Health-Related Effects of Early Part-Time Sick Leave Due to Musculoskeletal Disorders: A Randomized Controlled Trial

By Shiri, Rahman; Kausto, Johanna et al. | Scandinavian Journal of Work, Environment & Health, January 2013 | Go to article overview

Health-Related Effects of Early Part-Time Sick Leave Due to Musculoskeletal Disorders: A Randomized Controlled Trial


Shiri, Rahman, Kausto, Johanna, Martimo, Kari-Pekka, Kaila-Kangas, Leena, Takala, Esa-Pekka, Viikari-Juntura, Eira, Scandinavian Journal of Work, Environment & Health


Objective Previously we reported that early part-time sick leave enhances return to work (RTW) among employees with musculoskeletal disorders (MSD). This paper assesses the health-related effects of this intervention.

Methods Patients aged 1 8-60 years who were unable to perform their regular work due to MSD were randomized to part- or full-time sick leave groups. In the former, workload was reduced by halving working time. Using validated questionnaires, we assessed pain intensity and interference with work and sleep, region-specific disability due to MSD, self-rated general health, health-related quality of life (measured via EuroQol), productivity loss, depression, and sleep disturbance at baseline, 1 , 3, 8, 1 2, and 52 weeks. We analyzed the repeated measures data (171-356 observations) with the generalized estimating equation approach.

Results The intervention (part-time sick leave) and control (full-time sick leave) groups did not differ with regard to pain intensity, pain interference with work and sleep, region-specific disability, productivity loss, depression, or sleep disturbance. The intervention group reported better self-rated general health (adjusted P=0.07) and health-related quality of life (adjusted P=0.02) than the control group. In subgroup analyses, the intervention was more effective among the patients whose current problem began occurring <6 weeks before baseline and those with <30% productivity loss at baseline.

Conclusions Our findings showed that part-time sick leave did not exacerbate pain-related symptoms and functional disability, but improved self-rated general health and health-related quality of life in the early stage of work disability due to MSD.

Key terms back; EuroQol; lower extremity; neck; pain; quality of life; upper extremity.

Musculoskeletal disorders (MSD) are common among working populations and affect general health and quality of life (1, 2). Evidence increasingly supports the positive effects of staying active instead of bed rest in the treatment of MSD and associated disability (3, 4).

Work is a determinant of good health. Good workplace conditions may have a positive impact on workers' health, especially in common public health problems (5). Long-term sick leave is known to be associated with increased risk of disability pension (6, 7). Work participation in most cases has positive effects on health (5). Part-time sick leave avoids the negative effects of full-time sick leave and offers the possibility to remain at work. In part-time sick leave, reduced working time decreases exposure to physical and psychosocial workrelated risk factors. Also flexibility in working patterns may have positive effects on health and wellbeing (8).

Recent register-based studies have reported the effects of partial sick leave among patients on long-term sick leave. A Danish study (9) found a positive effect of a graded return to work (RTW) program on the probability of returning to regular work. A Finnish study (10) showed initially increased recurrence of sick leave but - on a longer prospective - decreased risk of permanent disability after part-time sick leave.

We have previously (11) shown that early part-time sick leave leads to earlier RTW and lower rates of subsequent sickness absence compared to full-time sick leave. It is unknown how early RTW affects symptoms, functional disability, self-rated health and quality of life in comparison with full-time sick leave (12). The aim of the current study was to assess the secondary healthrelated outcomes, such as pain intensity and interference with work and sleep and functional disability. In addition, we were interested in self-rated general health, health-related quality of life, depression, sleep disturbance, and productivity loss.

Methods

The study was carried out in Finland during a period when part-time sick leave was introduced as a sickness benefit. In Finland, employees receive full pay during full-time sickness absence, normally up to two months. …

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