Academic journal article Scandinavian Journal of Work, Environment & Health

Effect of the Danish Return-to-Work Program on Long-Term Sickness Absence: Results from a Randomized Controlled Trial in Three Municipalities

Academic journal article Scandinavian Journal of Work, Environment & Health

Effect of the Danish Return-to-Work Program on Long-Term Sickness Absence: Results from a Randomized Controlled Trial in Three Municipalities

Article excerpt

In 2008, the annual level of sickness absence in Den- mark corresponded to approximately 5% of the work- force, and reimbursement costs per year were estimated to be around euro5 billion (approximately euro1350 per capita age 18-64 years) not including treatment costs or loss of productivity (1). Promoting labor market participation is essential for Denmark and other European countries facing a decline in the proportion of people of working age due to an aging workforce (2). To reduce sickness absence and improve labor market participation, the Danish Government launched an action plan in 2008 encompassing 39 initiatives including the Danish return- to-work (RTW) program. The Danish National Research Centre for the Working Environment (NRCWE) was appointed to develop the program in accordance with the action plan, existing sickness management legislation, and previous experiences from national and international intervention studies.

Most RTW interventions focus on specific target groups, mostly sick-listed individuals with musculoskel- etal health problems (3-10), whereas RTW interventions addressing mental health problems are scarce (11, 12). A recent systematic review of the effectiveness of RTW interventions for persons sick-listed due to musculoskel- etal problems concluded that most interventions appeared beneficial. However, the effects were rather small and publication bias may have occurred (5). Another review concluded that most intervention studies were small and of limited quality (13). In addition, most previous RTW- intervention projects have focused on a single interven- tion element [ie, the effects of RTW coordinators (14), multidisciplinary teams (9, 10, 13), or work accommoda- tion by healthcare providers (13)].

Contrary to these previous studies, the goal of the Danish RTW program was to encompass a broad group of sick-listed persons, including sick-listed beneficia- ries with both somatic and mental health problems and with all types of employment status (employed, self-employed, temporary employed, or unemployed). In addition, the program is based on a combination of a coordinated, tailored and multidisciplinary (CTM) approach, including designated RTW coordinators and multidisciplinary teams, and work accommodation by healthcare providers was used when appropriate. The basic assumption of the Danish program was that the concerted action of both the RTW coordinator and team ensured better clarification of the barriers and resources for RTW and a faster initiation of RTW activities, which were better tailored to meet the specific needs of each sick-listed beneficiary.

The Danish RTW program comprised a stratified cluster-controlled study in 21 municipalities and a ran- domized controlled trial (RCT) in 3 municipalities. The effect evaluation of the RCT aimed to test the following four hypothesis regarding effects of the CTM interven- tion: participants in the intervention (i) have a shorter duration of full-time sickness absence, (ii) have a lon- ger time off sick before recurrent long-term sickness absence (have a more sustainable RTW), (iii) are faster in achieving a full RTW, and (iv) report a more positive development in self-rated general health, mental and physical health, workability, pain, and sleep.

This present article presents the results related to the first hypothesis. In addition, two supplementary hypoth- eses related to time-dependency of the effect were tested: (i) the effect of the CTM intervention would improve with time after onset of the project (learning processes could be potential explanations for effect increasing with time); and (ii) the CTM intervention would be more beneficial in the more complex sickness absence cases, defined as long-lasting cases. Consequently the effect of the CTM intervention would be more pronounced late in the long-lasting sickness absence cases.

Methods

Full details of the intervention and evaluation design of the RTW program have previously been published (15). …

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