Return to Work Expectations of Workers on Long-Term Non-Work-Related Sick Leave 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 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 A two-year follow-up on a program theory of return to work intervention. 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Introduction Despite suggestions that worker perception might be the best predictor of return to work ( RTW ) , there still is limited research on time to RTW in workers with lengthy non-work-related sick leave . Methods Prospect i ve cohort study of 663 workers with a current long-term non-work-related sick leave episode recruited during the first medical visit in a mutua ( Spanish health insurance company ) and followed until their sick leave episode ended . Workers completed a baseline question naire regarding their perceptions of sick leave episode and expectations of RTW ( i.e. , health status , work ability , expectations and time required to RTW , self-efficacy and self-perceived connection between health and job ) . Time to RTW  was established based on the mutua ’s register . Cox regression models were used to examine the associations of worker perception and expectation of  RTW  with time to RTW within the study population as a whole as well as in three diagnostic subgroups ( i.e. , musculoskeletal disorders , mental disorders and other physical conditions ) . Results As a whole , time to RTW was longer for workers reporting poor health [ hazard ratio ( HR ) = 0.71 , 95%CI 0.59–0.85 ] , extremely reduced work ability ( HR = 0.69 , 95%CI 0.53–0.88 ) , a longer period of time required to RTW ( HR = 0.36 , 95%CI 0.25–0.52 ) and lack of expectation of returning to the same job ( HR = 0.13 , 95%CI 0.06–0.31 ) . Workers with musculoskeletal and other physical conditions showed a similar pattern to whole study population , while workers with mental disorders did not . Conclusion Self-required time and RTW expectations are important prognostic factors in sick listed workers by all types of health conditions certified as non-work-related . Question ing the workers on their perceptions and expectations of RTW during medical visits could help health care professionals to identify individuals at risk of long-term sickness absence and facilitate triage and management of the patient 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 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 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 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 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 Objective To identify potentially effective complementary approaches for musculoskeletal (MSK)–mental health ( MH ) comorbidity , by synthesis ing evidence on effectiveness , cost-effectiveness and safety from systematic review s ( SRs ) . Design Scoping review of SRs . Methods We search ed literature data bases , registries and reference lists , and contacted key authors and professional organisations to identify SRs of r and omised controlled trials for complementary medicine for MSK or MH . Inclusion criteria were : published after 2004 , study ing adults , in English and scoring > 50 % on Assessing the Method ological Quality of Systematic Review s ( AMSTAR ) ; quality appraisal checklist ) . SRs were synthesis ed to identify research priorities , based on moderate/good quality evidence , sample size and indication of cost-effectiveness and safety . Results We included 84 MSK SRs and 27 MH SRs . Only one focused on MSK – MH comorbidity . Meditative approaches and yoga may improve MH outcomes in MSK population s. Yoga and tai chi had moderate/good evidence for MSK and MH conditions . SRs reported moderate/good quality evidence ( any comparator ) in a moderate/large population for :  low back pain ( LBP )  ( yoga , acupuncture , spinal manipulation/mobilisation , osteopathy ) , osteoarthritis ( OA ) ( acupuncture , tai chi ) , neck pain  ( acupuncture , manipulation/manual therapy ) , myofascial trigger point pain ( acupuncture ) , depression ( mindfulness-based stress reduction ( MBSR ) , meditation , tai chi , relaxation ) , anxiety ( meditation/MBSR , moving meditation , yoga ) , sleep disorders ( meditative/mind – body movement ) and stress/distress ( mindfulness ) . The majority of these complementary approaches had some evidence of safety — only three had evidence of harm . There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP , and manual therapy/manipulation for neck pain , but few SRs review ed cost-effectiveness and many found no data . Conclusions Only one SR studied MSK – MH comorbidity . Research priorities for complementary medicine for both MSK and MH ( LBP , OA , depression , anxiety and sleep problems ) are yoga , mindfulness and tai chi . Despite the large number of SRs and the prevalence of comorbidity , more high- quality , large r and omised controlled trials in comorbid population s are needed 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 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 Background The aim of the present study was to conduct subgroup-analyses in a prospect i ve cohort of workers on long-term sickness absence to investigate whether associations between perceived work attitude , self-efficacy and perceived social support and time to RTW differ across different health conditions . Methods The study was based on a sample of 926 workers on sickness absence ( 6–12 weeks ) . The participants filled out a baseline question naire and were subsequently followed until the tenth month after listing sick .  Perceived work attitude  was measured with a Dutch language version of the Work Involvement Scale .  Perceived social support  was measured with a self-constructed st and ardized scale reflecting a person ’s perception of social support regarding RTW . Self-efficacy was measured with the st and ardised Dutch version of the General self-efficacy scale , assessing the subjects ’ expectations of their general capacities . The sample was divided into three subgroups : musculoskeletal health conditions , other physical health conditions and mental health conditions . Anova analyses and Cox proportional hazards regression analyses were used to identify differences in association between the three factors and the time to RTW between different subgroups . Results The associations between the perceived work attitude , self-efficacy and perceived social support and the time to RTW vary across different health condition subgroups , not only with regard to the strength of the association but also for the type of factor . In the multivariate model , hazard ratios ( HRs ) of 1.33 ( 95 % CI 1.01–1.75 ) in the musculoskeletal subgroup , and 1.26 ( 95 % CI 0.89–1.78 ) in the other physical subgroup were found in perceived work attitude . With regard to perceived social support HRs of 1.39 ( 95 % CI 1.12–1.99 ) respectively 1.51 ( 1.05–2.17 ) in the same subgroups were found . Only self-efficacy remained in the multivariate model in all subgroups with HRs of 1.49 ( 95 % CI 1.12–1.99 ) in the musculoskeletal subgroup , 1.53 ( 95 % CI 1.07–2.18 ) in the other physical subgroup and 1.60 ( 1.07–2.40 ) in the mental subgroup . Conclusions The results of this study show that perceived work attitude , self-efficacy and perceived social support are relevant predictors with regard to the time to RTW in all types of health conditions , but that important differences are observed in type of factor and strengths of the relationships between physical and mental health conditions Background Common mental disorders ( CMD ) have a major impact on both society and individual workers , so return to work ( RTW ) is an important issue . In The Netherl and s , the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW . Evidence -based guidelines are available , but seem not to be effective in improving RTW in people with CMD . An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed . A blended E-health module embedded in collaborative occupational health care is now available , and comprises a decision aid supporting the occupational physician and an E-health module , Return@Work , to support sick-listed workers in the RTW process . The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual . Methods This study is a two-armed cluster r and omized controlled trial , with r and omization done at the level of occupational physicians . Two hundred workers with CMD on sickness absence for 4–26 weeks will be included in the study . Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention . Occupational physicians allocated to the care as usual group will give conventional sickness guidance . Follow-up assessment s will be done at 3 , 6 , 9 , and 12 months after baseline . The primary outcome is duration until RTW . The secondary outcome is severity of symptoms of CMD . An economic evaluation will be performed as part of this trial . Conclusion It is hypothesized that collaborative occupational health care intervention will be more (cost)-effective than care as usual . This intervention is innovative in its combination of a decision aid by email sent to the occupational physician and an E-health module aim ed at RTW for the sick-listed worker Background Since a higher level of self-efficacy in common mental disorders is associated with earlier return-to-work ( RTW ) , it is important to know if work related self-efficacy can be increased by occupational health care . The primary aim of this study was to evaluate whether an intervention to enhance guideline adherence of occupational physicians lead to an increase in RTW self-efficacy in workers three months later . The secondary aim was to evaluate whether the intervention modified the association between RTW self-efficacy and return-to-work three months later . Methods A total of 66 occupational physicians participated in the study . They were r and omized into two groups ; the intervention group received a training , the control group did not . The training aim ed to enhance adherence to a mental health guideline that contained strategies that are supposed to enhance RTW self-efficacy . In 128 sick-listed workers guided by these occupational physicians , RTW self-efficacy , RTW , and personal , health-related and work-related variables were measured at baseline and three months later . Generalized linear mixed models analysis and linear mixed models analysis were used for the evaluations . Results In workers whose occupational physicians had received the training RTW self-efficacy increased significantly more than in workers whose occupational physicians had participated in the control group ( t = −2.626 , p ≤ .05 ) . Higher baseline RTW self-efficacy scores were significantly more often associated with full RTW than with no RTW three months later ( OR 2.20 , 95 % CI 1.18–4.07 ) , but the intervention did not affect this association . Conclusions This study showed that a training to enhance guideline adherence of occupational physicians leads to increased RTW self-efficacy in workers sick-listed with common mental disorders during the first months of sickness absence in a real-life occupational health care setting . This insight is helpful for optimizing the recovery and RTW process , and for underst and ing the role of RTW self-efficacy in this process . Trial registration IS RCT 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 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 In case of long-term sick leave , gradually increasing workload appears to be an effective component of work-directed interventions to reduce sick leave due to common mental disorders ( CMD ) . CMD are defined as stress-related , adjustment , anxiety , or depressive disorders . We developed an exposure-based return-to-work ( RTW-E ) intervention and evaluated the effect on time-to-full return to work ( RTW ) among workers who were on sick leave due to CMD in comparison to those treated with care-as-usual ( CAU ) . CAU is guideline -directed and consists of problem-solving strategies and grade d activities . METHODS Using a two-armed cluster-r and omized trial , we r and omized 56 occupational physicians ( OP ) . Of these , 35 OP treated 160 workers at the start of their sick leave ; 75 workers received RTW-E and 85 workers received CAU .  These workers were followed over a 12-month follow-up period . The time-to-full RTW lasting ≥28 days without recurrence was the primary outcome measure . To evaluate differences between groups , we used intention-to-treat and multilevel Cox 's regression analysis . RESULTS The median time-to-full RTW differed significantly between groups [ hazard ratio ( HR ) 0.55 ; 95 % confidence interval ( 95 % CI ) 0.33 - 0.89 ] . The workers receiving RTW-E ( 209 days ; 95 % CI 62 - 256 ) had a prolonged time-to-full RTW compared to workers receiving CAU ( 153 days ; 95 % CI 128 - 178 ) . CONCLUSIONS Workers on sick leave due to CMD treated with RTW-E showed a prolonged time-to-full RTW compared to those treated with CAU . We recommend that OP do not apply RTW-E but continue counseling workers on sick leave due to CMD according to CAU Compare the effects of integrated case management and usual care on patient satisfaction in employees with work-related upper extremity disorder ( WRUED ) , and consider the implication s of higher levels of satisfaction . Describe those patient-related and work-related factors that predict the severity of upper limb symptoms and the degree of functional limitation 6 and 12 months after intervention . Enumerate the factors influencing the interval before return to work in employees with WRUED who are managed by traditional or integrated case management . An integrated case management ( ICM ) approach ( ergonomic and problem-solving intervention ) to work-related upper-extremity disorders was examined in relation to patient satisfaction , future symptom severity , function , and return to work ( RTW ) .  Federal workers with work-related upper-extremity disorder workers ’ compensation cl aims ( n = 205 ) were r and omly assigned to usual care or ICM intervention .  Patient satisfaction was assessed after the 4-month intervention period . Question naires on clinical outcomes and ergonomic exposure were administered at baseline and at 6- and 12-months postintervention . Time from intervention to RTW was obtained from an administrative data base . ICM group assignment was significantly associated with greater patient satisfaction . Regression analyses found higher patient satisfaction levels predicted decreased symptom severity and functional limitations at 6 months and a shorter RTW . At 12 months , predictors of positive outcomes included male gender , lower distress , lower levels of reported ergonomic exposure , and receipt of ICM . Findings highlight the utility of targeting workplace ergonomic and problem solving skills 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 Purpose Evidence -based guidelines in occupational health care improve the quality of care and may reduce sickness absence duration . Notwithst and ing that , guideline adherence of occupational physicians ( OPs ) is limited . Based on the literature on guideline implementation , an intervention was developed that was shown to effectively improve self-reported adherence in OPs . The aim of present study was to evaluate whether this intervention leads to earlier return to work ( RTW ) in workers with common mental disorders ( CMD ) . Methods In a two-armed cluster r and omized controlled trial , 66 OPs were r and omized . The trial included 3379 workers , with 1493 in the intervention group and 1886 in the control group . The outcome measures were : time to full RTW , time to first RTW , and total hours of sickness absence . Cox regression analyses and generalized linear mixed model analyses were used for the evaluations . Results The median time to RTW was 154 days among the 3228 workers with CMD . No significant differences occurred in ( time to ) full RTW between intervention and control group HR 0.96 ( 95 % CI 0.81–1.15 ) nor for first RTW HR 0.96 ( 95 % CI 0.80–1.15 ) . The mean total hours of sickness absence was 478 h in the intervention group and 483 h in the control group . Conclusions The intervention to enhance OPs ’ guideline adherence did not lead to earlier RTW in workers with CMD guided by the OPs . Possible explanations are the remaining external barriers for guideline use , and that perceived guideline adherence might not represent actual guideline adherence and improved care . Trail registration : IS RCT N86605310 Objective : To evaluate the effectiveness of guideline -based care ( GBC ) of workers with mental health problems , which promotes counseling by the occupational physician ( OP ) facilitating return to work ( RTW ) . Methods : In a r and omized controlled trial with police workers on sick leave due to mental health problems ( n = 240 ) , trained OPs delivered GBC in the intervention group .  Time to RTW and recurrences during 1-year follow-up , analyzed using Cox proportional hazards models , were compared with usual care ( UC ) with easy access to a psychologist . Results : GBC by OPs did not result in earlier RTW than UC . Subgroup analysis showed a small effect in favor of GBC for workers with administrative functions and /or “ minor ” stress-related symptoms . Conclusions : GBC did not differ in RTW compared with UC , but may be beneficial for the majority of workers with minor stress-related disorders Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 The aim of this study was to compare the effectiveness of two individual-level psychotherapy interventions : ( a ) treatment as usual consisting of cognitive-behavioral therapy ( CBT ) and ( b ) work-focused CBT ( W-CBT ) that integrated work aspects early into the treatment . Both interventions were carried out by psychotherapists with employees on sick leave because of common mental disorders ( depression , anxiety , or adjustment disorder ) . In a quasi-experimental design , 12-month follow-up data of 168 employees were collected . The  CBT group consisted of 79 clients , the W-CBT group of 89 . Outcome measures were duration until return to work ( RTW ) , mental health problems , and costs to the employer . We found significant effects on duration until RTW in favor of the W-CBT group : full RTW occurred 65 days earlier . Partial RTW occurred 12 days earlier . A significant decrease in mental health problems was equally present in both conditions . The average financial advantage for the employer of an employee in the W-CBT group was estimated at $ 5,275 U.S. dollars compared with the CBT group . These results show that through focusing more and earlier on work-related aspects and RTW , functional recovery in work can be substantially speeded up within a regular psychotherapeutic setting . This result was achieved without negative side effects on psychological complaints over the course of 1 year . Integrating work-related aspects into CBT is , therefore , a fruitful approach with benefits for employees and employers alike 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 OBJECTIVES The purpose of this study was to assess the effects of early part-time sick leave on return to work ( RTW ) and sickness absence among patients with musculoskeletal disorders . METHODS A r and omized controlled trial was conducted in six occupational health units of medium- and large-size enterprises . Patients aged 18 - 60 years with musculoskeletal disorders ( N=63 ) unable to perform their regular work were r and omly allocated to part- or full-time sick leave . In the former group , workload was reduced by restricting work time by about a half . Remaining work tasks were modified when necessary , as specified in a " fit note " from the physician . The main outcomes were time to return to regular work activities and sickness absence during 12-month follow-up . RESULTS Time to RTW sustained for ≥4 weeks was shorter in the intervention group ( median 12 versus 20 days , P=0.10 ) . Hazard ratio of RTW adjusted for age was 1.60 [ 95 % confidence interval ( 95 % CI ) 0.98 - 2.63 ] and 1.76 ( 95 % CI 1.21 - 2.56 ) after further adjustment for pain interference with sleep and previous sickness absence at baseline . Total sickness absence during the 12-month follow-up was about 20 % lower in the intervention than the control group . Compliance with the intervention was high with no discontinuations of part-time sick leave due to musculoskeletal reasons . CONCLUSIONS Early part-time sick leave may provide a faster and more sustainable return to regular duties than full-time sick leave among patients with musculoskeletal disorders . This is the first study to show that work participation can be safely increased with early part-time sick leave Background This is a r and omized clinical trial ( RCT ) to investigate the efficacy of a job placement and support program design ed for workers with musculoskeletal injuries and having difficulties in resuming the work role . The program was planned to help injured workers to successfully return to work ( RTW ) by overcoming the difficulties and problems during the process of job seeking and sustaining a job using a case management approach . Methodology A total of 66 injured workers were recruited and r and omly assigned into the job placement and support group ( PS group ) or the self-placement group ( SP group ) . A three-week job placement and support program was given to subjects in the PS group while subjects in the control group ( SP group ) were only given advice on job placement at a workers ’ health center . The PS program was comprised of an individual interview , vocational counseling , job preparation training , and assisted placement using the case management approach . The Chinese Lam Assessment of Stages of Employment Readiness ( C-LASER ) , the Chinese State Trait and Anxiety Inventory ( C-STAI ) , and the SF-36 were the outcome measures for the two groups before and after the training program to observe the changes in subjects ’ work readiness status , emotional status and their health related quality of life pre- and post-training program . The rate of return to work was measured for both groups of subjects after the training program . Results The results indicated that the rate of success in RTW ( 73 % ) was significantly higher in the job placement ( PS ) group than that of the self-placement ( SP ) group ( 51.6 % ) with P < 0.05 . Significant differences were also found in C-STAI ( P < 0.05 ) , SF-36 ( P < 0.05 ) and C-LASER scores on action ( P < 0.05 ) between the two groups . Conclusion The job placement ( PS ) program appeared to have enhanced the employability of injured workers . Workers who participated in the program also showed higher levels of work readiness and emotional status in coping with their work injuries 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 Introduction In Denmark , the magnitude and impact of work disability on the individual worker and society has prompted the development of a new “ coordinated and tailored work rehabilitation ” ( CTWR ) approach . The aim of this study was to compare the effects of CTWR with conventional case management ( CCM ) on return-to-work of workers on sick leave due to musculoskeletal disorders ( MSDs ) . Methods The study was a r and omized controlled trial with economic evaluation undertaken with workers on sick leave for 4–12 weeks due to MSDs . CTWR consists of a work disability screening by an interdisciplinary team followed by the collaborative development of a RTW plan . The primary outcome variable was registered cumulative sickness absence hours during 12 months follow-up . Secondary outcomes were work status as well as pain intensity and functional disability , measured at baseline , 3 and 12 months follow-up . The economic evaluation ( intervention costs , productivity loss , and health care utilization costs ) was based on administrative data derived from national registries . Results For the time intervals 0–6 months , 6–12 months , and the entire follow-up period , the number of sickness absence hours was significantly lower in the CTWR group as compared to the control group . The total costs saved in CTWR participants compared to controls were estimated at US $ 1,366 per person at 6 months follow-up and US $ 10,666 per person at 12 months follow-up . Conclusions Workers on sick leave for 4–12 weeks due to MSD who underwent “ CTWR ” by an interdisciplinary team had fewer sickness absence hours than controls . The economic evaluation showed that — in terms of productivity loss — CTWR seems to be cost saving for the society 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 Background To reduce the duration of sick leave and loss of productivity due to common mental disorders ( CMDs ) , we developed a return-to-work programme to be provided by occupational physicians ( OPs ) based on the principles of exposure in vivo ( RTW-E programme ) . This study evaluates this programme 's effectiveness and cost-effectiveness by comparing it with care as usual ( CAU ) . The three research questions we have are : 1 ) Is an RTW-E programme more effective in reducing the sick leave of employees with common mental disorders , compared with care as usual ? 2 ) Is an RTW-E programme more effective in reducing sick leave for employees with anxiety disorders compared with employees with other common mental disorders ? 3 ) From a societal perspective , is an RTW-E programme cost-effective compared with care as usual ? Methods / design This study was design ed as a pragmatic cluster-r and omized controlled trial with a one-year follow-up and r and omization on the level of OPs . We aim ed for 60 OPs in order to include 200 patients . Patients in the intervention group received the RTW-E programme .  Patients in the control group received care as usual .  Eligible patients had been on sick leave due to common mental disorders for at least two weeks and no longer than eight weeks . As primary outcome measures , we calculated the time until full return to work and the duration of sick leave . Secondary outcome measures were time until partial return to work , prevalence rate of sick leave at 3 , 6 , 9 , and 12 months ' follow-up , and scores of symptoms of distress , anxiety , depression , somatization , and fatigue ; work capacity ; perceived working conditions ; self-efficacy for return to work ; coping behaviour ; avoidance behaviour ; patient satisfaction ; and work adaptations . As process measures , we used indices of compliance with the intervention in the intervention group and employee-supervisor communication in both groups . Economic costs were calculated from a societal perspective . The total costs consisted of the costs of consuming health care , costs of production loss due to sick leave and reduced productivity , and out-of-pocket costs of patients for travelling to their OP . Discussion The results will be published in 2009 . The strengths and weaknesses of the study protocol are discussed . Trial registration IS RCT 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 Robot-assisted radical prostatectomy ( RARP ) has been associated with reduced bleeding and shorter hospital stays than open retropubic radical prostatectomy ( RRP ) , but it is unclear whether these differences translate into shorter absence from work . OBJECTIVE To investigate short- and long-term rates of work disability following RARP and RRP . DESIGN , SETTING , AND PARTICIPANTS We conducted a nationwide population -based cohort study of 2571 men of working age treated with RARP or RRP between 2007 and 2009 identified in the National Prostate Cancer Register of Sweden . Information about physician-certified sick leave and disability pension was retrieved from the Swedish Social Insurance Agency through 2012 . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used Cox regression to calculate time to return to work ( RTW , or duration of sick leave ) after surgery and used generalised estimating equations to analyse days lost from work ( because of sick leave and disability pension ) after RTW . RESULTS AND LIMITATIONS Men treated with RARP returned to work after a median of 35 d , whereas the corresponding time for RRP was 48 d ( p<0.001 ) . The difference was seen early ; within the first month , men treated with RARP returned to work nearly four times faster than men treated with RRP ( adjusted relative RTW rate 3.76 ; 95 % confidence interval [ CI ] , 3.04 - 4.66 ) . During a median of 3.6 yr after return to work , men treated with RARP lost fewer days from work per person-year than men treated with RRP-12 d versus 15 d-but the association was not statistically significant ( p=0.10 ) . The adjusted rate ratio was 1.08 ( 95 % CI , 0.82 - 1.42 ) . One limitation is the nonr and omised design of this study . CONCLUSIONS RARP was associated with a faster RTW compared with RRP , but the surgical method did not influence long-term rates of work disability in terms of days lost from work after RTW . PATIENT SUMMARY We compared disease-related absence from work between two surgical methods for the removal of the prostate . Robot-assisted surgery was associated with a faster return to work compared with open surgery but did not influence absence from work in a long-term perspective 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 Objectives Major depressive disorder ( MDD ) is associated with absenteeism . In this study , the effectiveness of collaborative care , with a focus on return to work ( RTW ) , was evaluated in its effect on depressive symptoms and the duration until RTW in sick-listed workers with MDD in the occupational health setting . Methods In this r and omised controlled trial , 126 sick-listed workers with MDD were r and omised to usual care  ( N=61 ) or  collaborative care  ( N=65 ) . Collaborative care was applied by the occupational physician care manager , supported by a web-based tracking system and a consultant psychiatrist . Primary outcome measure was time to response . Secondary outcome measures were time to remission , depressive symptoms as continuous measure and the duration until full RTW . Results Collaborative care participants had a shorter time to response , with a difference of 2.8 months . However , no difference was found on time to remission or depressive symptoms as continuous measure . With a mean of 190 days in the collaborative care group , and 210 days in the usual care group , the groups did not differ significantly from each other in the duration until full RTW . Adherence to the collaborative care intervention was low . Conclusions These results do not justify a widespread implementation of collaborative care in occupational healthcare , as it was operationalised in this study . However , since the study might have been underpowered for RTW and because treatment integrity was low , further research , with larger sample sizes , is needed to develop the best fitting ( collaborative care ) model for addressing RTW in depressed sick-listed workers . Trial registration : IS RCT Purpose Underst and ing individual factors associated with  return to work ( RTW ) post-injury is an important goal of compensation systems research . The aim of the present study was to determine factors associated with time to return to work following acute unintentional injuries . Methods A prospect i ve cohort study was conducted in Victoria , Australia . The cohort comprised 133 persons who were employed at the time they were admitted to one of three study hospitals . Baseline health status data was obtained retrospectively at one-week post-injury and participants were further surveyed at 1 , 6 , 12 , 26 and 52 weeks post-injury to measure recovery . Multivariate Cox proportional hazards regression analysis was used to examine the association between potential prognostic factors and  time to RTW  during the 12 month study . Results At the end of 12 months follow-up , 81.2 % of the study cohort had returned to work . Older age , increased injury severity , self reported symptomatic pain and poor mental health at 1 week post-injury were associated with extended time to RTW . A significant statistical interaction between the receipt of compensation and high social functioning as measured by the SF-36 or strong social relationships as measured by the Assessment of Quality of Life was associated with earlier RTW . Participants reporting strong social relationships and high social functioning at 1 week post-injury and entitled to injury compensation returned to work 2.05 and 3.66 times earlier respectively , than similar participants with no entitlement to compensation . Conclusions Both injury-related and psychosocial factors were associated with the duration of time to RTW following acute unintentional injuries . This study replicated previously reported findings on social functioning and compensation from an independent acute trauma sample . Programs or policies to improve social functioning early post-injury may provide opportunities to improve the duration of time to RTW following injury 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 Background Common mental disorders are strongly associated with long-term sickness absence , which has negative consequences for the individual employee ’s quality of life and leads to substantial costs for society . It is important to focus on return to work ( RTW ) during treatment of sick-listed employees with common mental disorders . Factors such as self-efficacy and the intention to resume work despite having symptoms are important in the RTW process . We developed “ E-health module embedded in Collaborative Occupational health care ” ( ECO ) as a blended Web-based intervention with 2 parts : an eHealth module ( Return@Work ) for the employee aim ed at changing cognitions of the employee regarding RTW and a decision aid via email supporting the occupational physician with advice regarding treatment and referral options based on monitoring the employee ’s progress during treatment . Objective This study evaluated the effect of a blended eHealth intervention ( ECO ) versus care as usual on time to RTW of sick-listed employees with common mental disorders . Methods The study was a 2-armed cluster r and omized controlled trial . Employees sick-listed between 4 and 26 weeks with common mental disorder symptoms were recruited by their occupational health service or employer . The employees were followed up to 12 months . The primary outcome measures were time to first RTW ( partial or full ) and time to full RTW . Secondary outcomes were response and remission of the common mental disorder symptoms ( self-assessed ) . Results A total of 220 employees were included : 131 participants were r and omized to the ECO intervention and 89 to care as usual ( CAU ) . The duration until first RTW differed significantly between the groups . The median duration was 77.0 ( IQR 29.0 - 152.3 ) days in the CAU group and 50.0 ( IQR 20.8 - 99.0 ) days in the ECO group ( hazard ratio [ HR ] 1.390 , 95 % CI 1.034 - 1.870 , P=.03 ) . No significant difference was found for duration until full RTW . Treatment response of common mental disorder symptoms did not differ significantly between the groups , but at 9 months after baseline significantly more participants in the ECO group achieved remission than in the CAU group ( OR 2.228 , 95 % CI 1.115 - 4.453 , P=.02 ) . Conclusions The results of this study showed that in a group of sick-listed employees with common mental disorders , applying the blended eHealth ECO intervention led to faster first RTW and more remission of common mental disorder symptoms than CAU . Trial Registration Netherl and s Trial Register NTR2108 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2108 . ( Archived by WebCite at http://www.webcitation.org/6YBSnNx3P ) Introduction The present study aim ed to gain insight in the predictors of full return to work ( RTW ) among employees on long-term sick leave due to three different self-reported reasons for sick leave : physical , mental or co-morbid physical and mental problems . This knowledge can be used to develop diagnosis-specific interventions that promote earlier RTW . Methods This prospect i ve cohort study with a two-year follow-up employs a sample of 682 Dutch employees , sick-listed for 19 weeks ( SD = 1.68 ) , who filled out two question naires : at 19 weeks and 2 years after the start of sick leave . The dependent measure was duration until full RTW , the independent measures were cause of sick leave , health characteristics , individual characteristics and work characteristics . Results Reporting both physical and mental problems as reasons for sick leave was associated with a longer duration until full RTW . Nonparametric Cox survival analysis showed that partial RTW at baseline and lower age were strong predictors of earlier RTW in all three groups , and that RTW self-efficacy predicted earlier RTW in two groups . Other predictors of full RTW varied among groups . Conclusions Tailoring for different reasons for sick leave might improve the effects of new interventions because the predictors of full RTW differ among groups . Enhancement of partial RTW and RTW self-efficacy may be relevant components of any intervention , as these were predictors of full RTW in at least two groups 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 Long-term  sickness absence and incapacity benefits ( disability pension ) rates have increased across industrialised countries . Effective measures are needed to support return to work . The recommendations of this guidance were informed by the most appropriate available evidence of effectiveness and cost-effectiveness . Public health evidence was provided by research using a variety of study design s that attempted to determine the outcome of a particular intervention by evaluating status before and after the intervention had been effected , and was not limited to r and omised control trials . Where the evidence base was depleted or underdeveloped , expert witnesses were called to give their opinion on the best available evidence and emerging interventions . The process enabled challenge and contestability from stakeholder groups at different points as the guidance was developed . Forty-five heterogeneous studies were included in the review of interventions to reduce long-term sickness absence and transitions from short-term to long-term absence ( mainly covering the former and also mainly examining musculoskeletal conditions ) . The analysis of evidence was restricted to descriptive synthesis . Three general themes emerged from an analysis of the studies that were more likely to report positive results : early interventions ; multidisciplinary approaches ; and interventions with a workplace component . Two further review s were undertaken , one on interventions to reduce the re-occurrence of sickness absence , which identified seven studies on lower back pain , and concluded that early intervention and direct workplace input are important factors . The final evidence review focused on six studies of interventions for those in receipt of incapacity benefit . The evidence was that work-focused interviews coupled with access to tailored support are effective and cost-effective interventions . Practitioners should consider the impact of interventions and management options on work ability for patients of working age . Work ability should be considered a key outcome for future intervention studies OBJECTIVES This study aims to explore the trajectories of  return to work ( RTW )  and examine the predictors of different trajectories among workers following traumatic limb injury . METHODS A total of 804 participants were recruited during hospital admission for a 2-year prospect i ve study . The RTW outcome was repeatedly assessed at 1 , 3 , 6 , 12 , 18 , and 24 months after the injury . A group-based trajectory model ( GBTM ) was employed to identify trajectories of RTW among the participants . Comparisons of group characteristics of different trajectories were performed based on a multinomial logistic regression . RESULTS GBTM identified three distinct trajectories of RTW : ( i ) fast RTW consisted of workers with early and stable RTW status from the first month after the injury ; ( ii ) average RTW consisted of workers who achieved and remained at a stable RTW status within 6 months ; and ( iii ) slow RTW consisted of workers who had slow and unsustainable RTW status within the 2-year follow-up period . The estimated proportions were 21.5 % , 50.7 % , and 27.8 % , respectively . Workers with slow and unsustainable RTW after injury were found to be older , married , less educated , employed as repair personnel/operators/laborers , seriously injured , and depressed ; they were also found to feel more disturbance in daily life , have lower self-efficacy , and believe they experience a poorer quality of life . CONCLUSION Following traumatic limb injury , individual workers showed three distinct RTW trajectories , each of which was associated with different categories of biopsychosocial factors . An underst and ing of how different factors contribute to increasing the likelihood of RTW for injured workers in each trajectory group should aid policy-making in worker-oriented vocational rehabilitation programs Background The percentage of older and chronically ill workers is increasing rapidly in the US and in many other countries , but few interventions are available to help employees overcome the workplace challenges of chronic pain and other physical health conditions . While most workers are eligible for job accommodation and disability compensation benefits , other workplace strategies might improve individual-level coping and problem solving to prevent work disability . In this study , we hypothesize that an employer-sponsored group intervention program employing self-management principles may improve worker engagement and reduce functional limitation associated with chronic disorders . Methods In a r and omized controlled trial ( RCT ) , workers participating in an employer-sponsored self-management group intervention  will be compared with a no-treatment ( wait list ) control condition .  Volunteer employees ( n = 300 ) will be recruited from five participating employers and r and omly assigned to intervention or control . Participants in the intervention arm will attend facilitated group workshop sessions at work ( 10 hours total ) to explore methods for improving comfort , adjusting work habits , communicating needs effectively , applying systematic problem solving , and dealing with negative thoughts and emotions about work . Work engagement and work limitation are the principal outcomes . Secondary outcomes include fatigue , job satisfaction , self-efficacy , turnover intention , sickness absence , and health care utilization . Measurements will be taken at baseline , 6- , and 12-month follow-up . A process evaluation will be performed alongside the r and omized trial . Discussion This study will be most relevant for organizations and occupational setting s where some degree of job flexibility , leeway , and decision-making autonomy can be afforded to affected workers . The study design will provide initial assessment of a novel workplace approach and to underst and factors affecting its feasibility and effectiveness . Trial registration Clinical trials.gov : NCT01978392 ( Issued November 6 , 2013 Purpose . The main aim of this study was to describe the thoughts and feelings of future working life related to return to work ( RTW ) in sick-listed persons due to musculoskeletal disorders ( MSD ) . Further aim was to compare these descriptions with the person 's actual working situation 1 , 5 and 10 years after a rehabilitation period . Methods . This study consisted of two parts . The first part had an explorative design , and qualitative content analysis was chosen in order to analyse the response to an open question regarding future working life answered before , persons sick-listed due to MSD ( n = = 320 ) , took part in a rehabilitation programme 10 years ago . The second part had a prospect i ve design and quantitative analysis was used to compare the results of the qualitative analysis with RTW and the working situation 1 , 5 and 10 years after baseline . Results . Three categories emerged from the data with a total of nine subcategories . In the categories Motivation and optimism and Limitations to overcome , there were significantly more persons who had RTW 1 year after baseline when compared with the category Hindrance and hesitation . There were also some significant differences between the subcategories . Conclusions . The question , regarding thoughts and feelings of future working life , may be a simple screening method to predict RTW in persons sick-listed with MSD . This will guide the rehabilitation team to adjust the rehabilitation to each person 's needs and facilitating RTW Purpose This study aim ed to identify self-perception variables which may predict return to work ( RTW ) in orthopedic trauma patients 2 years after rehabilitation . Methods A prospect i ve cohort investigated 1,207 orthopedic trauma in patients , hospitalised in rehabilitation , clinics at admission , discharge , and 2 years after discharge . Information on potential predictors was obtained from self administered question naires . Multiple logistic regression models were applied . Results In the final model , a higher likelihood of RTW was predicted by : better general health and lower pain at admission ; health and pain improvements during hospitalisation ; lower impact of event ( IES-R ) avoidance behaviour score ; higher IES-R hyperarousal score , higher SF-36 mental score and low perceived severity of the injury . Conclusion RTW is not only predicted by perceived health , pain and severity of the accident at the beginning of a rehabilitation program , but also by the changes in pain and health perceptions observed during hospitalisation Introduction Return to work ( RTW ) of employees on sick leave for common mental disorders may require a multidisciplinary approach . This article aims to assess time to RTW after a psychiatric consultation providing treatment advice to the occupational physician ( OP ) for employees on sick leave for common mental disorders in the occupational health ( OH ) setting , compared to care as usual ( CAU ) . Methods Cluster r and omized clinical trial evaluating patients of 12 OPs receiving consultation by a psychiatrist , compared to CAU delivered by 12 OPs in the control group . 60 patients suffering from common mental disorders and ≥ six weeks sicklisted were included . Follow up three and six months after inclusion . Primary outcome measure was time to RTW . Intention- to-treat multilevel analysis and a survival analysis were performed to evaluate time to RTW in both groups . Results In CAU , referral was the main intervention . Both groups improved in terms of symptom severity and quality of life , but time to RTW was significantly shorter in the psychiatric consultation group . At three months follow up , 58 % of the psychiatric consultation group had full RTW versus 44 % of the control group , a significant finding ( P = 0.0093 ) . Survival analysis showed 68 days earlier RTW after intervention in the psychiatric consultation group ( P = 0.078 ) compared to CAU . Conclusion Psychiatric consultation for employees on sick leave in the OH setting improves time to RTW in patients with common mental disorders as compared to CAU . In further research , focus should be on early intervention in patients with common mental disorders on short sick leave duration  . Psychiatric consultation might be particularly promising for improvement of RTW in those patients . Trial registration number IS RCT N : OBJECTIVE Many factors influence return to work ( RTW ) following  cancer treatment . However specific factors affecting RTW across different cancer types are unclear . This study examined the role of clinical , sociodemographic , work and psychological factors in RTW following treatment for breast , gynaecological , head and neck , and urological cancer . METHODS A 12-month prospect i ve question naire study was conducted with 290 patients .  Cox regression analyses were conducted to calculate hazard ratios ( HR ) for time to RTW . RESULTS Between 89 - 94 % of cancer survivors  returned to work . Breast cancer survivors took the longest to return ( median 30 weeks ) , and urology cancer survivors returned the soonest ( median 5 weeks ) . Earlier return among breast cancer survivors was predicted by a greater sense of control over their cancer at work ( HR 1.2 ; 95 % CI : 1.09 - 1.37 ) and by full-time work ( HR 2.1 ; CI : 1.24 - 3.4 ) . Predictive of a longer return among gynaecological cancer survivors was a belief that cancer treatment may impair ability to work ( HR 0.75 ; CI : 0.62 - 0.91 ) . Among urological cancer survivors constipation was predictive of longer RTW ( HR 0.99 ; CI : 0.97 - 1.00 ) , whereas undertaking flexible working was predictive of returning sooner ( HR 1.70 ; CI : 1.07 - 2.7 ) . Head and neck cancer survivors who perceived greater negative consequences of their cancer took longer to return ( HR 0.27 ; CI : 0.11 - 0.68 ) . Those reporting better physical functioning returned sooner ( HR1.04 ; CI : 1.01 - 1.08 ) . CONCLUSION A different profile of predictive factors emerged for the four cancer types . In addition to optimal symptom management and workplace adaptations , the findings suggest that eliciting and challenging specific cancer and treatment-related perceptions may facilitate RTW Context Low back pain causes frequent disability and lost productive time . Contribution This r and omized trial compared a behavioral-oriented grade d activity program with usual care in 134 Dutch airline company workers who had missed work because of persistent low back pain .  Grade d activity consisted of biweekly 1-hour exercise sessions with physiotherapists who emphasized operant-conditioning principles . Over 6 months of follow-up , participants in the grade d activity program missed 58 days of work , while participants receiving usual care missed 87 days . Implication s A behavioral-oriented grade d activity program returned participants with low back pain to work more often than did usual care . The Editors Nonspecific low back pain is an uncomfortable medical condition that causes frequent disability and absence from work . Most episodes of low back pain resolve fairly quickly and cause only short periods of absence from work . However , some workers with low back pain miss work for several days to weeks and are at risk for more permanent disability ( 1 ) . To reduce the individual and socioeconomic burden related to this absenteeism , we need effective intervention strategies in occupational health care setting s that promote safe and rapid return to work . One promising and often-advocated intervention strategy for workers with prolonged nonspecific low back pain is active rehabilitation that is directed toward return to normal activity and work ( 2 ) . Examples are grade d activity interventions that include physical exercise , application of operant-conditioning behavioral principals , and promotion of improved functioning and safe return to work even if pain persists ( 3 - 6 ) . In a r and omized , controlled trial , Lindstrm and colleagues ( 3 , 4 ) found that a grade d activity intervention reduced absence from work more than did traditional care in Swedish workers employed in the automobile industry . We investigate , in a second r and omized , controlled trial , whether absence from work because of low back pain is reduced more with grade d activity intervention than with traditional care in an occupational health care setting in the Netherl and s. Methods Study Design and Sample The study was a single-blind , r and omized , controlled trial in an occupational health services center ( KLM Health , Safety and Environment ) at Schiphol Airport , Amsterdam , the Netherl and s. The center provides occupational health services for all employees of a major Dutch airline ( KLM Royal Dutch Airlines ) . The source sample ( n = 20 000 ) consisted of workers who were employed in the following organizational units of the airline : baggage and aircraft turnaround services , passenger services , engineering and maintenance , cargo , and cabin and cockpit . Workers who were listed as absent from work because of low back pain were invited for a consultation with the occupational physician . Those who were thought to be eligible for inclusion were referred to the research assistant , who judged whether they met the inclusion criteria : full or partial absence from work because of nonspecific low back pain and low back pain symptoms with a minimum duration of 4 weeks in succession . The exclusion criteria were low back pain with radiation below the knee with signs of nerve-root compression ( 7 ) ; cardiovascular contraindications for physical activity , as checked according to the Physical Activities Readiness Question naire ( 8 , 9 ) ; any conflict between worker and employer with legal involvement ; or pregnancy . Workers who met the inclusion criteria were informed of the purpose and procedures of the study and were enrolled after giving informed consent . The Medical Ethical Committee of the VU University Medical Center , Amsterdam , the Netherl and s , approved the study . Treatment Allocation The participants were assigned to grade d activity or usual care on the basis of block r and omization , after prestratification for the organizational unit in the workplace from which they were recruited ( the 5 organizational units listed earlier ) and for the severity of pain symptoms ( scored on a scale of 0 to 10 ; severity scores were < 6 or 6 points ) . This result ed in a total of 10 strata . R and omized , permuted blocks of 4 allocations were generated for each stratum through a computer-generated r and om-sequence table . Opaque , sequentially numbered , sealed envelopes were prepared for each stratum by a research er who was not involved in enrolling the participants or assigning them to their groups . The envelopes contained a sheet of paper that indicated 1 of the 2 interventions . Participants learned their group assignments after a research assistant completed the baseline measurements and delivered the sealed envelopes . Blinding The research assistants who collected the data were blinded to the treatment allocation . All participants were repeatedly asked not to reveal any information about their treatment allocation . The participants and treatment providers were not blinded to treatment allocation . Interventions In the Dutch occupational health care system , occupational physicians guide disabled workers who are absent from work through their disability period . These occupational physicians are employed by occupational health services that are paid for by the companies . The occupational physicians adhere to back pain management strategies that consist of advising workers on ergonomics , prevention , and return-to-work schedules and advising and communicating with other stakeholders ( such as health care providers and representatives of the workplace ) . Disabled workers who participated in the present study were assigned to either grade d activity or usual care within the context of the Dutch occupational health care setting . Grade d Activity The intervention group received the usual guidance from the occupational physician about work-related problems and barriers to return to work as well as the grade d activity intervention supervised by a physiotherapist .  Three physiotherapists who worked in a private practice at Schiphol Airport provided the treatment according to the grade d activity protocol . Two of those physiotherapists were also trained as manual therapists , and 1 was also a human movement scientist . Before the study , the physiotherapists had been specifically trained to treat patients with low back pain according to behavioral principles . A research physiotherapist who was experienced in treating patients with chronic pain in rehabilitation centers instructed the physiotherapists in three 2-hour sessions and practice d patienttherapist interactions with them through role-play . Before the study , the physiotherapists treated several patients according to the grade d activity protocol to gain more experience . The physiotherapists made audiotapes of the intervention sessions before and during the study period . The contents of these audiotapes were assessed and discussed with the research physiotherapist in 3 additional meetings . Furthermore , the physiotherapists summarized the treatment after each session , and research ers used these summaries to review the sessions . The same physiotherapist treated participants each time , except for temporary st and -in sessions that were supervised by colleagues because of holidays or other reasons . Specific therapists were not systematic ally selected to treat specific participants ; selection was based on pragmatic reasons , such as the time available in the work schedules of the physiotherapists or the days of treatment preferred by the participants . Table 1 presents the concept and content of the grade d activity intervention . The intervention consisted of 1-hour exercise sessions that participants attended twice per week until they returned completely to regular work or until the maximum therapy duration of 3 months was reached . At the start of the intervention , the physiotherapist inquired about the participant 's medical history and completed a brief physical examination consisting of flexion , extension , and lateroflexion of the lumbar spine and a brief screening for nerve-root pain ( 10 ) . The purpose of the physical examination was to confirm the diagnosis of benign , nonspecific low back pain and to reduce participants ' fears about any presumed underlying disease . The participants were reassured that despite the annoying pain , nothing was seriously wrong with their backs . Subsequently , the physiotherapist and participant decided on a set of general exercises and individually tailored exercises . Both types of exercises had to be performed during each session . The general exercises were aerobic exercises , such as cycling or rowing , and strengthening exercises for large muscle groups , and most were carried out in a gym while using exercise equipment . The strengthening exercises were a floor abdominal sit-up exercise , a dynamic back extension exercise , a leg-press exercise , a latissimus pull-down exercise , and st and ing up from a low chair .  Participants in the grade d activity group had to perform not only these general exercises but also individually tailored exercises , which imitated physical tasks at work or difficult and painful activities of daily living . For example , a participant who reported back problems while lifting and moving suitcases from a luggage wagon into an airplane might be given an exercise to practice lifting and moving a suitcase with a certain number of repetitions . During the first 3 sessions , the maximal performance ( for example , the maximum number of repetitions ) was assessed for each exercise separately , and the average score for each exercise over the 3 sessions was used as a baseline value for specifying a gradually progressive exercise scheme . Subsequently , the participant was asked to propose a date for full return to regular work , which would consequently be the end point of the physical exercise program . Before returning to full regular work , participants could return to work with modified hours and duties . Advised by the physiotherapist , the participant OBJECTIVE People with psychiatric impairments ( primarily schizophrenia or a mood disorder ) are the largest and fastest-growing group of Social Security Disability Insurance ( SSDI ) beneficiaries . The authors investigated whether evidence -based supported employment and mental health treatments can improve vocational and mental health recovery for this population . METHOD Using a r and omized controlled trial design , the authors tested a multifaceted intervention : team-based supported employment , systematic medication management , and other behavioral health services , along with elimination of barriers by providing complete health insurance coverage ( with no out-of-pocket expenses ) and suspending disability review s. The control group received usual services .  Paid employment was the primary outcome measure , and overall mental health and quality of life were secondary outcome measures . RESULTS Overall , 2,059 SSDI beneficiaries with schizophrenia , bipolar disorder , or depression in 23 cities participated in the 2-year intervention . The teams implemented the intervention package with acceptable fidelity . The intervention group experienced more paid employment ( 60.3 % compared with 40.2 % ) and reported better mental health and quality of life than the control group . CONCLUSIONS Implementation of the complex intervention in routine mental health treatment setting s was feasible , and the intervention was effective in assisting individuals disabled by schizophrenia or depression to return to work and improve their mental health and quality of life STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers
There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains .
There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes .
There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW .
Evidence for the effectiveness of other single-domain interventions was mixed , with some studies reporting positive effects and others reporting no effects on lost time and work functioning .
Purpose The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work ( RTW ) interventions and work disability management ( DM ) interventions that assist workers with musculoskeletal ( MSK ) and pain-related conditions and mental health ( MH ) conditions with RTW .