Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain The effectiveness of graded activity for low back pain in occupational healthcare Return to work following an aquafitness and muscle strengthening program for the low back injured. Participatory ergonomics as a return-to-work intervention: a future challenge? Doctor Proactive Communication, Return-to-Work Recommendation, and Duration of Disability After a Workers’ Compensation Low Back Injury A workplace intervention for sick-listed employees with distress: results of a randomised controlled trial Cognitive Interventions and Nutritional Supplements (The CINS Trial): A Randomized Controlled, Multicenter Trial Comparing a Brief Intervention With Additional Cognitive Behavioral Therapy, Seal Oil, and Soy Oil for Sick-Listed Low Back Pain Patients Effectiveness of a Coordinated and Tailored Return-to-Work Intervention for Sickness Absence Beneficiaries with Mental Health Problems One-Year Follow-Up in Employees Sick-Listed Because of Low Back Pain: Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention A two-year follow-up on a program theory of return to work intervention. Prediction model for unsuccessful return to work after hospital-based intervention in low back pain patients A Prospective Study of the Effectiveness of Early Intervention with High-risk Back-injured Workers—A Pilot Study Sustainability of return to work in sick-listed employees with low-back pain. Two-year follow-up in a randomized clinical trial comparing multidisciplinary and brief intervention Implementation of a participatory ergonomics program in the rehabilitation of workers suffering from subacute back pain. Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness Subgroup analyses on return to work in sick-listed employees with low back pain in a randomised trial comparing brief and multidisciplinary intervention Early and Late Return to Work After Sick Leave: Predictors in a Cohort of Sick-Listed Individuals with Common Mental Disorders A Participatory Return-to-Work Intervention for Temporary Agency Workers and Unemployed Workers Sick-Listed Due to Musculoskeletal Disorders: Results of a Randomized Controlled Trial Process evaluation of a participatory ergonomics programme to prevent low back pain and neck pain among workers Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Design of a multicentre randomized controlled trial to evaluate the effectiveness of a tailored clinical support intervention to enhance return to work for gastrointestinal cancer patients Predictive tests for non-return to work in patients with chronic low back pain Economic evaluation of a workplace intervention for sick-listed employees with distress Predictors of return to work following motor vehicle related orthopaedic trauma Return to work after a workplace-oriented intervention for patients on sick-leave for burnout - a prospective controlled study Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands A cost-benefit analysis of a California county's back injury prevention program.
Objective : To evaluate the cost-effectiveness and cost-utility of a return to work ( RTW ) program for workers on sick-leave due to low back pain ( LBP ) , comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care , and a clinical intervention after 8 weeks of sick-leave with usual care . Design : Economic evaluation alongside a r and omised controlled trial ( RCT ) . Study population : Workers sick-listed for a period of 2 to 6 weeks due to LBP . Interventions : 1 . workplace assessment , work modifications and case management ) . 2 . physiotherapy based on operant behavioural principles . 3 . usual care : provided by an occupational physician . Outcomes : The primary outcome was return to work ( RTW ) . Other outcomes were pain intensity , functional status , quality of life and general health . The economic evaluation was conducted from a societal perspective . Outcomes were assessed at baseline ( after 2–6 weeks on sick-leave ) , and 12 weeks , 26 weeks , and 52 weeks after the first day of sick-leave . Results : The workplace intervention group returned to work 30.0 days ( 95 % CI=[3.1 , 51.3 ] ) earlier on average than the usual care group at slightly higher direct costs ( ratio of 1 day : € 19 ) . Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days ( 95 % CI= [ −74.1 , 29.2 ] ) later on average . The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days ( 95 % CI=[−89.4 , −2.7 ] ) later on average . A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes . A clinical intervention was less effective than usual care and associated with higher costs . Conclusion : The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP Background : Low back pain is a common medical and social problem associated with disability and absence from work . Knowledge on effective return to work ( RTW ) interventions is scarce . Objective : To determine the effectiveness of grade d activity as part of a multistage RTW programme . Design : R and omised controlled trial . Setting : Occupational healthcare . Subjects : 112 workers absent from work for more than eight weeks due to low back pain were r and omised to either grade d activity ( n = 55 ) or usual care ( n = 57 ) . Intervention : Grade d activity , a physical exercise programme aim ed at RTW based on operant-conditioning behavioural principles . Main outcome measures : The number of days off work until first RTW for more then 28 days , total number of days on sick leave during follow up , functional status , and severity of pain . Follow up was 26 weeks . Results : Grade d activity  prolonged RTW . Median time until RTW was equal to the total number of days on sick leave and was 139 ( IQR = 69 ) days in the grade d activity group and 111 ( IQR = 76 ) days in the usual care group ( hazard ratio = 0.52 , 95 % CI 0.32 to 0.86 ) . An interaction between a prior workplace intervention and grade d activity , together with a delay in the start of the grade d activity intervention , explained most of the delay in RTW ( hazard ratio = 0.86 , 95 % CI 0.40 to 1.84 without prior intervention and 0.39 , 95 % CI 0.19 to 0.81 with prior intervention ) . Grade d activity did not improve pain or functional status clinical ly significantly . Conclusions : Grade d activity was not effective for any of the outcome measures . Different interventions combined can lead to a delay in RTW . Delay in referral to grade d activity delays RTW . In implementing grade d activity special attention should be paid to the structure and process of care Our purpose , in this prospect i ve clinical study , was to identify the best predictors of 2-month return to work or retraining for a group of low back injured subjects ( n = 40 ) who completed at least 8 weeks of a community-based rehabilitation program that combined aerobic and flexibility exercise conducted in the water ( aquafitness ) with muscle strength and endurance training .  Baseline demographic characteristics and changes in physical fitness , pain , disability , and psychological well-being during the course of program participation were compared between two groups of low back injured subjects : those who returned to work ( RTW ) [ n = 24 ] , and those who did not ( N-RTW ) [ n = 16 ] . Subjects in both groups showed comparable improvement in measures of physical fitness at 8 weeks . However , multivariate analyses showed significant between-group differences in self-report measures . The RTW group showed significant improvement in measures of pain , disability , anxiety , and vigor while self-esteem and affect remained stable . The N-RTW group displayed no change in pain and disability variables and had significant deterioration in mean overall psychological well-being over time . The best predictors of return to work using logistic regression analyses were a first injury rather than a repeat injury to the lower back , and stability in self-esteem . Suggestions are offered for further research to examine the benefits of aquafit exercise for the low back injured , for additional interventions for those with a reinjury , and for maintaining or enhancing self-esteem as a treatment goal BACKGROUND Participatory ergonomics ( PE ) are often applied for prevention of low back pain ( LBP ) . In this pilot- study , a PE-program is applied to the disability management of workers sick listed due to LBP . METHODS The process , implementation , satisfaction , and barriers for implementation concerning the PE-program were analyzed quantitatively and qualitatively for 35 workers sick listed 2 - 6 weeks due to LBP and their ergonomists . RESULTS Two-hundred- and -seventy ergonomic solutions were proposed to the employer . They were targeted more at work design and organization of work ( 58.9 % ) than at workplace and equipment design ( 38.9 % ) . They were planned mostly on a short-term basis ( 74.8 % ) . Almost half ( 48.9 % ) of the solutions for work adjustment were completely or partially implemented within 3 months after the first day of absenteeism . Most workers were satisfied about the  PE-program  ( median score 7.8 on a 10-point scale ) and reported a stimulating effect on return-to-work ( 66.7 % ) . Main obstacles to implementation were technical or organizational difficulties ( 50.0 % ) and physical disabilities of the worker ( 44.8 % ) . CONCLUSIONS This study suggests that compliance , acceptance , and satisfaction related to the PE-program were good for all participants . Almost half of the proposed solutions were implemented Althoughdoctors are increasingly evaluated on the basis of return-to-work ( RTW ) outcomes , the effect of doctor – patient communication about the workplace and RTW after an occupational injury has received little research attention . The effect of  patient-reported doctor communication on duration of disabilitywas examined retrospectively in a 3-year cohort of 325 cl aim ants with alost-time low back injury . Although doctor proactive communication wasassociated with a greater likelihood of RTW during the acute phase ( < 30days of disability ) , this effect disappeared when injury and workloadcharacteristics were taken into account . A positive RTW recommendation wasassociated with about a 60 % higher RTW rate during the subacute/chronic phase(>30 days of disability ) only . Prospect i ve studies are needed to confirmthis effect . The impact of physician communication on RTW is largelyconfounded by injury and workplacefactors Objectives To evaluate the effectiveness of a participatory workplace intervention compared with usual care for sick-listed employees with distress , with regard to return to work ( RTW ) within the 12-month follow-up . Methods Employees with distress and sick-listed for 2–8 weeks were r and omised to a  workplace intervention ( n=73 ) or to usual care  ( n=72 ) . The participatory workplace intervention is a stepwise process involving the sick-listed employee and their supervisor , aim ed at reducing obstacles for RTW by reaching consensus about an action plan for RTW . Outcome variables were lasting RTW , cumulative sickness absence and stress-related symptoms . Results Overall , an HR of 0.99 ( 95 % CI 0.70 to 1.39 ) indicated no effect of the workplace intervention on lasting RTW . However , the workplace intervention significantly reduced the time until lasting RTW for employees who at baseline intended to return to work despite symptoms with an HR of 2.05 ( 95 % CI 1.22 to 3.45 ) . Employees who intended to return to work despite symptoms returned to work after 55 days in the workplace intervention group and 120 days in the usual care group . No such effect of the intervention was found for employees without baseline intentions to return to work despite symptoms ( HR=0.78 , 95 % CI 0.47 to 1.28 ) . Conclusions No overall effect of the participatory workplace intervention on lasting RTW was found . The workplace intervention appeared effective on lasting RTW for employees who at baseline intended to return to work despite symptoms . For employees who showed no baseline intention to return to work , the intervention did not have any effect . Other approaches are needed for this subgroup . This trial has been registered at the Dutch National Trial Register IS RCT N92307123 Study Design . A r and omized controlled trial . Objective . The aim of this study was to evaluate whether a tailored and manualized cognitive behavior therapy ( CBT ) or nutritional supplements of seal oil and soy oil had any additional benefits over a brief cognitive intervention ( BI ) on return to work ( RTW ) . Summary of Background Data . Brief intervention programs are clinical ly beneficial and cost-effective for patients with low back pain ( LBP ) .  CBT is recommended for LBP , but evidence on RTW is lacking . Seal oil has previously been shown to have a possible effect on muscle pain , but no r and omized controlled trials have so far been carried out in LBP patients . Methods . Four hundred thirteen adults aged 18 to 60 years were included . Participants were sick-listed 2 to 10 months due to LBP . Main outcome was objective ly ascertained work participation at 12-month follow-up . Participants were r and omly assigned to BI ( n = 100 ) , BI and CBT ( n = 103 ) , BI and seal oil ( n = 105 ) , or BI and soy oil ( n = 105 ) . BI is a two-session cognitive , clinical examination program followed by two booster sessions , while the CBT program is a tailored , individual , seven-session manual-based treatment . Results . At 12-month follow-up , 60 % of the participants in the BI group , 50 % in the BI and CBT group , 51 % in the BI and seal oil group , and 53 % in the BI and soy oil group showed reduced sick leave from baseline , and had either partly or fully RTW . The differences between the groups were not statistically significant ( & khgr;2 = 2.54 , P = 0.47 ) . There were no significant differences between the treatment groups at any of the other follow-up assessment s either , except for a significantly lower sick leave rate in the BI group than the other groups during the first 3 months of follow-up ( & khgr;2 = 9.50 , P = 0.02 ) . Conclusion . CBT and seal oil had no additional benefits over a brief cognitive intervention on sick leave . The brief cognitive intervention alone was superior in facilitating a fast RTW . Level of Evidence : Purpose Sickness absence and exclusion from the labour market due to mental health problems ( MHPs ) is a growing concern in many countries . Knowledge about effective return-to-work ( RTW ) intervention models is still limited , but a multidisciplinary , coordinated and tailored approach has shown promising results in the context of musculoskeletal disorders . The purpose of this study was to assess the effectiveness of this approach as implemented among sickness absence beneficiaries with MHPs . Methods In a quasi-r and omised , controlled trial , we assessed the intervention ’s effect in terms of time to RTW and labour market status after 1 year . We used two different analytical strategies to compare time to RTW between participants receiving the intervention ( n = 88 ) and those receiving conventional case management ( n = 80 ) : ( 1 ) a traditional multivariable regression analysis controlling for measured confounding , and ( 2 ) an instrumental variable ( IV ) analysis controlling for unmeasured confounding . Results The two analytical approaches provided similar results in terms of a longer time to RTW among recipients of the intervention ( HR = 0.50 ; 95 % CI 0.34–0.75 ) , although the estimate provided by the IV- analysis was non-significant ( HR = 0.70 ; 95 % CI 0.23–2.12 ) . After 1 year , more recipients of the intervention than of conventional case management were receiving sickness absence benefits ( p = 0.031 ) . Conclusion The intervention  delayed RTW compared to conventional case management , after accounting for measured confounding . The delayed RTW may be due to either implementation or program failure , or both . It may also reflect the complexity of retaining employees with mental health problems in the workplace Study Design . R and omized clinical trial comparing two interventions in employees sick-listed 3 to 16 weeks because of low back pain ( LBP ) . Objective . To compare 1-year return to work ( RTW ) , pain , disability and physical and mental health dimensions in subjects offered a hospital-based multidisciplinary intervention or a brief intervention .  Summary of Background Data . Previous studies in sick-listed employees with LBP have indicated efficacy of both brief and more comprehensive multidisciplinary interventions . However , it remains unknown , which is the more effective , and which elements are instrumental in furthering RTW , and improving health . Methods . The brief intervention comprised clinical examination and advice offered by a rehabilitation physician and a physiotherapist . In the multidisciplinary intervention , this intervention was supplemented with the expertise of a team and the assignment of a case manager who drew up a rehabilitation plan in collaboration with the patient and the multidisciplinary team . One-year RTW was estimated by data from a comprehensive national data base of social transfer payments . Question naires were used to obtain baseline and 1-year data on Rol and Morris disability score , LBP Rating Scale , SF36 , and fear-avoidance . Results . A total of 351 patients were included and r and omized and 344 ( 98 % ) patients participated in all the consultations according to the study protocol . RTW was achieved by 125 ( 71.0 % ) participants in the multidisciplinary and 133 ( 76.0 % ) participants in the brief intervention group . The hazard ratio was 0.84 after adjustment for sex , age , smoking , compensation cl aims , disability score , and diagnosis ( 95 % confidence interval [ CI ] : 0.65–1.08,P = 0.18 ) . Multiple linear regression analysis displayed no differences in secondary outcomes , except for the mental health score ( SF36 ) , which was a little higher in the multidisciplinary intervention group than in the brief intervention group . Conclusion . Hospital-based multidisciplinary intervention may be no better than brief intervention to increase RTW and improve health in sick-listed employees with low back pain OBJECTIVE Validation of a salutogenic theory for return to work ( RTW ) and an associated program process theory . METHODS A longitudinal non-r and omized one-year trial study design was used with a two-year follow-up and with comparison to a reference group . Changes in attitudes and active behaviour in the intervention group and at the workplace were supported by cognitive and behavioural approaches . PARTICIPANTS The intervention group included 118 unskilled Danish public employees and privately employed house-cleaners on sick leave due to musculoskeletal and /or common mental illnesses . RESULTS Significant improvements of work ability index and perceived health ( SF36 subgroups ) were reported . A significantly higher RTW and a shorter sick leave than in the reference group also emerged . Positive predictors of RTW were keeping the pre-sick-leave job and improving work ability index and physical impairment/role physical . Decline in self-efficacy was a negative predictor . CONCLUSIONS Support for the theory and associated program process theory was found . The intervention seemed to influence RTW and the employees ' attitudes , behaviour and health by affecting comprehensibility , meaningfulness and manageability . Sustainable RTW emerged from a synergism of support from the work place and improved personal re sources , especially such as concern mental health . The approach is consistent with integrating health promotion in RTW Background Many studies on low back pain ( LBP ) have identified prognostic factors , but prediction models for use in secondary health care are not available . The purpose of this cohort study , based on a r and omised clinical study , was to identify risk factors for unsuccessful return to work ( U-RTW ) in sick-listed LBP patients with or without radiculopathy and to vali date a prediction model for U-RTW . Methods 325 sick-listed LBP patients with or without radiculopathy were included in an intervention study and followed for one year . Afterwards , 117 other LBP patients were recruited similarly , included in a validation study and also followed for one year . All patients were subjected to identical procedures and interventions and received a brief intervention by the same rehabilitation doctor and physiotherapist . Half of them received case manager guidance within a multidisciplinary setting . At baseline , they completed a question naire and went through a clinical low-back examination . Sciatica was investigated by magnetic resonance imaging ( MRI ) . U-RTW was registered in a national data base both initially and at 1-year . Results Neither initial U-RTW ( 24.0 % ) nor one-year U-RTW ( 38.2 % ) were statistically significantly different in the two intervention groups nor in patients with and without radiculopathy . Multivariate logistic regression analysis identified two clinical and five psychosocial baseline predictors for one-year U-RTW ( primary outcome ) . The clinical predictors included pain score ( back+leg pain ) and side-flexion . The five psychosocial predictors included ‘ bodily distress ’ ‘ low expectations of RTW ’ , ‘ blaming the work for pain ’ , ‘ no home ownership ’ and ‘ drinking alcohol less than once/month ’ . These predictors were not statistically significantly different in patients with and without radiculopathy , and they also predicted initial U-RTW ( secondary outcome ) . Obesity and older age were only supplementary predictors in patients with radiculopathy . A prediction model was established and tested in the validation study group . The model predicted one-year U-RWT in patients with intermediate and high risk , but only partially in patients with low risk . The model predicted all three risk categories in initial U-RTW . Conclusions A prediction model combining baseline clinical and psychosocial risk factors predicted patients with low , intermediate and high risk for unsuccessful return to work , both initially and at 1-year Introduction It was postulated that workers , at the sub-acute stage after injury , respond differently to clinical and occupational interventions offered in a workers ’ compensation environment . Individual worker risk of disability , it was further believed , would influence the effectiveness of early intervention . The objective of the current pilot study was to evaluate return to work ( RTW ) outcomes following proactive , combined clinical , occupational and case management-based interdisciplinary early intervention , provided in a workers ’ compensation environment 4–10 weeks of onset of back pain , to workers with medium and high risk for disability . Methods The project was a controlled study comparing conventional workers ’ compensation case management with integrated , interdisciplinary and multimodal early intervention ( hereinafter referred to as “ EI ” ) . At baseline , risk status was determined by a vali date d Risk for Disability Question naire by Carragee et al. ( Spine 5(1):24–35 , 2005 ) . Seventeen workers at high risk of protracted disability and 20 workers at moderate risk of disability received conventional case management , and 17 workers assessed at high risk of protracted disability and 18 workers at moderate risk of disability received the Early Intervention . Results At 3 months post back pain onset , no statistically significant differences were identified in RTW outcomes between conventional case management and the Early Intervention . However , by 6 months post back pain onset , workers at high risk of work disability who received the Early Intervention were significantly more likely to RTW than high risk workers who received conventional case management . In contrast , moderate risk workers continued to exhibit no statistically significant differences in RTW outcomes . Conclusion Multimodal Early Intervention in the workers ’ compensation case management context is likely effective for workers with sub-acute back pain who are at high risk of occupational disability . The comprehensive Early Intervention is , however , likely redundant for workers who are not at high risk for disability and should not be applied indiscriminately . Further studies are required to determine longer-term Early Intervention outcomes , and to replicate the findings using a r and omized control design . Also , with a larger sample size , it will be possible to determine predictors of occupational outcomes Background Sick-listed employees with low back pain had similar  return to work ( RTW ) rates at one-year follow-up in a r and omized trial comparing two interventions , but the effects were modified by specific workplace related factors . The present study addressed the sustainability of the intervention effects by performing a two-year follow-up and by using different outcome measures . Methods A total of 351 employees sick-listed for 3–16 weeks due to LBP were recruited from their general practitioners and were r and omly allocated to a hospital-based brief or multidisciplinary intervention . Outcome measures were based on sick leave registered in a national data base of social and health-related benefits . RTW rates , RTW status , sick leave weeks and sick leave relapse were studied . Results During the two-year follow-up 80.0 % and 77.3 % had RTW for at least four weeks continuously , and the percentages with RTW at the 104th week were 61.1 % and 58.0 % in the brief and multidisciplinary intervention groups , respectively . At the 104th week 16.6 % and 18.8 % were on sick leave in the two groups , respectively , and about 12 % were employed in modified jobs or participated in job training . The number of weeks on sick leave in the first year was significantly lower in the brief intervention group ( median 14 weeks ) than in the multidisciplinary intervention group ( median 20 weeks ) , but during the second year the number of weeks on sick leave were not significantly different between intervention groups . Subgroups characterised by specific work related factors modified the effect of the intervention groups on RTW rates ( p = 0.017 ) . No difference in sick leave relapse was found between the intervention groups . Conclusion The effects of the brief and multidisciplinary interventions at the two-year follow-up were in general similar to the effects at one-year follow-up . Trial Registration Current Controlled Trials IS RCT This paper describes a participatory ergonomics program aim ed at early return to regular work of workers suffering from subacute occupational back pain and assesses the perceptions of the participants on the implementation of ergonomic solutions  in the workplace . The participatory ergonomics program was used in the rehabilitation of workers suffering from subacute back pain for more than 6 weeks , a program that was associated with an increased rate of return to work . The perceptions of the participatory ergonomics participants were assessed 6 months after completion of the ergonomic intervention through a question naire sent to employer representatives , union representatives and injured workers of participating workplaces . About half of the ergonomic solutions were implemented according to the perception of the participants , with a substantial agreement between respondents Background Low back pain ( LBP ) and neck pain ( NP ) are a major public health problem with considerable costs for individuals , companies and society . Therefore , prevention is imperative . The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics ( PE ) to prevent LBP and NP among workers . Methods In a r and omised controlled trial ( RCT ) , a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline . The departments consisting of about 150 workers are pre-stratified and r and omised . The control departments receive usual practice and the intervention departments receive PE . Within each intervention department a working group is formed including eight workers , a representative of the management , and an occupational health and safety coordinator . During a one day meeting , the working group follows the steps of PE in which the most important risk factors for LBP and NP , and the most adequate ergonomic measures are identified on the basis of group consensus . The implementation of ergonomic measures at the department is performed by the working group . To improve the implementation process , so-called ' ergocoaches ' are trained . The primary outcome measure is an episode of LBP and NP . Secondary outcome measures are actual use of ergonomic measures , physical workload , psychosocial workload , intensity of pain , general health status , sick leave , and work productivity . The cost-effectiveness analysis is performed from the societal and company perspective . Outcome measures are assessed using question naires at baseline and after 6 and 12 months . Data on the primary outcome as well as on intensity of pain , sick leave , work productivity , and health care costs are collected every 3 months . Discussion Prevention of LBP and NP is beneficial for workers , employers , and society . If the intervention is proven (cost-)effective , the intervention can have a major impact on LBP and NP prevention and , thereby , on work disability prevention . Results are expected in 2010.Trial registration IS RCT Background Multidisciplinary intervention is recommended for rehabilitation of employees sick-listed for 4 - 12 weeks due to low back pain ( LBP ) . However , comparison of a brief and a multidisciplinary intervention in a r and omised comparative trial of sick-listed employees showed similar return to work ( RTW ) rates in the two groups . The aim of the present study was to identify subgroups , primarily defined by work-related baseline factors that would benefit more from the multidisciplinary intervention than from the brief intervention . Methods A total of 351 employees sick-listed for 3 - 16 weeks due to LBP were recruited from their general practitioners . They received a brief or a multidisciplinary intervention . Both interventions comprised clinical examination and advice by a rehabilitation doctor and a physiotherapist . The multidisciplinary intervention also comprised assignment of a case manager , who made a rehabilitation plan in collaboration with the patient and a multidisciplinary team . Using data from a national data base , we defined RTW as no sickness compensation benefit disbursement for four consecutive weeks within the first year after the intervention . At the first interview in the clinic , it was ensured that sick leave was primarily due to low back problems . Question naires were used to obtain data on health , disability , demographic and workplace-related factors . Cox hazard regression analyses were used with RTW as outcome measure and hazard rate ratios ( HRR = HRmultidisciplinary/HRbrief ) were adjusted for demographic and health-related variables . An interaction term consisting of a baseline variable*intervention group was added to the multivariable regression model to analyse whether the effects of the interventions were moderated by the baseline factor . Subsequently , a new study was performed that included 120 patients who followed the same protocol . This group was analyzed in the same way to verify the findings from the original study group . Results The multidisciplinary intervention group ensured a quicker RTW than the brief intervention group in a subgroup with low job satisfaction , notably when cl aim ants were excluded . The opposite effect was seen in the subgroup with high job satisfaction . When cl aim ants were excluded , the effect was also in favour of the multidisciplinary intervention in subgroups characterised by no influence on work planning and groups at risk of losing their job . Inversely , the effect was in favour of the brief intervention in the subgroups who were able to influence the planning of their work and who had no risk of losing their job due to current sick leave . Interaction analysis of the data in the new study displayed similar or even more pronounced differences between subgroups in relation to intervention type . Conclusions Multidisciplinary intervention seemed more  effective than brief intervention in subgroups of patients with low job satisfaction , no influence on work planning and feeling at risk of losing their jobs due to their sick leave as compared with subgroups not fulfilling these criteria Objectives The study aims to identify individual and workplace factors associated with early return to work (RTW)—defined as within 3 months— and factors associated with later RTW — between 3 and 12 months after being sick-listed — in a cohort of newly sick-listed individuals with common mental disorders . Methods In a prospect i ve cohort study , a cross-sectional analysis was performed on baseline measures of patients granted sick leave due to common mental disorders . A total of 533 newly sick-listed individuals fulfilled the inclusion criteria and agreed to participate . A baseline question naire was sent by post within 3 weeks of their first day of certified medical sickness ; 354 ( 66 % ) responded . Those who were unemployed were excluded , result ing in a study population of 319 individuals . Sick leave was recorded for each individual from the Social Insurance Office during 1 year . Analyses were made with multiple Cox regression analyses . Results Early RTW was associated with lower education , better work ability at baseline , positive expectations of treatment and low perceived interactional justice with the supervisor . RTW after 3 months was associated with a need to reduce dem and s at work , and turnover intentions . Conclusions Early RTW among sick-listed individuals with common mental disorders seems to be associated with the individual ’s need to secure her/his employment situation , whereas later RTW is associated with variables reflecting dissatisfaction with work conditions . No health measures were associated with RTW . The study highlights the importance of considering not only health and functioning , but also workplace conditions and relations at the workplace in implementing RTW interventions Introduction Within the labour force workers without an employment contract represent a vulnerable group . In most cases , when sick-listed , these workers have no workplace/employer to return to . Therefore , the aim of this study was to evaluate the effectiveness on return-to-work of a participatory return-to-work program compared to usual care for unemployed workers and temporary agency workers , sick-listed due to musculoskeletal disorders . Methods The workers , sick-listed for 2–8 weeks due to musculoskeletal disorders , were r and omly allocated to the participatory return-to-work program ( n = 79 ) or to usual care ( n = 84 ) . The new program is a stepwise procedure aim ed at making a consensus-based return-to-work plan , with the possibility of a temporary ( therapeutic ) workplace . Outcomes were measured at baseline , 3 , 6 , 9 and 12 months . The primary outcome measure was time to sustainable first return-to-work . Secondary outcome measures were duration of sickness benefit , functional status , pain intensity , and perceived health . Results The median duration until sustainable first return-to-work was 161 days in the intervention group , compared to 299 days in the usual care group . The new return-to-work program result ed in a non-significant delay in RTW during the first 90 days , followed by a significant advantage in RTW rate after 90 days ( hazard ratio of 2.24 [ 95 % confidence interval 1.28–3.94 ] P = 0.005 ) . No significant differences were found for the measured secondary outcomes . Conclusions The newly developed participatory return-to-work program seems to be a promising intervention to facilitate work resumption and reduce work disability among temporary agency workers and unemployed workers , sick-listed due to musculoskeletal disorders Background Both low back pain ( LBP ) and neck pain ( NP ) are major occupational health problems . In the workplace , participatory ergonomics ( PE ) is frequently used on musculoskeletal disorders . However , evidence on the effectiveness of PE to prevent LBP and NP obtained from r and omised controlled trials ( RCTs ) is scarce . This study evaluates the process of the Stay@Work participatory ergonomics programme , including the perceived implementation of the prioritised ergonomic measures . Methods This cluster- RCT was conducted at the departments of four Dutch companies ( a railway transportation company , an airline company , a steel company , and a university including its university medical hospital ) . Directly after the r and omisation outcome , intervention departments formed a working group that followed the steps of PE during a six-hour working group meeting . Guided by an ergonomist , working groups identified and prioritised risk factors for LBP and NP , and composed and prioritised ergonomic measures . Within three months after the meeting , working groups had to implement the prioritised ergonomic measures at their department . Data on various process components ( recruitment , reach , fidelity , satisfaction , and implementation components , i.e. , dose delivered and dose received ) were collected and analysed on two levels : department ( i.e. , working group members from intervention departments ) and participant ( i.e. , workers from intervention departments ) . Results A total of 19 intervention departments ( n = 10 with mental workloads , n = 1 with a light physical workload , n = 4 departments with physical and mental workloads , and n = 4 with heavy physical workloads ) were recruited for participation , and the reach among working group members who participated was high ( 87 % ) . Fidelity and satisfaction towards the PE programme rated by the working group members was good ( 7.3 or higher ) . The same was found for the Stay@Work ergocoach training ( 7.5 or higher ) . In total , 66 ergonomic measures were prioritised by the working groups . Altogether , 34 % of all prioritised ergonomic measures were perceived as implemented ( dose delivered ) , while the workers at the intervention departments perceived 26 % as implemented ( dose received ) . Conclusions PE can be a successful method to develop and to prioritise ergonomic measures to prevent LBP and NP . Despite the positive rating of the PE programme the implementation of the prioritised ergonomic measures was lower than expected . Trial registration Current Controlled Trials IS RCT Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions Background Gastrointestinal ( GI ) cancer is frequently diagnosed in people of working age , and many GI cancer patients experience work-related problems . Although these patients often experience difficulties returning to work , supportive work-related interventions are lacking . We have therefore developed a tailored work-related support intervention for GI cancer patients , and we aim to evaluate its cost-effectiveness compared with the usual care provided . If this intervention proves effective , it can be implemented in practice to support GI cancer patients after diagnosis and to help them return to work . Methods / Design We design ed a multicentre r and omized controlled trial with a follow-up of twelve months . The study population ( N = 310 ) will include individuals aged 18–63 years diagnosed with a primary GI cancer and employed at the time of diagnosis . The participants will be r and omized to the intervention or to usual care . ‘ Usual care ’ is defined as psychosocial care in which work-related issues are not discussed . The intervention group will receive tailored work-related support consisting of three face-to-face meetings of approximately 30 min each . Based on the severity of their work-related problems , the intervention group will be divided into groups receiving three types of support ( A , B or C ) . A different supportive healthcare professional will be available for each group : an oncological nurse ( A ) , an oncological occupational physician ( B ) and a multidisciplinary team ( C ) that includes an oncological nurse , oncological occupational physician and treating oncologist/physician . The primary outcome measure is return to work ( RTW ) , defined as the time to a partial or full RTW . The secondary outcomes are work ability , work limitations , quality of life , and direct and indirect costs . Discussion The hypothesis is that tailored work-related support for GI cancer patients is more effective than usual care in terms of the RTW . The intervention is innovative in that it combines oncological and occupational care in a clinical setting , early in the cancer treatment process . Trial registration METC protocol number NL51444.018.14/Netherl and s Trial Register number NTR5022 . Registered 6 March 2015 Abstract . Return to work ( RTW ) is the primary goal in the rehabilitation of patients with chronic low back pain . In spite of expensive rehabilitative efforts , many patients do not RTW . To increase cost effectiveness , predictive tests for non-RTW are needed to select patients for rehabilitation . The reliability of these tests must be high , to prevent exclusion of patients who might improve . This study evaluates the reliability and predictive validity of four tests and the following psychosocial factors for non-RTW : nationality , off-work duration , unemployment and work load . It was design ed as a prospect i ve cohort study of 99 patients with chronic low back pain . Upon entry , physical work load , time off work , unemployment and nationality were recorded . The study investigated four tests with an anticipated prognostic value for non-RTW : the  Numeric Pain Rating Scale ( NRS , 9–10 of a maximum of 10 ) , the  Step Test and Pseudo Strength Test ( precipitous cessation ) and  Behavioural Signs .  After 12 months , the RTW rate was obtained from the physicians responsible for sick-listing by postal survey . The response rate regarding RTW was 91 % at 1 year . The RTW rate at 1 year was 20 % . All investigated tests significantly correlated with non-RTW . Regression analysis showed that the best prediction of non-RTW was obtained when at least two out of the four tests were positive ( positive predictive value 0.97 , sensitivity 0.45 ) . Unemployment , time off work , nationality and physical work load were less predictive . The results show that the combination of the four prognostic tests allows a very reliable prognosis of non-RTW . The cost effectiveness of rehabilitation aim ing at RTW will , therefore , be increased by excluding patients with two or more positive tests Objectives To evaluate the cost effectiveness , cost utility and cost benefit of a workplace intervention compared with usual care for sick-listed employees with distress . Methods An economic evaluation was conducted alongside a r and omised controlled trial . Employees with distress and who were sick-listed for 2–8 weeks were r and omised to a workplace intervention ( n=73 ) or to usual care ( n=72 ) . The workplace intervention is a stepwise process involving the sick-listed employee and their supervisor , aim ed at formulating a consensus-based plan for return to work ( RTW ) . The effect outcomes were lasting RTW and quality -adjusted life years ( QALYs ) . Healthcare utilisation was measured over 12 months . Cost effectiveness analyses ( CEA ) and cost utility analyses ( CUA ) were conducted from the societal perspective and cost benefit analyses ( CBA ) from the employer perspective . Bootstrapping techniques were used to estimate cost and effect differences , related CIs , and cost effectiveness and cost utility ratios . Cost effectiveness planes were presented and subgroup analyses were performed . Results CEA and CUA revealed no statistically significant differences in lasting RTW , QALYs or costs . The CBA indicated a statistically significant higher cost of occupational health services in the workplace intervention group . The workplace intervention was not cost effective according to the CEA , CUA and CBA . Conclusions Widespread implementation of the workplace intervention for sick-listed employees with distress is not recommended because there was no economic benefit compared with usual care . Future trials should confirm if the workplace intervention is cost effective for the subgroup employees who intended to return to work despite symptoms . This trial has been registered at the Dutch National Trial Register IS RCT N92307123 Background Work disability following motor vehicle related orthopaedic trauma is a significant contributor to the burden of injury and disease . Early identification of predictors for return to work ( RTW ) is essential for developing effective interventions to prevent work disability . The study aim was to determine the predictors ( including compensation related factors ) of time to RTW following motor vehicle related orthopaedic trauma . Methods Admitted patients were recruited prospect ively from two trauma hospitals with upper and /or lower extremity fractures following a motor vehicle crash . Baseline and follow up data were collected by written question naire . For baseline , this occurred in person within 2 weeks of injury . For follow up , this occurred by mail at six , 12 and 24 months . Additional demographic and injury-related information was retrieved from hospital data bases . Analysis involved : descriptive statistics ; logrank test to detect survival distributions of categorical variables ; and Cox proportional hazards regression models for risks of time to RTW using baseline characteristic and compensation related variables ( at 6 months ) . Results Of 452 study participants 334 ( 74 % ) were working pre-injury : results are based on this subset . Baseline characteristics were mean age 36 years ( 13.9 St and ard Deviation [ SD ] ) , 80 % male ; 72 % self-assessed very good-excellent pre-injury health , 83 % household income > AU$40,000 ( Australian Dollar ) . Follow up data was available for 233 ( 70 % ) , 210 ( 63 % ) , and 182 ( 54 % ) participants at six , 12 and 24 months respectively . Significant risks of a longer time to RTW were greater injury severity , as measured by the New Injury Severity Score ( NISS ) ( Hazards Rate Ratio [ HRR ] = 0.54 , 95 % CI 0.35 - 0.82 ) ; and lower occupational skill levels ( HRR = 0.53 , 95 % CI 0.34 - 0.83 ) . Significant risks of a shorter time to RTW were : recovery expectations for usual activities within 90 days ( HRR = 2.10 , 95 % CI 1.49 - 2.95 ) ; full-time pre-injury work hours ( HRR = 1.99 , 95 % CI 1.26 - 3.14 ) ; and very good self-assessed pre-injury health status ( HRR = 1.41 , 95 % CI 0.98 - 2.02 ) . Legal representation ( analysed at six months only ) was not associated with time to RTW . At each time period , there were 146 ( 63 % ) , 149 ( 71 % ) , and 137 ( 76 % ) working participants . Conclusions A longer time to RTW was associated with greater injury severity and lower occupational skill levels ; while a shorter time to RTW was associated with recovery expectations for usual activities within 90 days , full-time pre-injury work hours , and very good self-assessed pre-injury health status . Our findings reinforce existing research . There is an opportunity to trial interventions that address potentially modifiable factors . The issues surrounding legal representation are complex and require further research Background In the present study the effect of a workplace-oriented intervention for persons on long-term sick leave for clinical burnout , aim ed at facilitating return to work ( RTW ) by job-person match through patient-supervisor communication , was evaluated . We hypothesised that the intervention group would show a more successful RTW than a control group . Methods In a prospect i ve controlled study , subjects were identified by the regional social insurance office 2 - 6 months after the first day on sick leave . The intervention group ( n = 74 ) was compared to a  control group who had declined participation , being matched by length of sick leave ( n = 74 ) . The RTW was followed up , using sick-listing register data , until 1.5 years after the time of intervention . Results There was a linear increase of RTW in the intervention group during the 1.5-year follow-up period , and 89 % of subjects had returned to work to some extent at the end of the follow-up period . The increase in RTW in the control group came to a halt after six months , and only 73 % had returned to work to some extent at the end of the 1.5-year follow-up . Conclusions We conclude that the present study demonstrated an improvement of long-term RTW after a workplace-oriented intervention for patients on long-term sick leave due to burnout . Trial registration Current Controlled Trials NCT01039168 Objectives To support return to work ( RTW ) among cancer patients , a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy . The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes . Design Longitudinal prospect i ve intervention study using a one-group design . Setting Two hospitals in the Netherl and s. Participants Of the eligible patients , 56 % participated ; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included . Patients completed question naires on RTW , the importance of work , work ability ( WAI ) , RTW self-efficacy , fatigue ( MFI ) , and quality of life ( EORTC QLQ C-30 ) at baseline and 6 , 12 and 18 months follow-up . Before and after the exercise programme 1-repetition maximum ( 1RM ) muscle strength and cardiorespiratory fitness ( VO2 peak ) were assessed . Results Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme , 59 % of the cancer patients returned to work , 86 % at 12 months and 83 % at 18 months . In addition , significant improvements ( p<0.05 ) in the importance of work , work ability , RTW self-efficacy , and quality of life were observed , whereas fatigue levels were significantly reduced . After completing the exercise programme , 1RM muscle strength was significantly increased but there was no improvement in VO2 peak level . Conclusions RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme . A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW , reduced fatigue and increased importance of work , work ability , and quality of life Back-related injuries have become a major health problem in the workplace , affecting as many as 35 percent of the work force and accounting for about 25 percent of all compensation cl aims . This study evaluates a back injury prevention program  among employees in a northern California county in 1989 - 90 . Six divisions of the county government were selected for the study because they had the highest prevalence of back pain experienced and the most back-related injuries in recent years . Four of the six divisions were r and omly selected as the intervention group and the remaining two , the  control group . Overall , 77 percent or 205 of the targeted employees in the intervention group participated in the study . The intervention group was given an identical health risk assessment ( HRA ) before and after the 1-year back injury prevention program that offered employees a combination of education , training , physical fitness activities , and ergonomic improvement . The control group was neither given the HRA nor offered the program . The back injury and cost data of both the control and intervention groups were collected before and after the 1-year intervention . The results showed a modest overall decline in back pain prevalence rates , but significant improvement in satisfaction and reduction in risky behaviors . Cost-benefit analysis showed the net benefit of introducing back injury prevention program was $ 161,108 , and the return on investment is 179 percent . Therefore , the study offers suggestive evidence for the initial benefits of a back injury prevention program and lends support to the widely held belief that health promotion in the workplace can reduce employee health risks , increase healthful behaviors and attitudes , and improve attitudes toward the employer organization . Whether such intervention will continue to reap benefits in future years depends , to a large extent , on a favorable work environment and the maintenance and continuation of positive behavioral changes
The key features of the program include ; having trained personnel coordinate the RTW process , identifying and ranking barriers and solutions to RTW from the perspective of all important stakeholders , mediating practical solutions at the workplace and , empowering the injured worker in RTW decision-making .
Background Despite over 2 decades of research , the ability to prevent  work-related low back pain ( LBP ) and disability  remains elusive .
Recent research suggests that interventions that are focused at the workplace and incorporate the principals of participatory ergonomics and return-to-work ( RTW ) coordination can improve RTW and reduce disability following a work-related back injury .
Workplace interventions or programs to improve RTW  are difficult to design and implement given the various individuals and environments involved , each with their own unique circumstances .
Intervention mapping provides a framework for design ing and implementing complex interventions or programs .
The objective of this study is to design a best evidence RTW program for occupational LBP tailored to the Ontario setting using an intervention mapping approach .