Early interventions to promote work participation in people with regional musculoskeletal pain: a systematic review and meta-analysis.
OBJECTIVE
To determine the effectiveness of early multidisciplinary interventions in promoting work participation and reducing work absence in adults with regional musculoskeletal pain.


METHODS
Seven databases (CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, OT Seeker, PEDro; 1990 to December 2016) were searched for eligible studies.


METHODS
Trials were included if they reported on work-based outcomes for participants experiencing difficulties at work or ≤ three months' sick leave. Interventions had to include two or more elements of the biopsychosocial model delivered as a coordinated programme. Quality was assessed using the GRADE criteria. Results were analysed by hazard ratios for return to work data; continuous outcomes were analysed as standardised mean difference with 95% confidence intervals.


RESULTS
A total of 20 randomized controlled trials, with 16,319 participants were included; the interventions were grouped according to their main components for meta-analyses. At 12-months follow-up, moderate quality evidence suggests that programmes involving a stepped care approach (four studies) were more effective than the comparisons in promoting return to work (hazard ratio (HR) 1.29 (95% confidence interval (CI) 1.03 to 1.61), p = 0.03), whereas case management (two studies) was not (HR 0.92 (95% CI 0.69 to 1.24), p = 0.59). Analyses suggested limited effectiveness in reducing sickness absences, in pain reduction or functional improvement across the intervention categories.


CONCLUSIONS
There is uncertainty as to the effectiveness of early multicomponent interventions owing to the clinical heterogeneity and varying health and social insurance systems across the trials.
1 Department of Psychology, Maynooth University, Maynooth, Ireland.
Andy
A
Cochrane
1 Department of Psychology, Maynooth University, Maynooth, Ireland.
Niamh M
NM
Higgins
2 School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
Oliver
O
FitzGerald
3 School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
Pamela
P
Gallagher
4 Physiotherapy Services, Beaumont Hospital, Dublin, Ireland.
Jennifer
J
Ashton
5 Rheumatology Services, Waterford Regional Hospital, Waterford, Ireland.
Oriel
O
Corcoran
1 Department of Psychology, Maynooth University, Maynooth, Ireland.
Deirdre
D
Desmond
D006801:Humans; D059352:Musculoskeletal Pain / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D015397:Program Evaluation; D062707:Return to Work; D018582:Sick Leave
Musculoskeletal disorders; pain; return to work; vocational rehabilitation