Academic journal article Scandinavian Journal of Work, Environment & Health

Effectiveness of Very Early Workplace Interventions to Reduce Sickness Absence: A Systematic Review of the Literature and Meta-Analysis

Academic journal article Scandinavian Journal of Work, Environment & Health

Effectiveness of Very Early Workplace Interventions to Reduce Sickness Absence: A Systematic Review of the Literature and Meta-Analysis

Article excerpt

Sickness absence (SA) remains a significant problem globally, notably in developed countries (1). For example, in the UK (2014-2015), 23.3 million days were lost due to work-related ill health, 4.1 million due to workplace injuries (2), and it has been estimated that two million people are suffering from an illness (long standing as well as new cases) they believe is caused or made worse by their current or past work (2). Musculoskeletal disorders (MSD) and mental health problems such as depression and anxiety accounted for the majority of days lost due to work-related ill health (2). In a cross-national comparative study (3), musculoskeletal and mental health disorders accounted for almost half of the registered SA episodes that lasted >2 weeks and occurred between January and December 2010 in the Netherlands and Sweden.

In addition to substantial cost implications for employers and social security systems, SA has a huge impact on well-being, self-esteem and the livelihood of workers (4). Recent pension policy changes and workforce demographics, with a shift towards extending working lives and management of the ageing worker (5), are also likely to have important implications on attendance management. In order to address this, management programs to reduce SA have become an inherent element of workplace and organizational policies.

Several workplace evidence-based return-to-work (RTW) interventions for workers on sick leave have been identified in the literature (6-10). These interventions include maintaining contact with an occupational physician (OP) or nurse (11, 12), case management (13-15), work modification (13, 15) and health promotion activities (16). However, the majority of interventions are focused on long-term SA.

It has been observed that the probability of resuming work diminishes with time on sick leave (17). Therefore, early intervention to enhance RTW has been identified as a key priority in the management of SA and disability (1). Few "very early" (defined here as starting <15 days after the start of SA) intervention studies (13, 18, 19), and early workplace interventions for sick-listed employees (20-22) exist to our knowledge, despite the fact that there are a number of commercially successful companies offering SA management services to employers that involve the employee being seen or telephoned on the first day of absence (23, 24). Some of those interventions implemented in the very early/ early stages of SA episodes indicate that they may result in a quicker RTW and be cost-effective (20, 22). For example, the implementation of simple and inexpensive workplace enhancements, such as task modifications or job accommodation, are likely to be cost-beneficial in terms of returning to work (17). Timing of enrolment of workers into the intervention, together with the RTW pattern in the target population and the nature of the intervention, are crucial factors in order to achieve a successful RTW (17). However, current evidence remains inconclusive about the optimal timing of implementing workplace interventions. This has led to a lack of consistency in the definition of what a "very early" versus "early" intervention means. Based on these findings, this systematic review aims to (i) fill the knowledge gap on the effectiveness of workplace interventions for RTW delivered at very early stages (before day 15) of SA, (ii) understand the health and organizational factors influencing the effectiveness of very early SA workplace interventions, and (iii) enable a complete mapping of the current evidence to inform employees, employers, and health professionals dealing with SA management.


This systematic review sought to answer whether very early interventions at the workplace are effective to reduce SA. To this end, we have considered all workplace interventions, defined as all interventions carried out in the workplace before day 15 of SA, implemented directly or indirectly by the employer, including the involvement and participation of a variety of professionals from internal (company/sector occupational health departments) or external occupational health services. …

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