator. Respondents' characteristics (e.g., age, workers' compensation jurisdiction, work experience, stakeholder group) were associated with factor rating. The factors stakeholders rated as having the greatest influence on RTW were predominately psychosocial and modifiable. These variables should be the focus of future research to determine prognostic factors for RTW for workers with upper extremity conditions, and to develop effective RTW interventions.

The effectiveness of return-to-work interventions that incorporate work-focused problem-solving skills for workers with sickness absences related to mental disorders: a systematic literature review

ObjectivesThis paper reviews the current state of the published peer-reviewed literature related to return-to-work (RTW) interventions that incorporate work-related problem-solving skills for workers with sickness absences related to mental disorders....