McCluskey Serena, Burton A Kim, Main Chris J
Centre for Public Health Research, University of Salford, Allerton Building, Frederick Road Campus, Salford M6 6PU, UK.
Occup Med (Lond). 2006 Jun;56(4):237-42. doi: 10.1093/occmed/kql003. Epub 2006 Mar 7.
Occupational health guidelines recommend a biopsychosocial approach to manage sickness absence due to musculoskeletal disorders (MSDs), with a primary focus on early intervention through provision of a supportive network.
To investigate the implementation of a guidelines-based intervention (early contact of absentees; addressing psychosocial obstacles; offering temporary modified work; communicating among the players), and to determine whether this is effective for reducing return-to-work times and duration of future absence.
A non-randomized controlled trial was conducted within a UK company. Occupational health nurses at two experimental sites (1,435 workers) were trained to deliver the intervention to workers taking absence due to MSDs (low back and upper limb disorders), while usual care was delivered at three control sites (1,483 workers). Company-recorded absence data were collected over a 12-month follow-up period.
The implementation of the experimental intervention was impeded by unforeseen organizational obstacles at one site (policies, procedures and individual approaches) which had a detrimental effect on uptake and delivery. At the site where the intervention was delivered per protocol, absence was significantly less compared with controls; 6.5 and 10.8 days, respectively. However, the duration of future absence was not significantly different (13.0 and 25.1 days, respectively).
An early intervention addressing psychosocial obstacles to recovery can be effective for reducing absence due to MSDs. Successful implementation, where the key players are onside and organizational obstacles are overcome, is difficult to achieve.
职业健康指南推荐采用生物心理社会方法来管理因肌肉骨骼疾病（MSD）导致的病假，主要侧重于通过提供支持网络进行早期干预。
调查基于指南的干预措施（早期联系缺勤人员；解决心理社会障碍；提供临时调整工作；各方沟通）的实施情况，并确定这是否对缩短返岗时间和减少未来缺勤时长有效。
在一家英国公司内进行了一项非随机对照试验。两个试验地点（1435名员工）的职业健康护士接受培训，为因MSD（腰背部和上肢疾病）缺勤的员工提供干预措施，而三个对照地点（1483名员工）则提供常规护理。在12个月的随访期内收集公司记录的缺勤数据。
在一个地点，意外的组织障碍（政策、程序和个人方法）阻碍了试验性干预措施的实施，对接受度和实施产生了不利影响。在按照方案实施干预措施的地点，与对照组相比，缺勤天数明显更少，分别为6.5天和10.8天。然而，未来缺勤的时长没有显著差异（分别为13.0天和25.1天）。
解决康复过程中心理社会障碍的早期干预措施对减少因MSD导致的缺勤可能有效。要实现成功实施，关键参与者需支持且克服组织障碍，这很难做到。
