Factors affecting return to work after injury or illness: Best Evidence Synthesis of Systematic Reviews

Carol Cancelliere, James Donovan, Mette Jensen Stochkendahl, Melissa Biscardi, Carlo Ammendolia, Corrie Myburgh, J. David Cassidy

Research output: Contribution to journalReviewResearchpeer-review

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Abstract

Purpose: To identify common prognostic factors for return to work (RTW) across different health and injury conditions and to describe their association with RTW outcomes.
Methods: Medline, Embase, PsychINFO, Cinahl, and Cochrane Database of Systematic Reviews and the grey literature were searched from January 1, 2004 to September 1, 2013. Systematic reviews addressing RTW in various conditions and injuries were selected. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) criteria to identify low risk of bias reviews. Prognostic factors were synthesized within domains of the International Classification of Functioning and Health (ICF) model of disability.
Results: Of the 36,193 titles screened and the 94 eligible studies reviewed, 56 systematic reviews were accepted as low risk of bias. Over half of these focused on musculoskeletal disorders, which were primarily spine related (e.g., neck and low back pain). The other half of studies assessed workers with mental health or cardiovascular conditions, stroke, cancer, multiple sclerosis or other non-specified health conditions. Many factors have been assessed, but few consistently across conditions. Common factors associated with positive RTW outcomes were higher education and socioeconomic status, higher self-efficacy and optimistic expectations for recovery and RTW, lower severity of the injury/illness, RTW coordination, and multidisciplinary interventions that include the workplace and stakeholders. Common factors associated with negative RTW outcomes were older age, being female, higher pain or disability, depression, higher physical work demands, previous sick leave and unemployment, and activity limitations.
Conclusions: Expectations of recovery and RTW, pain and disability levels, depression, workplace factors, and access to multidisciplinary resources are important modifiable factors in progressing RTW across health and injury conditions. Employers, healthcare providers and other stakeholders can use this information to facilitate RTW for injured/ill workers regardless of the specific injury or illness. Future studies should investigate the cost-effectiveness of implementing these principles, novel interventions and other factors that may be common across health conditions.
Key Words: return to work, work disability, prognosis, intervention, sick leave, absenteeism, presenteeism
Original languageEnglish
Article number32
JournalChiropractic & Manual Therapies
Volume24
Number of pages23
ISSN2045-709X
DOIs
Publication statusPublished - 2016

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