Advantages and disadvantages of an objective selection process for early intervention in employees at risk for sickness absence.
BACKGROUND
It is unclear if objective selection of employees, for an intervention to prevent sickness absence, is more effective than subjective 'personal enlistment'. We hypothesize that objectively selected employees are 'at risk' for sickness absence and eligible to participate in the intervention program.


METHODS
The dispatch of 8603 screening instruments forms the starting point of the objective selection process. Different stages of this process, throughout which employees either dropped out or were excluded, were described and compared with the subjective selection process. Characteristics of ineligible and ultimately selected employees, for a randomized trial, were described and quantified using sickness absence data.


RESULTS
Overall response rate on the screening instrument was 42.0%. Response bias was found for the parameters sex and age, but not for sickness absence. Sickness absence was higher in the 'at risk' (N = 212) group (42%) compared to the 'not at risk' (N = 2503) group (25%) (OR 2.17 CI 1.63-2.89; p = 0.000). The selection process ended with the successful inclusion of 151 eligible, i.e. 2% of the approached employees in the trial.


CONCLUSIONS
The study shows that objective selection of employees for early intervention is effective. Despite methodological and practical problems, selected employees are actually those at risk for sickness absence, who will probably benefit more from the intervention program than others.
Duijts
Saskia F A
SF
Maastricht University, Department of Epidemiology, Maastricht, The Netherlands. sfa.duijts@epid.unimaas.nl
Kant
Ijmert
I
Swaen
Gerard M H
GM
D000293:Adolescent; D000328:Adult; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology*; D009786:Occupational Health Services; D018579:Patient Selection; D011314:Preventive Health Services; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015983:Selection Bias; D018582:Sick Leave / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors