针对医疗机构和工作场所中孕妇病假情况的干预措施的系统评价。
Systematic review of interventions targeting sickness absence among pregnant women in healthcare settings and workplaces.
作者信息
Pedersen Pernille, Labriola Merete, Nielsen Claus Vinther, Maimburg Rikke Damkjær, Nohr Ellen Aagaard, Momsen Anne-Mette
机构信息
Central Denmark Region, DEFACTUM - Social and Health Services & Labour Market, Aarhus, Denmark.
Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark.
出版信息
BMJ Open. 2018 Oct 25;8(10):e024032. doi: 10.1136/bmjopen-2018-024032.
OBJECTIVES
The high rate of sickness absence from work during pregnancy is recognised as a problem, and may be higher than necessary from a health perspective. The aim was to evaluate the effectiveness of interventions in healthcare settings and workplaces targeting sickness absence among pregnant women.
METHODS
Studies were eligible if they included pregnant women participating in any intervention in healthcare settings or workplaces. The outcome was length of sickness absence in days or number of episodes. Study design had to be either randomised controlled trials (RCTs) or quasi-experimental studies.The search for studies was conducted in PubMed, Scopus, CINAHL, PsycINFO, ClinicalTrials.gov and WHO trial registry. Risk of bias was assessed by the Joanna Briggs Institute standardised quality assessment instrument.
RESULTS
A total of nine studies were quality assessed and of these, four were excluded due to insufficient methodological quality. Five RCTs conducted in healthcare settings in Sweden and Norway were included. Due to heterogeneity, meta-analysis was not performed.Two RCTs examined complementary and alternative medicine and three RCTs the effect of physical exercise. In general, the frequency of women on sickness absence was lower in the intervention groups than the control groups, however, only among pregnant women who participated in a 12-week exercise programme, the frequency was significantly lower (22% vs 30%, p=0.04).
CONCLUSION
The evidence of interventions targeting sickness absence among pregnant women in healthcare settings is sparse, and no studies were conducted at workplaces.Future interventions including physical activity provided in collaboration with healthcare settings and workplaces are requested. Studies should measure sickness absence based on valid methods, measure compliance to the intervention and provide transparency of statistical methods.
PROSPERO REGISTRATION NUMBER
CRD42018084802.
目的
孕期病假缺勤率高被视为一个问题，从健康角度来看可能高于必要水平。目的是评估针对孕妇病假缺勤在医疗保健场所和工作场所进行干预的效果。
方法
如果研究纳入了参与医疗保健场所或工作场所任何干预措施的孕妇，则这些研究符合条件。结局指标为病假缺勤天数或发作次数。研究设计必须为随机对照试验（RCT）或准实验研究。在PubMed、Scopus、CINAHL、PsycINFO、ClinicalTrials.gov和世界卫生组织试验注册库中检索研究。采用乔安娜·布里格斯研究所标准化质量评估工具评估偏倚风险。
结果
共对9项研究进行了质量评估，其中4项因方法学质量不足而被排除。纳入了在瑞典和挪威的医疗保健场所进行的5项RCT。由于存在异质性，未进行荟萃分析。2项RCT研究了补充和替代医学，3项RCT研究了体育锻炼的效果。总体而言，干预组中病假缺勤的女性频率低于对照组，然而，仅在参与12周锻炼计划的孕妇中，该频率显著更低（22%对30%，p=0.04）。
结论
针对医疗保健场所孕妇病假缺勤的干预证据稀少，且未在工作场所开展相关研究。需要未来开展包括与医疗保健场所和工作场所合作提供体育活动在内的干预措施。研究应基于有效方法测量病假缺勤情况，测量对干预措施的依从性，并提供统计方法的透明度。
PROSPERO注册号：CRD42018084802。
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