Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities

Abstract

This is the largest RCT ever conducted on effects of a multiple component return-to-work intervention (coordinated, tailored, and multidisciplinary). The effects of the intervention on duration of sickness absence were remarkably different between the three municipalities examined indicating that contextual factors are of major importance for success or failure of this complex intervention. 47Original article Scand J Work Environ Health. 2014;40(1):47-56. doi:10.5271/sjweh.3383 Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities Objectives The aim of this study was to evaluate the effect of the Danish return-to-work (RTW) program on long-term sickness absence in a randomized controlled trial in three municipalities. MethodsThe intervention group comprised 1948 participants while the control group comprised 1157 participants receiving ordinary sickness benefit management (OSM). Study participants were working-age adults receiving long-term (≥8 weeks or more) benefits, included regardless of reason for sickness absence or employment status. Each beneficiary was followed-up for a maximum period of 52 weeks. Cox proportional hazards model was used to estimate hazard ratios (HR) for return to work (RTW) with 95% confidence intervals (95% CI). ResultsThe intervention effect differed significantly between the municipalities (P=0.00005). In one municipality (M2) the intervention resulted in a statistically significant increased rate of recovery from long-term sickness absence (HR 1.51, 95% CI 1.31-1.74). In the other two municipalities, the intervention did not show a statistically significant effect (HR M1 1.12, 95% CI 0.97-1.29, and HR M3 0.80, 95% CI 0.63-1.03, respectively). Adjustment for a series of possible confounders only marginally altered the estimated HR. ConclusionThe effect of the intervention differed substantially between the three municipalities, indicating that that contextual factors are of major importance for success or failure of this complex intervention.Key terms coordinated case management; Denmark; effect evaluation; intervention; multidisciplinary; RTW; work resumption. In 2008, the annual level of sickness absence in Denmark corresponded to approximately 5% of the workforce, and reimbursement costs per year were estimated to be around €5 billion (approximately €1350 per capita age 18-64 years) not including treatment costs or loss of productivity (1). Promoting labor market participation is essential for Denmark and other European countries facing a decline in the proportion of people of working age due to an aging workforce (2). To reduce sickness absence and improve labor market participation, the Danish Government launched an action plan in 2008 encompassing 39 initiatives including the Danish returnto-work (RTW) program. The Danish National Research Centre for the Working Environment (NRCWE) was appointed to develop the program in accordance with the action plan, existing sickness management leg...

Long-term sick leave and the impact of a graded return-to-work program: evidence from Germany

“…With a focus on mental disorders, the Danish program on part-time sick leave shows no effect when controlling for unobserved heterogeneity, only program effects for physical illness are present [25]. For three Danish municipalities, the effects of the RTW program are studied [26]. The authors find strong differences between the three municipalities and conclude contextual factors to be important for program success.…”

Effects of a randomized controlled intervention trial on return to work and health care utilization after long-term sickness absence

“…The review further showed that high-quality studies reported smaller effects than low-quality studies. Later studies have reported no, ambiguous or even negative effects on RTW for sickness beneficiaries [6–9]. Several studies show that early interventions are preferable, however a better understanding of which specific components of the interventions work for different sickness beneficiaries is clearly needed as interventions may have different effects on different subgroups of participants [10–13].…”

“…Poulsen et al suggested that comprehensive multidisciplinary interventions may be more appropriate for sickness beneficiaries with complex reasons for not returning to work than for beneficiaries with less complex reasons [9, 14]. Highly complex reasons may include long duration of sickness absence, problematic social relations at work, poor health and unclear diagnoses based on multiple symptom patterns [15–17].…”

Effects of graded return-to-work: a propensity-score-matched analysis

“…The loss in productivity due to sickness absence is estimated to be €103 billion annually (2). To meet the challenge of work disability, prevention and management of work disability have become a priority in many national health and welfare strategies (3)(4)(5)(6)(7)(8). These strategies are diverse.…”