Affecting patients with work-related problems by educational training of their GPs: a cost-effectiveness study.

BACKGROUND: Assessing the cost effectiveness of training aimed at increasing general practitioners' (GP) work awareness and patients' work-related self-efficacy and quality of life. METHODS: A cluster randomized controlled trial in twenty-six GP practices in the southeast of the Netherlands with 32 participating GPs. GPs working in an intervention group practice received training and GPs working in a control group practice delivered usual care. The training intervention consisted of lectures and workshops aimed at increasing GPs' work awareness and more proactive counseling for patients with work-related problems (WRP). Subjects were working age patients with paid work for at least 12 h per week, who visited one of the participating GPs during the study period. As outcome measures we used the Return to Work Self Efficacy scale to assess patients' work-related self-efficacy and the Euroquol to assess quality of life. We also measured health care costs and productivity costs. With a 4-item questionnaire we asked patients to assess their GPs' work awareness. Data were collected at baseline, after 6 and 12 months. RESULTS: Data of 280 patients could be analyzed. The patient related outcomes did not improve after GP training. The change in GP work awareness and the overall mean cost difference (of €770) in favor of the intervention group were not significant. CONCLUSIONS: The training intervention presented in this paper was not cost-effective. Training which is further personalized and targeted at high risk groups with respect to WRP, is more likely to be cost effective.

Factors associated with participation on the competitive labour market of people with visual impairments in The Netherlands.

BACKGROUND: Worldwide, the employment rate of people with visual impairments (PVIs) is lower than that of the general working-age population. To improve the employment rate of this group, there is a need for knowledge about differences in modifiable factors between working and non-working PVIs. OBJECTIVE: To identify modifiable factors associated with participation on the competitive labour market of PVIs. Based on the findings, we aim to develop an individual assessment instrument for determining the odds of labour market success of PVIs. METHODS: Data were collected among 299 PVIs by means of a cross-sectional telephone survey based on existing (validated) and self-developed scales and items. Logistic regression analysis was used to find the strongest predictors of the dichotomous outcome of 'having paid work on the competitive labour market' (yes/no). RESULTS: We found three personal non-modifiable factors (level of education, comorbidity, level of visual impairment) and three modifiable factors (mobility, acceptance and optimism) to be significantly (p <  0.05) associated with having paid work. CONCLUSIONS: The factors of optimism, acceptance and mobility should be included in an individual assessment instrument which can provide PVIs and their job coaches with good starting points for improving the labour market situation of the PVIs.

Economic evaluation of an intervention program with the aim to improve at-work productivity for workers with rheumatoid arthritis.

OBJECTIVES: Evaluating the cost effectiveness and cost utility of an integrated care intervention and participatory workplace intervention for workers with rheumatoid arthritis (RA) to improve their work productivity. METHODS: Twelve month follow-up economic evaluation alongside a randomized controlled trial (RCT) within specialized rheumatology treatment centers. Adults diagnosed with RA between 18-64 years, in a paid job for at least eight hours per week, experiencing minor difficulties in work functioning were randomized to the intervention (n = 75) or the care-as-usual (CAU) group (n = 75). Effect outcomes were productivity and quality of life (QALYs). Costs associated with healthcare, patient and family, productivity, and intervention were calculated from a societal perspective. Cost effectiveness and cost utility were assessed to indicate the incremental costs and benefits per additional unit of effect. Subgroup and sensitivity analyses evaluated the robustness of the findings. RESULTS: At-work productivity loss was about 4.6 hours in the intervention group and 3.5 hours in the care as usual (CAU) group per two weeks. Differences in QALY were negligible; 0.77 for the CAU group and 0.74 for the intervention group. In total, average costs after twelve months follow-up were highest in the intervention group (€7,437.76) compared to the CAU group (€5,758.23). The cost-effectiveness and cost-utility analyses show that the intervention was less effective and (often) more expensive when compared to CAU. Sensitivity analyses supported these findings. DISCUSSION: The integrated care intervention and participatory workplace intervention for workers with RA provides gains neither in productivity at the workplace nor in quality of life. These results do not justify the additional costs.

Improving a web-based employability intervention for work-disabled employees: results of a pilot economic evaluation.

Purpose The purpose of this study is to improve web-based employability interventions for employees with work-related health problems for both intervention content and study design by means of a pilot economic evaluation. Methods Uptake rate analysis for the intervention elements, cost effectiveness, cost utility and subgroup analyses were conducted to identify potential content-related intervention improvements. Differences in work ability and quality-adjusted life years and overall contribution of resource items to the total costs were assessed. These were used to guide study design improvements. Results Sixty-three participants were a-select allocated to either the intervention (n = 29) or the control (n = 34) group. Uptake regarding the intervention elements ranged between 3% and 70%. Cost-effectiveness and cost-utility analyses resulted in negative effects although higher total costs. Incremental effects were marginal (work ability -0.51; QALY -0.01). Conclusions The web-based tool to enhance employability among work disabled employees requires improvements regarding targeting and intensity; outcome measures selected and collection of cost data. With respect to the studies of disability and rehabilitation, the findings and methods presented in this pilot economic evaluation could guide the assessment of future assistive "e-health" technologies. IMPLICATIONS FOR REHABILITATION The methods presented in this pilot economic evaluation have large potentials to guide the assessment of future assistive e-health technologies addressing work-disabilities. The findings show that the web-based tool requires content related improvements with respect to targeting and intensity to enhance employability among work disabled employees. The findings show that the web-based tool would benefit from improvements related to the study design by more adequately selecting and collecting both outcome measures and cost data. The burden attributable to large-scale studies and implementation issues were prevented as the outcomes of the pilot economic evaluation did not support the implementation of the web-based tool.

A process evaluation of a return-to-work intervention to improve Cooperation between Sick-listed employees and their Supervisors (COSS).

BACKGROUND: This is a process evaluation of an intervention to improve Cooperation regarding return-to-work (RTW) between sick-listed employees and their supervisors (COSS, which consists of a conversation roadmap, monitoring of cooperation using questionnaires and, if necessary, extra support by an occupational physician (OP). OBJECTIVE: Objectives were to study (1) the adoption of COSS by a banking organization and (2) its implementation among individual employees, supervisors and OPs. METHODS: We used quantitative data (online questionnaire, project administration, conversation minutes, emails) and qualitative data (semi-structured interviews). We analyzed quantitative data descriptively (by calculating sum scores, percentages, mean scores and standard deviations). The coding system to analyze the qualitative data was data-driven. RESULTS: The organization's representatives reported positively (e.g. fit with existing policy) and negatively (e.g. high intensity) about COSS. At least one OP (out of five) used the monitoring information. Project administration data show a modest reach of COSS among employees and supervisors. The roadmap was used by a minority (35% of the employees and 25% of the supervisors). Relatively many (40% of the employees and 100% of the supervisors who used COSS to evaluate conversations) were satisfied with COSS as a  tool to evaluate conversations with the employee/supervisor afterwards. Interview results indicate that the roadmap was considered useful in specific situations (e.g. psychological complaints). All employees and supervisors participated in the monitoring. The majority of the responding employees and supervisors received OP support and was satisfied about this support. CONCLUSIONS: Despite the good adoption of COSS by the organisation, it was only partially implemented by professionals, employees and supervisors. We hypothesize that our implementation approach did not fit completely with the culture at the bank. Also, the results illustrate the need for other intervention methods for improving cooperation between employees and supervisors and a more specific target population.

Which resources moderate the effects of demanding work schedules on nurses working in residential elder care? A longitudinal study.

BACKGROUND: Shiftwork is a major job demand for nurses and has been related to various negative consequences. Research suggests that personal and job resources moderate the impact of work schedules on stress, health and well-being. OBJECTIVES: This longitudinal study examined whether the interactions of personal and job resources with work schedule demands predicted work engagement and emotional exhaustion in nursing. DESIGN: This longitudinal study included two waves of data collection with a one year follow-up using self-report questionnaires among 247 nurses working shifts or irregular working hours in residential care for the elderly in the Netherlands. METHODS: Moderated structural equation modelling was conducted to examine the interactions between personal and job resources and work schedule demands. Two work schedule demands were assessed: type of work schedule (demanding vs. less demanding) and average weekly working hours. Two personal resources, active coping and healthy lifestyle, and two job resources, work schedule control and the work schedule fit with nurses' private life, were assessed. RESULTS: Results showed that the work schedule fit with nurses' private life buffered the relationship between work schedule demands and emotional exhaustion one year later. Furthermore, the work schedule fit with nurses' private life increased work engagement one year later when work schedule demands were high. Work schedule control strengthened the positive relationship between work schedule demands and emotional exhaustion one year later. The personal resources, active coping and healthy lifestyle were no moderators in this model. CONCLUSION: Nurses suffer less from decreasing work engagement and emotional exhaustion due to work schedule demands when their work schedules fit with their private lives. Work schedule control did not buffer, but strengthened the positive relationship between weekly working hours and emotional exhaustion one year later. Job resources appeared to be more important for nurses' well-being than personal resources. These findings highlight the importance of the fit of a work schedule with nurse's private life, if the work schedule is demanding.

The exchangeability of self-reports and administrative health care resource use measurements: assessement of the methodological reporting quality.

OBJECTIVE: To assess the exchangeability of self-reported and administrative health care resource use measurements for cost estimation. STUDY DESIGN AND SETTING: In a systematic review (NHS EED and MEDLINE), reviewers evaluate, in duplicate, the methodological reporting quality of studies comparing the validation evidence of instruments measuring health care resource use. The appraisal tool Methodological Reporting Quality (MeRQ) is developed by merging aspects form the Guidelines for Reporting Reliability and Agreement Studies and the Standards for Reporting Diagnostic Accuracy. RESULTS: Out of 173 studies, 35 full-text articles are assessed for eligibility. Sixteen articles are included in this study. In seven articles, more than 75% of the reporting criteria assessed by MERQ are considered "good." Most studies score at least "fair" on most of the reporting quality criteria. In the end, six studies score "good" on the minimal criteria for reporting. Varying levels of agreement among the different data sources are found, with correlations ranging from 0.14 up to 0.93 and with occurrences of both random and systematic errors. CONCLUSION: The validation evidence of the small number of studies with adequate MeRQ cautiously supports the exchangeability of both the self-reported and administrative resource use measurement methods.

The Effectiveness of an Intervention to Enhance Cooperation Between Sick-Listed Employees and Their Supervisors (COSS).

Introduction Early return-to-work (RTW) after sick leave is considered to support employees' quality of life. Successful RTW requires adequate cooperation between absent employees and their supervisors. This study assesses the effectiveness of an intervention for COoperation regarding RTW between Sick-listed employees and their Supervisors (COSS; i.e. 'conversation roadmap', monitoring of cooperation and, if necessary, extra occupational physician support). Methods In this field study, employees on sick leave for 2-10 weeks, aged 18 up to and including 60, and performing paid labour for at least 12 h per week were included. Terminally ill were excluded. Multivariate regression (correcting for baseline quality of life) was used to compare 6-months follow up data regarding quality of life between the groups. Using Cox regression analyses, time until first-, full-, and sustainable RTW was compared between groups. Results In total 64 employees received COSS or common practice. No significant group differences were found regarding all study outcomes. The COSS group had a higher chance of work resumption than the common practice group. The hazard ratio was 1.39 for first RTW (95 % CI 0.81-2.37), 1.12 for full RTW (95 % CI 0.65-1.93) and 1.10 for sustainable RTW (95 % CI 0.63-1.95). Conclusions COSS has no significant effects. Yet, the results regarding work resumption show a tendency towards effectiveness. Therefore, COSS can be further developed and applied in practice. Researchers should try to prevent some limitations of the present study in future research, for instance by finding a more common research setting.

Economic Evaluation of a New Organizational RTW Intervention to Improve Cooperation Between Sick-Listed Employees and Their Supervisors: A Field Study.

OBJECTIVE: The purpose of this study is to assess the cost-effectiveness, -utility, and -benefit of a new organizational return-to-work intervention to improve COoperation between Sick-listed employees and their Supervisors (COSS). METHODS: A field study with 6 months follow-up comparing COSS with common practice randomized participants aged 18 to 60, working at least 12  hours/week and absent for at least 2 weeks. Outcomes were initial return-to-work, quality-adjusted life years, and productivity gains. RESULTS: After 6 months, COSS generated less costs when compared with common practice. Participants in the COSS group returned to work earlier, improvement in quality-adjusted life years were uncertain. Net benefits of COSS versus common practice yielded a productivity gain of €395.89. CONCLUSIONS: Implementing COSS for sick-listed employees has potentials to reduce costs and improve productivity, and potentially quality of life. Longitudinal research might detect whether COSS also has the potential reaching sustainable return-to-work.

Policy on professional support in return-to-work: Occupational health professionals' experiences in a Canadian setting.

BACKGROUND: In Canada and other countries, sickness-based absences among workers is an economic and sociological problem. Return-to-work (RTW) policy developed by both employer and worker' representatives (that is, bipartite policy) is preferred to tackle this problem. OBJECTIVE: The intent was to examine how this bipartite agreed-upon RTW policy works from the perspective of occupational health professionals (those who deliver RTW services to workers with temporary or permanent disabilities) in a public healthcare organization in Canada. METHODS: In-depth interviews were held with 9 occupational health professionals and transcribed verbatim. A qualitative, social constructivist, analysis was completed. RESULTS: The occupational health professionals experienced four main problems: 1) timing and content of physicians' medical advice cannot be trusted as a basis for RTW plans; 2) legal status of the plans and thus needing workers' consent and managers' approval can create tension, conflict and delays; 3) limited input and thus little fruitful inference in transdisciplinary meetings at the workplace; and yet 4) the professionals can be called to account for plans. CONCLUSIONS: Bipartite representation in developing RTW policy does not entirely delete bottlenecks in executing the policy. Occupational health professionals should be offered more influence and their professionalism needs to be enhanced.

Sustainable employability in shiftwork: related to types of work schedule rather than age.

PURPOSE: There is scarce research on age and sustainable employability of nurses working in various types of work schedules. Earlier research showed that nurses working in work schedules differ regarding age. Different operationalisations of age might explain variations in sustainable employability. Therefore, the aim of this study was to investigate how nurses working in various types of work schedule differ regarding sustainable employability, and the role that age plays in these differences. Age was defined as chronological age, organisational age, life-span age, and functional age. METHOD: Questionnaires were distributed to 974 Dutch nurses in residential elder care (response rate 51 %) with questions about the type of work schedule, aspects of sustainable employability, various operationalisations of age, and registered sickness absence data were used. RESULTS: Nurses working in various types of work schedules differed regarding aspects of sustainable employability, also when operationalisations of age were added. The 'life-span age' was directly related to aspects of sustainable employability. Statistically, work ability and job satisfaction were only explained by varying operationalisations of age. CONCLUSIONS: Nurses' sustainable employability appeared to be mainly related to differences between the types of work schedule rather than age. Fixed early shifts are characterised by the most positive aspects of sustainable employability, and three rotating schedules score worst. To improve sustainable employability, organisations should implement a system in which nurses with different types of work schedule are monitored in combination with their life-span perspective.

Quality appraisal of generic self-reported instruments measuring health-related productivity changes: a systematic review.

BACKGROUND: Health impairments can result in disability and changed work productivity imposing considerable costs for the employee, employer and society as a whole. A large number of instruments exist to measure health-related productivity changes; however their methodological quality remains unclear. This systematic review critically appraised the measurement properties in generic self-reported instruments that measure health-related productivity changes to recommend appropriate instruments for use in occupational and economic health practice. METHODS: PubMed, PsycINFO, Econlit and Embase were systematically searched for studies whereof: (i) instruments measured health-related productivity changes; (ii) the aim was to evaluate instrument measurement properties; (iii) instruments were generic; (iv) ratings were self-reported; (v) full-texts were available. Next, methodological quality appraisal was based on COSMIN elements: (i) internal consistency; (ii) reliability; (iii) measurement error; (iv) content validity; (v) structural validity; (vi) hypotheses testing; (vii) cross-cultural validity; (viii) criterion validity; and (ix) responsiveness. Recommendations are based on evidence syntheses. RESULTS: This review included 25 articles assessing the reliability, validity and responsiveness of 15 different generic self-reported instruments measuring health-related productivity changes. Most studies evaluated criterion validity, none evaluated cross-cultural validity and information on measurement error is lacking. The Work Limitation Questionnaire (WLQ) was most frequently evaluated with moderate respectively strong positive evidence for content and structural validity and negative evidence for reliability, hypothesis testing and responsiveness. Less frequently evaluated, the Stanford Presenteeism Scale (SPS) showed strong positive evidence for internal consistency and structural validity, and moderate positive evidence for hypotheses testing and criterion validity. The Productivity and Disease Questionnaire (PRODISQ) yielded strong positive evidence for content validity, evidence for other properties is lacking. The other instruments resulted in mostly fair-to-poor quality ratings with limited evidence. CONCLUSIONS: Decisions based on the content of the instrument, usage purpose, target country and population, and available evidence are recommended. Until high-quality studies are in place to accurately assess the measurement properties of the currently available instruments, the WLQ and, in a Dutch context, the PRODISQ are cautiously preferred based on its strong positive evidence for content validity. Based on its strong positive evidence for internal consistency and structural validity, the SPS is cautiously recommended.

Environmental and personal factors that support early return-to-work: a qualitative study using the ICF as a framework.

BACKGROUND: Occupational health professionals such as occupational physicians (OPs) increasingly understand that in addition to health improvement, environmental factors (such as work adaptations) and personal factors (such as an employee's attitude towards return-to-work (RTW)) may stimulate employees on sick leave to return to work early. To target their professional interventions more specifically according to these factors, occupational health professionals need further insight into environmental and personal factors that stimulate RTW. OBJECTIVE: The objectives of this study are (1) to identify which and how environmental and personal factors support RTW, and (2) to examine whether the International Classification of Functioning, Disability and Health (ICF) can be used to describe these factors. METHODS: We performed interviews with 14 employees, 15 employers and 4 OPs from multiple organisations with varying organisational sizes and types of industry such as healthcare and education. We used a qualitative data analysis partially based on the Qualitative Analysis Guide of Leuven. RESULTS: The following environmental factors were found to support early RTW: 'social support from relatives', 'belief that work stimulates health', 'adequate cooperation between stakeholders in RTW' (e.g., employees, employers and OPs) and 'the employers' communicative skills'. One personal factor stimulated RTW: 'positive perception of the working situation' (e.g. enjoyment of work). Most factors stimulated RTW directly. In addition, adequate treatment and social support stimulated medical recovery. Environmental factors can either fully (social support, belief that RTW stimulates health), partially (effective cooperation), or not (employers' communicative skills) be described using ICF codes. The personal factor could not be classified because the ICF does not contain codes for personal factors. CONCLUSIONS: RTW interventions should aim at the environmental and personal factors mentioned above. Professionals can use the ICF to describe most environmental factors.

Policy on manager involvement in work re-integration: managers' experiences in a Canadian setting.

BACKGOUND: In Canada and other countries, sickness absence among workers is a significant concern. Local return-to-work policies developed by both management and workers' representatives are preferred to tackle the problem. OBJECTIVE: This article examines how managers perceive this local bipartite agreed upon return-to-work policy, wherein a social constructivist view on the policy process is taken. METHODS: In-depth interviews were held with 10 managers on their experiences with execution of this policy in a Canadian healthcare organization. Interviews were transcribed verbatim and qualitative analyses were completed to gain deep insight into the managers' perspectives. RESULTS: Results show that the managers viewed themselves as a linchpin between the workplace and the worker. They did not feel heard by the other stakeholders, wrestled with worker's limitations, struggled getting plans adjusted and became overextended to meet return-to-work objectives. CONCLUSIONS: The study shows that the managers felt unable to meet the responsibilities the policy demanded and got less involved in the return-to-work process than this policy intended. RTW policy needs to balance on the one hand, flexibility to safeguard active involvement of managers and, on the other hand, strictness regarding taking responsibility by stakeholders, particularly the health care and re-integration professionals.

Disembodied abilities: sick role and participation in 'activating' return-to-work practices.

In 'active welfare states', labour participation is regarded essential for being part of and contributing to society. In the striving for an increase in labour participation of people who were considered (partly) disabled for work, not 'disabilities', but 'abilities' are put centre stage in vocational rehabilitation programmes. In this article we explore what this change in focus means in practice. We do this by investigating tensions experienced by participants of vocational rehabilitation practices that aim at facilitating return-to-work for people with disabilities. Our analysis derives from stories that clients and professionals told about daily experiences with disability, vocational rehabilitation and (labour) participation. These stories illustrate the logic embedded in vocational rehabilitation practices. Our analysis demonstrates that this logic, that focuses on will power, stable abilities and employability, hampers the realization of labour participation for a part of the population. We conclude that a logic of embodiment in which lived experiences of clients are acknowledged and in which it is explored what clients are concretely able to do in a specific context may be better equipped to facilitate return-to-work.

Factors affecting the acceptance of people with disabilities at work: a literature review.

PURPOSE: A lack of social acceptance by non-disabled co-workers is often the reason why employees with disabilities fail to stay in regular organizations for sustained periods. The aim of the study is to present a coherent review of the extant literature on factors affecting the acceptance of people with disabilities in regular employment. METHOD: We conducted a search of the electronic databases PsychINFO and Web of Science (period: 1996-2011) supplemented with a search for additional relevant articles by means of cross-referencing. In total 48 articles were selected, coded and analyzed by three coders into three overarching themes. RESULTS: The analysis of included articles shows that the acceptance of employees with disabilities is influenced by three main variable groups: characteristics of co-workers, of the persons with disabilities and of the employers/organizations. Most studies present factors that influence co-workers' or employers' attitudes toward employees with disabilities such as demographic variables. CONCLUSION: Although, recent research has started to accumulate findings on factors that affect the acceptance of employees with disabilities, many gaps remain in the understanding of the concept of acceptance and its relation to the employment of people with disabilities.

How policy on employee involvement in work reintegration can yield its opposite: employee experiences in a Canadian setting.

PURPOSE: Canada has a long tradition of involving employee representatives in developing work reintegration policies and expects this to positively affect employee involvement to improve work reintegration success. The purpose of this study was to examine employee involvement in reintegration in a Canadian province as experienced by employees. METHOD: Fourteen semi-structured interviews were held with employees in a healthcare organization. The interview topic list was based on a review of local reintegration policy documents and literature. Interviews were transcribed verbatim and analysed using ethnographic methodology. RESULTS: Employees do not feel in control of their reintegration trajectory. In the phase of reporting sickness absence, they wrestle with a lack of understanding on how to report in sick. In the phase of reintegration planning and coordination, they hesitate to get involved in the organization of reintegration. In the phase of reintegration plan execution, employees encounter unfulfilled expectations on interventions. CONCLUSION: Employee involvement in the organization of reintegration makes them responsible for the development of reintegration trajectories. However, they consider themselves often incapable of completing this in practice. Moreover, employees experience that their contribution can boomerang on them. IMPLICATIONS FOR REHABILITATION: • It is not that employees are not able to think along or decide on their reintegration trajectory but rather they are expected to do so at times when they cannot oversee their illness and/or recovery trajectory. • Settings out reintegration procedures that are inflexible in practice do not recognize that employee involvement in work reintegration trajectories can develop over time. • The disability management professional has a central role in organizing and supporting employee involvement in work reintegration, however, the employees do not experience this is indeed happening.

A sociological perspective on "the unmotivated client": public accountability and professional work methods in vocational rehabilitation.

PURPOSE: This study aims at a sociological understanding of the concept of (un)motivation in order to provide clues for improving vocational rehabilitation (VR) support. METHOD: (Un)motivation is understood as the product of the interaction between clients and professionals in an institutional context. To gain better understanding of this construction of (un)motivation, in depth-interviews are held with 14 VR professionals. Based on the stories professionals told about their professional practices, we analysed the ways in which they guide their clients during their VR path within the institutional context of the Dutch welfare state. RESULTS: "The unmotivated client" is a judgment that arises in the interaction between professional and client if the institutional goals of VR are not achieved. Two work methods are distinguished in which this judgment takes shapes in various ways, namely "Professional as a Signpost" and "Professional as a Personal Guide". CONCLUSIONS: Professionals work in a dichotomous public accountability framework with a strong focus on labour participation. This causes professionals to look for ways out of VR paths in which labour participation is not achieved. The construction of "the unmotivated client" is such a way out. An alternative way out is to explicitly value clients' (intermediary) achievements. IMPLICATIONS FOR REHABILITATION: • In vocational rehabilitation (VR) there exists the risk that a perceived lack of motivation is only considered a personal problem in stead of a social issue. • Reconsideration of the public accountability framework of VR may lead to more inclusive VR support in which a differentiated concept of participation is valued. • Lessons can be drawn from the articulation of achievements made in VR paths that are now considered unsuccessful. • For more inclusive VR support, the specific situation and situated needs of clients need to be taken as a starting point instead of a primary focus on the final goal of labour participation.

Intervention characteristics that facilitate return to work after sickness absence: a systematic literature review.

INTRODUCTION: In many Western countries, a vast amount of interventions exist that aim to facilitate return to work (RTW) after sickness absence. These interventions are usually focused on specific target populations such as employees with low back pain, stress-related complaints or adjustment disorders. The aim of the present study is to detect and identify characteristics of RTW interventions that generally facilitate return to work (i.e. in multiple target populations and across interventions). This type of knowledge is highly relevant to policy makers and health practitioners who want to deliver evidence based care that supports the employee's health and participation in labour. METHODS: We performed a keyword search (systematic literature review) in seven databases (period: 1994-2010). In total, 23 articles were included and assessed for their methodological quality. The characteristics of the interventions were evaluated as well. RESULTS: Early interventions, initiated in the first 6 weeks of the RTW process were scarce. These were effective to support RTW though. Multidisciplinary interventions appeared effective to support RTW in multiple target groups (e.g. back pain and adjustment disorders). Time contingent interventions in which activities followed a pre-defined schedule were effective in all physical complaints studied in this review. Activating interventions such as gradual RTW were effective in physical complaints. They have not been studied for people with psychological complaints. CONCLUSIONS: Early- and multidisciplinary intervention and time-contingent-, activating interventions appear most effective to support RTW.

Design of a trial-based economic evaluation on the cost-effectiveness of employability interventions among work disabled employees or employees at risk of work disability: the CASE-study.

BACKGROUND: In the Netherlands, absenteeism and reduced productivity due to work disability lead to high yearly costs reaching almost 5% of the gross national product. To reduce the economic burden of sick leave and reduced productivity, different employability interventions for work-disabled employees or employees at risk of work disability have been developed. Within this study, called 'CASE-study' (Cost-effectiveness Analysis of Sustainable Employability), five different employability interventions directed at work disabled employees with divergent health complaints will be analysed on their effectiveness and cost-effectiveness. This paper describes a consistent and transparent methodological design to do so. METHODS/DESIGN: Per employability intervention 142 participants are needed whereof approximately 66 participants receiving the intervention will be compared with 66 participants receiving usual care. Based on the intervention-specific characteristics, a randomized control trial or a quasi-experiment with match-criteria will be conducted. Notwithstanding the study design, eligible participants will be employees aged 18 to 63, working at least 12 h per week, and at risk of work disability, or already work-disabled due to medical restrictions. The primary outcome will be the duration of sick leave. Secondary outcomes are health status and quality of life. Outcomes will be assessed at baseline and then 6, 12 and 18 months later. Economic costs will consist of healthcare costs and cost of lost production due to work disability, and will be evaluated from a societal perspective. DISCUSSION: The CASE-study is the first to conduct economic evaluations of multiple different employability interventions based on a similar methodological framework. The cost-effectiveness results for every employability intervention will be published in 2014, but the methods, strengths and weaknesses of the study protocol are discussed in this paper. To contribute to treatment options in occupational health practice and enable the development of guidelines on how to conduct economic evaluation better suited to this field; this paper provides an important first step. TRIAL REGISTRATION: Four trials involved in the CASE-study are registered with the Netherlands Trial Registry: Care for Work (NTR2886), Health and Motion (NTR3111), Guidance to Excel in Return to Work (NTR3151), Care for Companies/Second Care (NTR3136).