title: Return-to-work coordination programmes for improving return to work in workers on sick leave.
abstract: BACKGROUND
  To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people's return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncertain. We conducted a systematic review to determine the long-term effectiveness of return-to-work coordination programmes compared to usual practice in workers at risk for long-term disability.
  
  
  OBJECTIVE
  To assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11), MEDLINE, Embase, CINAHL and PsycINFO up to 1 November 2016.
  
  
  METHODS
  We included randomised controlled trials (RCTs) that enrolled workers absent from work for at least four weeks and randomly assigned them to return-to-work coordination programmes or usual practice.
  
  
  METHODS
  Two review authors independently screened titles, abstracts and full-text articles for study eligibility; extracted data; and assessed risk of bias from eligible trials. We contacted authors for additional data where required. We conducted random-effects meta-analyses and used the GRADE approach to rate the quality of the evidence.
  
  
  RESULTS
  We identified 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.We found no benefits for return-to-work coordination programmes on return-to-work outcomes.For short-term follow-up of six months, we found no effect on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) -16.18 work days per year, 95% CI -32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95% CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95% CI 0.63 to 1.19, very low-quality evidence).For long-term follow-up of 12 months, we found no effect on time to return to work (HR 1.25, 95% CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD -14.84 work days per year, 95% CI -38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95% CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95% CI 0.97 to 1.09, moderate-quality evidence).For very long-term follow-up of longer than 12 months, we found no effect on time to return to work (HR 0.93, 95% CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95% CI -15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95% CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95% CI 0.88 to 1.02, low-quality evidence).We found only small benefits for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID).
  
  
  CONCLUSIONS
  Offering return-to-work coordination programmes for workers on sick leave for at least four weeks results in no benefits when compared to usual practice. We found no significant differences for the outcomes time to return to work, cumulative sickness absence, the proportion of participants at work at end of the follow-up or the proportion of participants who had ever returned to work at short-term, long-term or very long-term follow-up. For patient-reported outcomes, we found only marginal effects below the MID. The quality of the evidence ranged from very low to moderate across all outcomes.
authors.affiliation: Department Clinical Research, EbIM Evidence-based Insurance Medicine, University of Basel Hospital, Spitalstrasse 8+12, Basel, Switzerland, 4031.|Leonardo, Hirslanden Klinik Birshof, Reinacherstrasse 28, Münchenstein, Switzerland, 4142.
authors.forename: Nicole
authors.initials: N
authors.lastname: Vogel
authors.affiliation: Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, Canada, L8S4L8.|Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel, Spitalstrasse 12, Basel, Switzerland, 4031.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schandelmaier
authors.affiliation: Clinical Trial Unit, University of Basel Hospital, Schanzenstrasse 55, Basel, Switzerland, 4031.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zumbrunn
authors.affiliation: School of Medicine, Stanford University, Stanford, USA.
authors.forename: Shanil
authors.initials: S
authors.lastname: Ebrahim
authors.affiliation: Department Clinical Research, EbIM Evidence-based Insurance Medicine, University of Basel Hospital, Spitalstrasse 8+12, Basel, Switzerland, 4031.
authors.forename: Wout El
authors.initials: WE
authors.lastname: de Boer
authors.affiliation: Department of Anesthesia, McMaster University, 1280 Main Street West, Rm. 2C12, Hamilton, ON, Canada, L8S 4K1.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
authors.affiliation: Department Clinical Research, EbIM Evidence-based Insurance Medicine, University of Basel Hospital, Spitalstrasse 8+12, Basel, Switzerland, 4031.
authors.forename: Regina
authors.initials: R
authors.lastname: Kunz
mesh_terms: D000041:Absenteeism; D005500:Follow-Up Studies; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology; D009140:Musculoskeletal Diseases / Q000453:epidemiology; D000071066:Patient Reported Outcome Measures; D015397:Program Evaluation / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D062707:Return to Work / Q000706:statistics & numerical data; D018582:Sick Leave / Q000706:statistics & numerical data; D013997:Time Factors