National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100 Copenhagen, Denmark.
Scand J Work Environ Health. 2014 Jan;40(1):47-56. doi: 10.5271/sjweh.3383. Epub 2013 Sep 17.
The aim of this study was to evaluate the effect of the Danish return-to-work (RTW) program on long-term sickness absence in a randomized controlled trial in three municipalities.
The intervention group comprised 1948 participants while the control group comprised 1157 participant receiving ordinary sickness benefit management (OSM). Study participants were working-age adults receiving long-term (≥8 weeks or more) benefits, included regardless of reason for sickness absence or employment status. Each beneficiary was followed-up for a maximum period of 52 weeks. Cox proportional hazards model was used to estimate hazard ratios (HR) for return to work (RTW) with 95% confidence intervals (95% CI).
The intervention effect differed significantly between the municipalities (P=0.00005). In one municipality (M2) the intervention resulted in a statistically significant increased rate of recovery from long-term sickness absence (HR 1.51, 95% CI 1.31-1.74). In the other two municipalities, the intervention did not show a statistically significant effect (HR M11.12, 95% CI 0.97-1.29, and HR M30.80, 95% CI 0.63-1.03, respectively). Adjustment for a series of possible confounders only marginally altered the estimated HR.
The effect of the intervention differed substantially between the three municipalities, indicating that that contextual factors are of major importance for success or failure of this complex intervention.
本研究旨在通过在三个市的随机对照试验评估丹麦的返工（RTW）方案对长期病假的影响。
干预组包括 1948 名参与者，而对照组包括 1157 名接受常规疾病津贴管理（OSM）的参与者。研究参与者为正在工作年龄的成年人，长期（≥8 周或更长时间）领取福利，无论病假原因或就业状况如何，均包括在内。每位受益人最多随访 52 周。使用 Cox 比例风险模型来估计（95%置信区间[95%CI]）重返工作岗位（RTW）的风险比（HR）。
干预效果在市之间存在显著差异（P=0.00005）。在一个市（M2），干预导致长期病假康复的速度有统计学意义的提高（HR 1.51，95%CI 1.31-1.74）。在另外两个市，干预没有显示出统计学意义上的效果（HR M11.12，95%CI 0.97-1.29，和 HR M30.80，95%CI 0.63-1.03，分别）。对一系列可能的混杂因素进行调整，仅略微改变了估计的 HR。
干预效果在三个市之间存在很大差异，表明情境因素对于这种复杂干预的成功或失败至关重要。
