Return to work after early part-time sick leave due to musculoskeletal disorders: a randomized controlled         trial.
OBJECTIVE
The purpose of this study was to assess the effects of early part-time sick leave on return to work (RTW) and sickness absence among patients with musculoskeletal disorders.


METHODS
A randomized controlled trial was conducted in six occupational health units of medium- and large-size enterprises. Patients aged 18-60 years with musculoskeletal disorders (N=63) unable to perform their regular work were randomly allocated to part- or full-time sick leave. In the former group, workload was reduced by restricting work time by about a half. Remaining work tasks were modified when necessary, as specified in a "fit note" from the physician. The main outcomes were time to return to regular work activities and sickness absence during 12-month follow-up.


RESULTS
Time to RTW sustained for ≥4 weeks was shorter in the intervention group (median 12 versus 20 days, P=0.10). Hazard ratio of RTW adjusted for age was 1.60 [95% confidence interval (95% CI) 0.98-2.63] and 1.76 (95% CI 1.21-2.56) after further adjustment for pain interference with sleep and previous sickness absence at baseline. Total sickness absence during the 12-month follow-up was about 20% lower in the intervention than the control group. Compliance with the intervention was high with no discontinuations of part-time sick leave due to musculoskeletal reasons.


CONCLUSIONS
Early part-time sick leave may provide a faster and more sustainable return to regular duties than full-time sick leave among patients with musculoskeletal disorders. This is the first study to show that work participation can be safely increased with early part-time sick leave.
Finnish Institute of Occupational Health, Topeliuksenkatu 41a A, 00250 Helsinki, Finland. eira.viikari-juntura@ttl.fi
Eira
E
Viikari-Juntura
Johanna
J
Kausto
Rahman
R
Shiri
Leena
L
Kaila-Kangas
Esa-Pekka
EP
Takala
Jaro
J
Karppinen
Helena
H
Miranda
Ritva
R
Luukkonen
Kari-Pekka
KP
Martimo
D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000534:rehabilitation; D016272:Occupational Health / Q000706:statistics & numerical data*; D009788:Occupational Therapy; D010146:Pain / Q000453:epidemiology*; D010147:Pain Measurement; D016016:Proportional Hazards Models; D018582:Sick Leave / Q000706:statistics & numerical data*; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013997:Time Factors; D014938:Work Capacity Evaluation; D055815:Young Adult