Effectiveness and characteristics of interventions to improve work participation in adults with chronic physical conditions: a systematic review

Abstract

Purpose: Chronic physical conditions often negatively affect work participation. The objective of this systematic review is to investigate the effectiveness and characteristics of vocational rehabilitation interventions for people with a chronic physical condition. Methods: Searches in five databases up to April 2020 identified 30 studies meeting our inclusion criteria. Two reviewers independently assessed and extracted data. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) framework was used to evaluate quality of evidence for three outcome measures related to work participation. Results: All vocational rehabilitation interventions consisted of multiple components, but their characteristics varied widely. Analysis of 22 trials yielded a moderate positive effect with moderate certainty of interventions on work status; analysis of five trials with low risk of bias showed a large positive effect with moderate certainty (risk ratio 1.33 and 1.57, respectively). In addition, in eight studies we found a moderate to small positive effect with low certainty on work attitude (standardized mean difference ¼ 0.59 or 0.38, respectively). We found no effect on work productivity in nine studies. Conclusion: The systematic review of the literature showed positive effects of vocational rehabilitation interventions on work status and on work attitude; we found no effect on work productivity. ä IMPLICATIONS FOR REHABILITATION In rehabilitation, addressing work participation of persons with a chronic physical condition using targeted interventions is beneficial to improve or sustain work participation, irrespective of the intervention characteristics and diagnosis. Interventions that include multiple components and offer individual support, whether or not combined with group sessions, are likely to be more effective in improving work participation in persons with a chronic physical condition. The overview of vocational interventions in this systematic review may assist healthcare professionals in making informed decisions as to which intervention to provide. Vocational rehabilitation, as well as studies on work participation in chronic disease, should include a long follow-up period to explore if work participation is sustainable and contributes to health and wellbeing.

Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial

“…Since the return-to-work process may be influenced by several interrelated factors, it is recommended that interventions include clinical, psychological, and work environment factors, as well as relevant stakeholders (1,2). However, the precise mechanisms involved in successful return-to-work remain unclear (12)(13)(14). Our results emphasize that clinicians should not only assess clinical factors, such as pain intensity, but also include psychosocial factors.…”

What is the volume, quality and characteristics of evidence relating to the effectiveness and cost‐effectiveness of multi‐disciplinary occupational health interventions aiming to improve work‐related outcomes for employed adults? An evidence and gap map of systematic reviews

“…Scores are provided for each item on the AMSTAR‐2 checklist, alongside an overall rating. Of the 30 systematic reviews, 10 were allocated a rating of ‘High’ quality (Gaillard et al, 2020 ; Gensby et al, 2014 ; Heathcote et al, 2019 ; NICE, 2019 ; Nieuwenhuijsen et al, 2020 ; Schaafsma et al, 2013 ; Schandelmaier et al, 2012 ; van Vilsteren et al, 2015 ; Verhoef et al, 2020 ; Vogel et al, 2017 ), four of ‘Moderate’ quality (Bernaers et al, 2022 ; Cochrane et al, 2017 ; Mikkelsen & Rosholm, 2018 ; Tingulstad et al, 2022 ), four of ‘Low’ quality (Cullen et al, 2018 ; Lefever et al, 2018 ; Odeen et al, 2013 ; Tompa et al, 2008 ) and 12 of ‘Critically Low’ quality (Axén et al, 2020 ; Brewer et al, 2007 ; Carroll et al, 2010; Franche et al, 2005 ; Hoefsmit et al, 2012 ; Ishimaru et al, 2021 ; Kojimahara et al, 2020 ; Neverdal, 2015 ; Oakman et al, 2016 ; Palmer et al, 2012 ; van Geen et al, 2007 ; Venning et al, 2021 ).…”

“…For interventions with individuals with musculoskeletal disorders, nine reviews reported a significant beneficial effect of the intervention. However, only two of these reviews were of ‘High’ quality (Heathcote et al, 2019 ; Verhoef et al, 2020 ), with one appraised as ‘Moderate’ quality (Cochrane et al, 2017 ), one as ‘Low’ quality (Brewer et al, 2007 ) and five as ‘Critically Low’ quality (Carroll et al, 2010 ; Franche et al, 2005 ; Kojimahara et al, 2020 ; Neverdal, 2015 ; van Geen et al, 2007 ). The next largest group of evidence was for reviews reporting inconclusive or weak evidence with respect to intervention effectiveness ( n = 7), three were of ‘High’ quality (Gensby et al, 2014 ; NICE, 2019 ; Schaafsma et al, 2013 ), one of ‘Moderate’ quality, (Tingulstad et al, 2022 ) and three were of ‘Critically Low’ quality (Ishimaru et al, 2021 ; Oakman et al, 2016 ; Palmer et al, 2012 ).…”

“…In general, systematic review evidence was predominantly split between those reporting a beneficial effect of the interventions being evaluated on RTW outcomes and those reporting inconclusive/weak evidence. Of the 15 reviews to report a positive effect of interventions on RTW outcomes or cost‐effectiveness (Brewer et al, 2007 ; Carroll et al, 2010 ; Cochrane et al, 2017 ; Franche et al, 2005 ; Gaillard et al, 2020 ; Heathcote et al, 2019 ; Kojimahara et al, 2020 ; Lefever et al, 2018 ; Mikkelsen & Rosholm, 2018 ; Neverdal, 2015 ; Nieuwenhuijsen et al, 2020 ; Schandelmaier et al, 2012 ; Tompa et al, 2008 ; van Geen et al, 2007 ; Verhoef et al, 2020 ), five were of ‘High’ quality (Gaillard et al, 2020 ; Heathcote et al, 2019 ; Nieuwenhuijsen et al, 2020 ; Schandelmaier et al, 2012 ; Verhoef et al, 2020 ), and two were of ‘Moderate’ quality (Cochrane et al, 2017 ; Mikkelsen & Rosholm, 2018 ).…”

Work Ability in the Year after Rehabilitation—Results from the RehabNytte Cohort

“…A substantial population live with disability caused by chronic disease, which affects their ability to participate in working life [1,2]. Work participation is important at a societal level, with labor market participation supporting local and national economies, and at an individual level with benefits for health, function and quality of life [3][4][5]. Longitudinal observational data are warranted to identify factors facilitating work participation and factors associated with an increased risk of poor work outcomes [6].…”