Discipline of Behavioural Health, College of Medicine & Public Health, Flinders University, South Australia, Australia.
Remedy HealthCare Group, Melbourne, Victoria, Australia.
BMC Public Health. 2021 Nov 25;21(1):2164. doi: 10.1186/s12889-021-11898-z.
Work can offer a myriad of social and health benefits. Long-term sick leave can be detrimental to employers, individuals, families, and societies. The burden of long-term sick leave has motivated the development of return to work (RTW) interventions. This study sought to determine what constitutes an effective psychosocial RTW intervention, which included exploring whether the level of intervention intensity and intervention characteristics matter to RTW outcomes.
A systematic review and narrative synthesis were undertaken. Studies were identified through six databases (Ovid Medline, CINAHL (EBSCOhost), PsycInfo (Ovid), ProQuest, Scopus, and Google Scholar) between 2011 and 3 September 2019. Randomised controlled trials (RCTs) or reviews published in English were eligible for inclusion if they targeted adults who were on sick leave/unemployed trying to return to full-capacity employment, had at least one structured psychosocial RTW intervention, and assessed RTW. Study quality was assessed using checklists from the Joanna Briggs Institute.
Database searching yielded 12,311 records. Eighteen RCTs (comprising 42 intervention/comparison groups), seven reviews (comprising 153 studies), and five grey literature documents were included. Included studies were of moderate-to-high quality. Research was primarily conducted in Europe and focused on psychological or musculoskeletal problems. RTW outcomes included RTW status, time until RTW, insurance claims, and sick days. Participating in a RTW program was superior to care-as-usual. RTW outcomes were similar between diverse interventions of low, moderate, and high intensity. Common foundational characteristics seen across effective RTW interventions included a focus on RTW, psychoeducation, and behavioural activation.
Evidence suggests that a low intensity approach to RTW interventions may be an appropriate first option before investment in high intensity, and arguably more expensive interventions, as the latter appear to provide limited additional benefit. More high-quality RCTs, from diverse countries, are needed to provide stronger evidence.
工作能带来诸多社会效益和健康效益。长期病假对雇主、个人、家庭和社会都不利。长期病假的负担促使人们开发了重返工作岗位（RTW）干预措施。本研究旨在确定哪些是有效的心理社会 RTW 干预措施，包括探讨干预强度水平和干预特征是否对 RTW 结果有影响。
系统综述和叙述性综合。研究通过六个数据库（Ovid Medline、CINAHL（EBSCOhost）、PsycInfo（Ovid）、ProQuest、Scopus 和 Google Scholar）进行检索，检索时间为 2011 年至 2019 年 9 月 3 日。如果研究对象为正在休病假/失业、试图恢复全产能工作的成年人，有至少一项结构化心理社会 RTW 干预措施，并评估 RTW，则纳入随机对照试验（RCT）或发表于英文期刊的综述。研究质量使用 Joanna Briggs 研究所的清单进行评估。
数据库检索得到 12311 条记录。纳入 18 项 RCT（包括 42 个干预/对照组）、7 项综述（包括 153 项研究）和 5 篇灰色文献。纳入研究质量为中高度。研究主要在欧洲进行，重点是心理或肌肉骨骼问题。RTW 结果包括 RTW 状态、RTW 时间、保险索赔和病假天数。参加 RTW 方案优于常规护理。低、中、高强度的不同干预措施的 RTW 结果相似。有效的 RTW 干预措施的共同基本特征包括关注 RTW、心理教育和行为激活。
证据表明，低强度的 RTW 干预措施可能是高强度、更昂贵干预措施的首选，因为后者似乎提供的额外益处有限。需要更多来自不同国家的高质量 RCT 来提供更强有力的证据。
