Vargas-Prada Sergio, Demou Evangelia, Lalloo Drushca, Avila-Palencia Ione, Sanati Kaveh A, Sampere Maite, Freer Kerry, Serra Consol, Macdonald Ewan B
Center for Research in Occupational Health, Universitat Pompeu Fabra. Carrer Doctor Aiguader 88, 08003-Barcelona, Spain.
Scand J Work Environ Health. 2016 Jul 1;42(4):261-72. doi: 10.5271/sjweh.3576. Epub 2016 Jun 7.
The aim of this review was to investigate the effectiveness of workplace return-to-work (RTW) interventions delivered at very early stages (<15 days) of sickness absence (SA).
A systematic literature search was conducted in PubMed, Health Management Information Consortium (HMIC), Cochrane library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychInfo and Embase. Using pre-established criteria, independent pairs of researchers carried out the study selection, quality appraisal and data extraction. Workplace interventions before day 15 of SA, were included. Primary outcome measures included rates of and time until RTW, productivity loss, and recurrences of SA.
We found limited available evidence on the benefits of "very early" workplace interventions in terms of RTW after a SA episode compared to usual care. Only three randomized controlled trials classed as high or intermediate quality were identified. Early part-time sick leave together with appropriate job modifications led to a reduction in the duration and recurrence of SA. There is evidence of benefit of intervening during the first two weeks of SA for musculoskeletal disorders.
Our review has identified a lack of evidence from the literature at this time point to support "very early" intervention compared to usual care. The methodological design of the studies, notably the extent and timing of usual care provided and variable compliance/crossover between groups could however explain the lack of demonstrated benefit. Consensus is required on the definition of "early" and "very early" interventions, and further research is recommended to improve understanding of the factors influencing when and how best to intervene for maximum gain.
本综述的目的是调查在病假（SA）非常早期阶段（<15天）实施的工作场所重返工作岗位（RTW）干预措施的有效性。
在PubMed、健康管理信息联盟（HMIC）、Cochrane图书馆数据库、护理学与健康相关文献累积索引（CINAHL）、PsychInfo和Embase中进行了系统的文献检索。独立的研究人员对根据预先确定的标准进行研究选择、质量评估和数据提取。纳入了在SA第15天之前的工作场所干预措施。主要结局指标包括RTW率、RTW所需时间、生产力损失和SA复发情况。
与常规护理相比，我们发现关于“非常早期”工作场所干预措施在SA发作后RTW方面益处的现有证据有限。仅确定了三项高质量或中等质量的随机对照试验。早期的兼职病假加上适当的工作调整可减少SA的持续时间和复发。有证据表明，在SA的前两周对肌肉骨骼疾病进行干预有益。
我们的综述发现，在这个时间点，与常规护理相比，缺乏文献证据支持“非常早期”干预。然而，研究的方法设计，特别是提供常规护理的范围和时间以及组间可变的依从性/交叉情况，可能解释了缺乏已证明的益处。需要就“早期”和“非常早期”干预的定义达成共识，建议进一步开展研究，以更好地理解影响何时以及如何进行最佳干预以获得最大收益的因素。
