Appendix D: Gaps in the evidence

Appendix D: Gaps in the evidence

The PDG identified a number of gaps in the evidence related to the programmes under examination based on an assessment of the evidence, stakeholder comments and expert papers and fieldwork. These gaps are set out below.

  1. Limited evidence was identified on interventions that:

    • aim to prevent employees moving from short- to long-term sickness absence

    • attempt to reduce the number of employees taking repeated short- or long-term sickness absence.

  2. There was very limited, UK-based evidence that met the inclusion criteria for this guidance on interventions that help those receiving incapacity (or similar benefit) return to work. The evidence that was available either only demonstrated a small effect size or did not provide detailed information about the different population groups that benefited from the interventions.

  3. There was limited evidence on interventions that help people with mental health problems return to work after sickness absence.

  4. Evidence on biopsychological interventions was limited in terms of the range of therapies covered. For example, other 'talk therapies' like counselling were not identified. Also, very few studies examined or described the wider social context of sickness absence (part of a bio-psychosocial approach).

  5. The following details were often missing from descriptions of interventions:

    • a definition of the sickness absence period, the primary reasons for or details of the conditions causing the sickness absence period or incapacity and duration of the sickness absence and the point when the employee was ready to return to work

    • content, when it was delivered, by whom, in what setting, at what point during the individual's absence or incapacity, how frequently and for how long?

    • any variation in effectiveness and cost effectiveness in relation to characteristics such as gender/sex, age, race/ethnicity, disability, sexual orientation and religion or belief

    • whether or not a particular component of a multi-component intervention was responsible for effectiveness/cost effectiveness – and the differential impact of each component

    • the perceptions of both those delivering the intervention and the recipients of the benefits of, and barriers to, taking in part in compulsory versus voluntary components

    • a control or comparison element

    • statistical data for reported intended and unintended outcomes

    • the economic costs and benefits

    • follow-up periods and sustainability.

  6. There was a lack of evidence on specific components that make an intervention effective. For example, few studies provided data to answer questions such as: 'Does effectiveness depend on the intervener?' or 'Does the intensity or duration influence effectiveness or duration of effect'?

  7. Few studies evaluated the factors that hinder or help someone to return to work following sickness absence or incapacity (for example, whether mandatory compared to voluntary components help or hinder effectiveness).

  8. Few studies described the barriers experienced by those planning, designing, delivering or managing the interventions. None described how to overcome these barriers.

  9. Long-term return-to-work or quality of working life outcomes for a number of potentially relevant interventions were not always available (for example, they were not available for the Expert Patients' Programme and condition management programmes).

  10. There was a lack of robust evaluations of recent interventions using employment case managers.

  11. Routine data collection (such as the collection of details on occupation, sickness certification and sickness absence) was not standardised, recorded and made accessible for research.

  12. There is no standardised database (such as that used by GPs) which links across government departments.

  13. Routine health care data collection does not include information on occupation or employment status. This information is needed to assess progress in tackling health inequalities. For example, to assess whether people from different occupational groups receive the same interventions or whether their recovery time and any sustained return to work is comparable.

The Group made four recommendations for research. These are listed in section 5.

  • National Institute for Health and Care Excellence (NICE)