title: Management of long term sickness absence: a systematic realist review.
abstract: OBJECTIVE
  The increasing impact and costs of long term sickness absence have been well documented. However, the diversity and complexity of interventions and of the contexts in which these take place makes a traditional review problematic. Therefore, we undertook a systematic realist review to identify the dominant programme theories underlying best practice, to assess the evidence for these theories, and to throw light on important enabling or disabling contextual factors.
  
  
  METHODS
  A search of the scholarly literature from 1950 to 2011 identified 5,576 articles, of which 269 formed the basis of the review.
  
  
  RESULTS
  We found that the dominant programme theories in relation to effective management related to: early intervention or referral by employers; having proactive organisational procedures; good communication and cooperation between stakeholders; and workplace-based occupational rehabilitation. Significant contextual factors were identified as the level of support for interventions from top management, the size and structure of the organisation, the level of financial and organisational investment in the management of long-term sickness absence, and the quality of relationships between managers and staff.
  
  
  CONCLUSIONS
  Consequently, those with responsibility for managing absence should bear in mind the contextual factors that are likely to have an impact on interventions, and do what they can to ensure stakeholders have at least a mutual understanding (if not a common purpose) in relation to their perceptions of interventions, goals, culture and practice in the management of long term sickness absence.
authors.affiliation: School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Higgins
authors.forename: Peter
authors.initials: P
authors.lastname: O'Halloran
authors.forename: Sam
authors.initials: S
authors.lastname: Porter
mesh_terms: D019468:Disease Management; D006801:Humans; D008962:Models, Theoretical; D009784:Occupational Diseases / Q000534:rehabilitation*; D016272:Occupational Health; D016134:Organizational Policy; D012017:Referral and Consultation; D018582:Sick Leave / Q000191:economics / Q000706:statistics & numerical data*; D017132:Workplace