1 Department of Psychology, Maynooth University, Maynooth, Ireland.
2 School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
Clin Rehabil. 2017 Nov;31(11):1466-1481. doi: 10.1177/0269215517699976. Epub 2017 Mar 27.
To determine the effectiveness of early multidisciplinary interventions in promoting work participation and reducing work absence in adults with regional musculoskeletal pain.
Seven databases (CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, OT Seeker, PEDro; 1990 to December 2016) were searched for eligible studies.
Trials were included if they reported on work-based outcomes for participants experiencing difficulties at work or ≤ three months' sick leave. Interventions had to include two or more elements of the biopsychosocial model delivered as a coordinated programme. Quality was assessed using the GRADE criteria. Results were analysed by hazard ratios for return to work data; continuous outcomes were analysed as standardised mean difference with 95% confidence intervals.
A total of 20 randomized controlled trials, with 16,319 participants were included; the interventions were grouped according to their main components for meta-analyses. At 12-months follow-up, moderate quality evidence suggests that programmes involving a stepped care approach (four studies) were more effective than the comparisons in promoting return to work (hazard ratio (HR) 1.29 (95% confidence interval (CI) 1.03 to 1.61), p = 0.03), whereas case management (two studies) was not (HR 0.92 (95% CI 0.69 to 1.24), p = 0.59). Analyses suggested limited effectiveness in reducing sickness absences, in pain reduction or functional improvement across the intervention categories.
There is uncertainty as to the effectiveness of early multicomponent interventions owing to the clinical heterogeneity and varying health and social insurance systems across the trials.
评估早期多学科干预对促进区域肌肉骨骼疼痛成年人工作参与和减少工作缺勤的有效性。
七个数据库（CENTRAL、CINAHL、EMBASE、MEDLINE、Scopus、OT Seeker、PEDro；1990 年至 2016 年 12 月）被检索以获取合格的研究。
如果研究报告了工作中遇到困难或病假不超过三个月的参与者的工作结果，则纳入试验。干预措施必须包括生物心理社会模型的两个或更多要素，作为一个协调的方案提供。使用 GRADE 标准评估质量。使用风险比分析回归工作数据；连续结果以标准化均数差和 95%置信区间进行分析。
共纳入 20 项随机对照试验，共 16319 名参与者；干预措施根据其主要组成部分进行分组进行荟萃分析。在 12 个月的随访中，有中等质量的证据表明，涉及阶梯式护理方法的方案（四项研究）在促进回归工作方面比对照组更有效（风险比（HR）1.29（95%置信区间（CI）1.03 至 1.61），p = 0.03），而病例管理（两项研究）则不然（HR 0.92（95%CI 0.69 至 1.24），p = 0.59）。分析表明，在减少缺勤、减轻疼痛或改善功能方面，干预措施的效果有限。
由于试验之间的临床异质性和不同的健康和社会保险制度，早期多组分干预的有效性存在不确定性。
