title: Pre-employment examinations for preventing occupational injury and disease in workers.
abstract: BACKGROUND
  Many employers and other stakeholders believe that health examinations of job applicants prevent occupational diseases and sickness absence.
  
  
  OBJECTIVE
  To evaluate the effectiveness of pre-employment examinations of job applicants in preventing occupational injury, disease and sickness absence compared to no intervention or alternative interventions.
  
  
  METHODS
  We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO and PEDro (to December 2009) not restricted by date, language or publication type.
  
  
  METHODS
  We included randomised controlled trials (RCTs), controlled before-after studies (CBA), and interrupted time-series (ITS) of health examinations to prevent occupational diseases and injuries in job applicants.
  
  
  METHODS
  Four review authors (NM, ML, JV, ES) independently selected studies, extracted data, and determined study quality. The studies were too heterogeneous for statistical pooling of results.
  
  
  RESULTS
  We included two RCTs, five CBA studies and two ITS. Seven studies with 5872 participants evaluated the screening process of pre-employment examinations and two studies with 2164 participants evaluated the measures to mitigate the risks found following the screening process.Of those studies that evaluated the screening process, one study found that a general examination did not reduce sick leave (Mean Difference -0.1 95% CI -0.5 to 0.3) but another study found that a more task focused examination did (MD -36 95% CI -68.3 to -3.8). One study found that incorporation of a bronchial challenge test decreased occupational asthma (trend change -2.6 95% CI -3.6 to -1.5). Three studies that included functional capacity evaluation found contradictory effects on injury rates and number of medical visits. The rates of rejecting job applicants varied from 2% to 35%.Neither of the two studies that evaluated risk mitigation found an increased injury rate after training or work accommodations had been implemented.We rated the evidence for all outcomes as very low quality.
  
  
  CONCLUSIONS
  There is very low quality evidence that pre-employment examinations that are specific to certain jobs or health problems could reduce occupational disease, injury, or sickness absence. This supports the current policy to restrict pre-employment examinations to job-specific examinations. More studies are needed that take into account the harms of rejecting job applicants.
authors.affiliation: Faculty of Health Sciences, University of Sydney, Cumberland Campus C42, PO Box 170, Lidcombe, NSW, Australia, 1825.
authors.forename: Norashikin
authors.initials: N
authors.lastname: Mahmud
authors.forename: Eva
authors.initials: E
authors.lastname: Schonstein
authors.forename: Frederieke
authors.initials: F
authors.lastname: Schaafsma
authors.forename: Marika M
authors.initials: MM
authors.lastname: Lehtola
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Fassier
authors.forename: Michiel F
authors.initials: MF
authors.lastname: Reneman
authors.forename: Jos H
authors.initials: JH
authors.lastname: Verbeek
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control*; D004651:Employment; D006801:Humans; D009784:Occupational Diseases / Q000517:prevention & control*; D010560:Personnel Selection / Q000379:methods*; D010808:Physical Examination; D016032:Randomized Controlled Trials as Topic; D018582:Sick Leave / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000517:prevention & control*