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Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss--a systematic review

Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss--a systematic review
Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss--a systematic review
Objective. To assess the effectiveness of interventions in community and workplace settings to reduce sickness absence and job loss in workers with musculoskeletal disorders (MSDs).

Methods. Relevant randomized controlled trials (RCTs) and cohort studies, published since 1990, were identified by screening citations from 35 earlier systematic reviews and by searching MEDLINE and Embase until April 2010. Effects were estimated by intervention category and other features, including study quality.

Results. Among 42 studies (including 34 RCTs), 27 assessed return to work (RTW), 21 duration of sickness absence and 5 job loss. Interventions included exercise therapy, behavioural change techniques, workplace adaptations and provision of additional services. Studies were typically small {median sample 107 [inter-quartile range (IQR) 77-148]} and limited in quality. Most interventions appeared beneficial: the median relative risk (RR) for RTW was 1.21 (IQR 1.00-1.60) and that for avoiding MSD-related job loss was 1.25 (IQR 1.06-1.71); the median reduction in sickness absence was 1.11 (IQR 0.32-3.20) days/month. However, effects were smaller in larger and better-quality studies, suggesting publication bias. No intervention was clearly superior, although effort-intensive interventions were less effective than simple ones. No cost-benefit analyses established statistically significant net economic benefits.

Conclusion. As benefits are small and of doubtful cost-effectiveness, employers' practice should be guided by their value judgements about the uncertainties. Expensive interventions should be implemented only with rigorous cost-benefit evaluation planned from the outset. Future research should focus on the cost-effectiveness of simple, low-cost interventions, and further explore impacts on job retention.
occupational disease, epidemiology, rehabilitation, systematic review, psychological techniques, physiotherapy
1462-0324
230-242
Palmer, Keith T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Harris, Elizabeth C.
3e4bd946-3f09-45a1-8725-d35e80dd7971
Linaker, Cathy
6c6d1b90-ee40-4c96-8b2e-b06efbe030ae
Barker, Mary
374310ad-d308-44af-b6da-515bf5d2d6d2
Lawrence, Wendy
e9babc0a-02c9-41df-a289-7b18f17bf7d8
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Coggon, David
2b43ce0a-cc61-4d86-b15d-794208ffa5d3
Palmer, Keith T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Harris, Elizabeth C.
3e4bd946-3f09-45a1-8725-d35e80dd7971
Linaker, Cathy
6c6d1b90-ee40-4c96-8b2e-b06efbe030ae
Barker, Mary
374310ad-d308-44af-b6da-515bf5d2d6d2
Lawrence, Wendy
e9babc0a-02c9-41df-a289-7b18f17bf7d8
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Coggon, David
2b43ce0a-cc61-4d86-b15d-794208ffa5d3

Palmer, Keith T., Harris, Elizabeth C., Linaker, Cathy, Barker, Mary, Lawrence, Wendy, Cooper, Cyrus and Coggon, David (2011) Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss--a systematic review. [in special issue: Themed Issue on Rheumatology and Work] Rheumatology, 51 (2), 230-242. (doi:10.1093/rheumatology/ker086). (PMID:21415023)

Record type: Article

Abstract

Objective. To assess the effectiveness of interventions in community and workplace settings to reduce sickness absence and job loss in workers with musculoskeletal disorders (MSDs).

Methods. Relevant randomized controlled trials (RCTs) and cohort studies, published since 1990, were identified by screening citations from 35 earlier systematic reviews and by searching MEDLINE and Embase until April 2010. Effects were estimated by intervention category and other features, including study quality.

Results. Among 42 studies (including 34 RCTs), 27 assessed return to work (RTW), 21 duration of sickness absence and 5 job loss. Interventions included exercise therapy, behavioural change techniques, workplace adaptations and provision of additional services. Studies were typically small {median sample 107 [inter-quartile range (IQR) 77-148]} and limited in quality. Most interventions appeared beneficial: the median relative risk (RR) for RTW was 1.21 (IQR 1.00-1.60) and that for avoiding MSD-related job loss was 1.25 (IQR 1.06-1.71); the median reduction in sickness absence was 1.11 (IQR 0.32-3.20) days/month. However, effects were smaller in larger and better-quality studies, suggesting publication bias. No intervention was clearly superior, although effort-intensive interventions were less effective than simple ones. No cost-benefit analyses established statistically significant net economic benefits.

Conclusion. As benefits are small and of doubtful cost-effectiveness, employers' practice should be guided by their value judgements about the uncertainties. Expensive interventions should be implemented only with rigorous cost-benefit evaluation planned from the outset. Future research should focus on the cost-effectiveness of simple, low-cost interventions, and further explore impacts on job retention.

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More information

Published date: 16 March 2011
Keywords: occupational disease, epidemiology, rehabilitation, systematic review, psychological techniques, physiotherapy
Organisations: Medicine

Identifiers

Local EPrints ID: 188011
URI: http://eprints.soton.ac.uk/id/eprint/188011
ISSN: 1462-0324
PURE UUID: 2ec68b39-5a9a-49d7-b632-4f751d029fde
ORCID for Elizabeth C. Harris: ORCID iD orcid.org/0000-0001-8037-566X
ORCID for Cathy Linaker: ORCID iD orcid.org/0000-0003-1091-9283
ORCID for Mary Barker: ORCID iD orcid.org/0000-0003-2976-0217
ORCID for Wendy Lawrence: ORCID iD orcid.org/0000-0003-1264-0438
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for David Coggon: ORCID iD orcid.org/0000-0003-1930-3987

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Date deposited: 19 May 2011 13:38
Last modified: 18 Mar 2024 02:54

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Contributors

Author: Keith T. Palmer
Author: Elizabeth C. Harris ORCID iD
Author: Cathy Linaker ORCID iD
Author: Mary Barker ORCID iD
Author: Wendy Lawrence ORCID iD
Author: Cyrus Cooper ORCID iD
Author: David Coggon ORCID iD

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